Erasmus+sport let’s move Europa: learning units for health promotion among children and adolescents

Background

School years are crucial for acquiring life-lasting healthy habits. However, an increasing rate of children and adolescents fail to maintain a healthy lifestyle. European Union has financed the Erasmus+ Sport Let’s Move Europa project to design an innovative digital tool for promoting healthy lifestyles among those age groups. University of Bologna, partner of the project, has developed 30 Learning Units (LUs) about Physical Activity, Sleep and Nutrition to be integrated in the school program by teachers.

Methods

A group of 17 teachers (15 females and 2 males, mean SD age 49,5 ±11,6) from primary and secondary schools located in Bologna province (Italy) took part in semi-structured focus groups (FGs). The investigation focused on facilitators/barriers of the intervention and possible solutions, identifying time frames and locations, suggestions for engaging the different stakeholders (teachers, students and families). All FGs were recorded, transcribed, anonymized, and analyzed through inductive thematic analysis.

Results

30 LUs were created based on the latest scientific evidence and the FGs output. Each LU addresses a specific topic and is tailored differently for primary and secondary school. The layout includes an investigation on the topic, classroom activities, and a section about “healthy homework” or “challenges” to be accomplished at home, engaging families in the construction of a healthy routine. All the activities were designed to be feasible and sustainable. Each LU includes a discussion phase to understand students’ feedback about proposed homework and learning content.

Conclusions

FGs have proven crucial to tailoring LUs on the needs of different stakeholders and co-designing an effective intervention. “Healthy homework” and “Challenges” encourage students to pursue healthy habits also outside the school setting, involving families. Feedback on the activity provides an insight into the progression and effectiveness of the intervention.

Key messages

• The EUmove project integrates knowledge about sleeping, nutritional and physical activity habits into the school curriculum to promote healthy lifestyles among students and their families.

• Thanks to the FGs, LUs are designed to suit the target audience. LUs integration into school curricula is therefore a feasible intervention, not requiring specialized personnel to be implemented.

Innovative Health Technologies to Improve Emergency Department Performance

Background

Emergency Departments (EDs) are increasingly pivotal, with a constant increment in their use, despite stable or declining fundings. Crowding can lead to disruptions and the COVID-19 epidemic has further burdened ED services. However, the pandemic has seen an increased use of telemedicine and digital health tools, which may be notably beneficial for EDs. This study offers a review of the latest available digital health technologies and their effectiveness to improve ED performance.

Methods

We performed a narrative review to identify digital and technological innovations in EDs. The themes of interest were defined in 4 areas: Patient Assessment, Patient Experience, Resource Allocation, and Discharge. Data was analyzed by 5 independent reviewers who focused on different macro-areas. Disagreement on data was discussed with 2 independent tiebreakers.

Results

Our search yielded 25 articles addressing 4 topics: Patient Assessment, Resource Allocation, Patient Experience, Discharge. We found that digital tools and Artificial Intelligence are powerful tools to detect, collect, and process data from patients, to improve healthcare delivery in EDs. The Resource Allocation category showed to be key in optimizing services already in place. New technologies showed effective to improve Patient Experience by curbing pain and anxiety. Innovative technologies demonstrated efficacy after Discharge when patients need guidance from clinicians for follow-up care.

Conclusions

Our review shows evidence of increasing effectiveness of innovative tools in reducing wait time and improving performance and patient experience in EDs. Technology applied to resource allocation appeared to be the most effective category. Prediction algorithms could be used to improve workforce allocation and bed management. Critical care systems must meet the challenge of innovative technologies which can lead to a new era in healthcare delivery with improvements for patients and healthcare professionals.

Key messages

• Digital innovation will have a significant impact on several dimensions of healthcare in the near future.

• Healthcare systems and EDs must meet the challenge of innovative technologies which can lead to a new era in healthcare delivery with improvements for both patients and healthcare professionals.

Association between parents’ education level and KIDMED index: a cross-sectional study

Background

Mediterranean diet (MD) is considered a healthy dietary model with several beneficial effects.

A strict adherence to the MD in children, coupled with daily exercise, can prevent obesity and significantly reduce the risk of correlated chronic diseases, such metabolic syndrome. The aim of this study is to evaluate the association between parents' educational level and compliance to the MD in a convenience sample of Italian children.

Methods

We conducted a cross-sectional study among 428 children aged 6-11 recruited in a primary school of Calderara di Reno (Italy) between May and June of 2017. Children's and parents' information were collected at baseline (i.e. age, BMI, occupation, educational level). A weekly food diary was administered to evaluate the participant's dietary habits. The degree of adherence to MD was derived from these diaries using the KIDMED index developed in 2003 by Serra-Majem et al. We used multiple linear regression models, adjusted for age and gender, to investigate how parents' educational level affected children's KIDMED index.

Results

Adherence to the MD was high, medium and poor in, respectively, 4%, 60% and 36% of children. Higher prevalence of overweight and obesity was observed among those with lower adherence to the MD. The linear regression model shows that fathers' educational level is not associated to children's KIDMED index variation. On the other hand, a higher mothers' educational level is linked to an increased weekly KIDMED index (p = 0.012) as well as an increased weekend KIDMED index (p = 0.048).

Conclusions

Mothers' education level is associated with increased adherence to MD, both weekly and weekend. The greater difference has been observed during weekend, when children of highly educated mothers score higher at KIDMED index.

Key messages

Mothers’ educational level plays an important role in children’s eating habits, with higher educational level associated with a better adherence to the MD. It is critical to implement parents' toolkit to promote healthy dietary patterns and adherence to MD in order to correct these social differences.

Meals adequacy during weekdays and weekends in an Italian primary school children sample

Background

Between 15 and 50% of European children aged 6-9 are overweight or obese and this number is rising dramatically over time, making it one of the most important public health challenges. Selection of healthy food and a balanced diet are key when addressing this obesity epidemic. At the same time, it is essential to consider schools' role and parents' influence on children's dietary habits. This study aims to assess the adequacy of meals during the weekdays (WD) and weekends (WE), therefore highlighting the critical moments where schools' and parents' involvement needs to be of greater impact.

Methods

A cross-sectional study was