Volume 60, N.3 Monografia

Key words: fruits, vegetables, promotion, children, adolescents

SUMMARY
Objectives: the promotion of fruit and vegetable consumption, particularly in the early age groups, is almost unan- imously considered among of the most effective nutritional actions in the prevention of chronic degenerative diseases of adulthood, but the most effective, evidence based, interventions to obtain an increase of these foodstuffs still remain a matter of debate.
Methods: examination of the main scientific reviews published after 2000 in order to discriminate which actions/ public health interventions have shown the best evidence of effectiveness in promoting fruit and veggies consumption. Results: to date, there is still a relative lack of high quality methodological studies that are able to “weigh” which are the most effective interventions to increase fruit and vegetable consumption.
Conclusions: there is enough room for policy makers, researchers and health professionals to work together with the aim of developing and evaluating initiatives to promote fruit and veggies consumption, particularly in children and adolescents.

Risultati: in oltre 30 giorni di rilevazione sono stati esaminati 2069 profili alimentari (colazione, merenda mattutina e pranzo). È emerso che mediamente sono stati consumati circa i tre quarti dei primi e dei secondi piatti, mentre il consumo di contorni, pane e frutta è stato di circa la metà. Chi fa una colazione e/o uno spuntino adeguato mediamente ha un consumo maggiore sia del primo che del secondo ma anche di contorno e frutta. Di particolare interesse alcune differenze registrate nelle due scuole interessate dal progetto. In una delle due scuole si è registrato un consumo dei pasti (così come della prima colazione e degli spuntini adeguati) nettamente superiore rispetto all’altra arrivando ad essere quasi il doppio per il contorno (76 vs 43%) e la frutta (64 vs 38%). Lo stile educativo degli insegnanti durante il consumo del pasto, più partecipe ed autorevole, sembra alla base di tale differenza registrata in scuole analoghe per contesto ambientale e socio economico.
Conclusioni: i questionari utilizzati sono risultati semplici e ben accetti dai bambini che hanno partecipato con molto impegno; renderli protagonisti attivi diplomandoli “piccoli assaggiatori” è stato un punto di forza del progetto. Il progetto ha consentito di far toccare con mano ai diversi protagonisti (educatori, ragazzi, genitori, ristorazione scolastica, ente locale ed ASL) i fattori che condizionano gradimento e scarti della ristorazione scolastica. Si è deciso di proseguire con la progettazione partecipata fra le diverse componenti (educativa, sanitaria e sociale) ed è in fase di avanzata realizzazione un progetto diretto a tutte le scuole del Comune di Bologna teso a favorire il consumo di spuntini adeguati anche attraverso l’offerta sistematica della frutta come spuntino e a realizzare un sistema di monitoraggio degli scarti utile a orientare gli interventi di educazione alimentare e l’offerta della ristorazione scolastica sempre più impegnata a conciliare menù salutari e gradimento degli utenti.

Key words: scholastic foodservice, food waste, joint planning, nutritional education.

SUMMARY
Objectives: monitor school meals and students’ appreciation of the different food preparations, promoting their awareness about food use/waste, also in relationship with breakfast and morning snacks. Test tools, determine approval rating, and measure food waste in school canteens in order to develop effective strategies for management and education about prevention or reduction of food waste.
Methods: a movement started by parents and teachers, who were worried about excessive food waste in schools, saw the development of an active collaboration between healthcare (SIAN, Bologna’s USL Agency), education (school) and society (parents of the involved classes, company for the scholastic foodservice and local administration). Two questionnaires were prepared, one about the appreciation and consumption of provided meals, and the other about the consumption of breakfast and morning snacks. Between March and May in 2015, a hundred 3rd and 4th grade children filled out the questionnaires at the end of the provided meal, with the help of teachers and UO Hygiene Food and Nutrition’ dietitians as observers. Leftover bread and fruits that were still edible were used as afternoon snacks or rescued for charity. Each phase of the project was recorded on videotape in order to prove the main involvement of all parties mentioned. The analyzed results were reported to all the participants of the project and were discussed jointly, beginning the planning for following school years.
Results: during more than 30 days, 2069 nutritional profiles were examined (breakfast, morning snack, and lunch). From these data, it could be seen that about 3⁄4 of the first and the second courses were eaten, while side dishes’, breads’, and fruits’, consumption was at about half. Those who had a proper breakfast and/or morning snack ate, on average, a greater quantity of first and second dishes, and also side dishes and fruits. Interestingly, some differences emerged between the two schools involved in the project. In one of the two schools a significantly higher meal consumption (as well as breakfast and morning snacks) was recorded, reaching a two-fold difference for both second dishes (80% vs 40%) and fruits (70% vs 35%). The active and authoritative teaching style of teachers during meals seems to be the basis for the observed difference between schools with equal socioeconomic status. Conclusions: the questionnaires used turned out to be simple and well accepted by the children, who participated with enthusiasm. A strong point of the project was making them active parts of the process and awarding them with the title of “little tasters”. The project allowed all the participants (teachers, students, parents, scholastic foodservice, local administration and ASL) to see the factors that impact on the acceptance of food choice, and the waste of uneaten food at scholastic foodservices. It has been decided to continue with joint planning between the education, healthcare, and social components, and a project for all the schools of Bologna is now at an advanced stage of planning. This project aims to promote the consumption of proper snacks, by offering fruits as a snack, and to create a system to monitor food waste that can be useful to guide both nutritional education interventions, and food choices offered by scholastic foodservices, which are focusing more and more on reaching a balance between offering healthy food and maximizing customer satisfaction.

Risultati: in atto, si riporta, quale indicatore di processo, l’esito relativo all’attività formativa (di I e di II livello) sinora svolta; gli indicatori di esito saranno disponibili alla conclusione del percorso regionale, ancora in itinere. Il Programma è stato presentato nel 2015 presso la sede Europea dell’Organizzazione Mondiale della Sanità ed è in fase di valutazione la stipula di un Protocollo di Intesa tra la Regione Siciliana e l’OMS, nell’ambito di un processo di internazionalizzazione del programma.

Conclusioni: si ritiene che il Programma FED, attraverso un’attività di formazione pluriennale e l’attivazione di Reti Integrate Territoriali, potrà consentire quel cambiamento culturale necessario per indurre positive modifiche nello stile di vita ed, in particolare, nei comportamenti alimentari, con conseguente miglioramento dello stato di salute della popolazione siciliana. Lo stesso, si profila come valido strumento operativo per supportare il Piano Re- gionale della Prevenzione nell’ambito del Macro Obiettivo 1 (contrasto all’insorgenza delle MCNT), diventando piattaforma sperimentata di sviluppo di un ben più ampio progetto destinato alla popolazione sana, con la finalità di evitare/ritardare il manifestarsi clinico delle principali malattie cronico degenerative, ad alto impatto economico-sociale ed epidemiologico.

Key Words: Mediterranean Diet, Prevention and Control of Non-Communicable Diseases, Health Promotion, Physical Activity

SUMMARY
Objectives: the Department of Health (DASOE, Division 5) of Sicilian Region has initiated the Program “For- mazione Educazione Dieta” (FED), aimed at the promotion and seminal diffusion of healthy lifestyles, according to the Mediterranean Diet.
Methods: the major methodological strength of the FED program consists in an intervention of health prevention and promotion based upon two strategic elements: a centralized planning adjustable according to outcome indica- tors; a multi-year action, with cyclic activities throughout the three regional territorial network (health, education and agribusiness); the “Program” is synergistically focused on: (a) a solid training program, aimed at qualifying people to become expert figures of trainers/educators able to impact on the cultural changes, behaviours and life- styles of population, by acting specifically on the various recipients, in accordance with appropriate methodologies and contents evidence-based; (b) the activation of local networks built to promote capillary activities in the regional territory. An essential junction of the program of a Regional Technical Board consisting of a team of experts has been established. Using an integrated multi-professional approach, the experts must have developed an operational and training program with centrality and uniqueness of address, making it uniformly applicable to the distinct organizational realities of the Sicilian territory.
Results: here we report, as a process indicator, the result of training activities (I and II level) carried out so far; the outcome indicators will be available at the conclusion of the regional path, which is still ongoing. The program has also been presented in 2015 at the European Headquarters of the WHO and the signing of a Memorandum of Understanding between the Sicilian Region and the WHO is being evaluated as part of the program’s internationalization.
Conclusions: we believe that through a multi-year training activity and implementation of integrated territorial networks, the FED program will enable the cultural change needed to induce positive changes in lifestyle and, in particular, in eating behaviour, with a consequent health improvement of the Sicilian population. The FED itself looms as a valid operational instrument supporting the Regional Prevention Plan under the Macro Objective 1 (contrast the onset of MCNT), thus becoming a validated platform to develop a much larger project addressed to healthy population, with aims to prevent/delay the clinical onset of major chronic diseases having high epidemiological, economic and social impact.

Risultati: nell’anno scolastico 2015/2016 hanno realizzato il progetto n. 7 classi terze elementari e n. 8 classi della scuola secondaria di primo grado; gli insegnanti complessivamente formati sono stati 46.
Conclusioni: i temi dell’alimentazione e dell’attività motoria sono percepiti come rilevanti sia dagli insegnanti che dagli studenti e le attività previste sono state regolarmente svolte in classe, integrandosi in diverse materie curricu- lari. L’utilizzo di testimonial, l’accesso ad una piattaforma web per gli insegnanti e gli studenti, nonché la disponi- bilità di materiali per il lavoro pratico in classe sono stati i punti di forza del progetto.

Key Words: fruit and vegetable, iodized salt, prevention, school

SUMMARY
Objectives: the project has been developed and implemented by the Local Health Department as part of the 2014- 2018 Prevention Plan for Lazio, described within the Primary and Secondary School setting for the promotion of fruit and vegetables consumption, physical activity and the reduction of salt consumption, while preferring the iodized salt.
Methods: the following activities have been organized: 1) education/information with teachers; 2) project launch with testimonials; 3) student education by the teachers in the classroom; 4) activities involving students (work- shops/games/direct experiences/regional contest); additional technological resources will be employed, such as the launch of an ad hoc web site. Families have also been involved through the distribution of material, web reach and project introduction to the parents representatives and/or Canteen management.
Results: during the 2015-2016 academic year, seven classes from primary school and eight classes from first grade in secondary school carried out the project. Forty six teachers have taken part in the training courses.
Conclusions: dieting and exercising have been overall perceived as relevant both by teachers and students and the additional subjects and themes have been introduced smoothly to the curriculums. Testimonials, web reach and materials used in class have been the key aspects contributing to the success.

Autore per corrispondenza: luciano.bondi@uslumbria1.it

Key words: health promotion, National Fight Against Drugs Fund, social-health integration, drugs

SUMMARY
The last century’s prevention policies on addictions, from the 1970s, the years of onset of the phenomena linked to the spread of drugs, have been constrained, until now, not only by the development of knowledge and experience, but by the push of cultural, social and economic factors. Over the years, the regulations adopted in Italy have given impulse to one or the other side of the actions put into place, and direction has transited across several institutions. Over the years this has led to the development of a set of ever more articulated interventions, supported by the evidence of effectiveness, although strong critical elements remain. The main phases of this historic course are iden- tified in: Act n. 685, 1975, which for the first time addresses the drug problem, organically integrating prevention alongside care and rehabilitation. Law n. 162,1990, which consolidates the intervention system and establishes the national Fund for the fight against drugs. Law n. 328, 2000, which gives a prominent role to the municipalities in their preventive actions of social and educational value. Law n. 49, 2006, which veers towards a highly repressive organization, the Earn Health Programme and the 2014-18 National Prevention Plan, initiatives of the Ministry of Health.To improve coordination of interventions, the definition of a National Action Plan for addictions has been proposed, including the area of prevention, in line with the directives of the Strategy and Plan adopted by the EU.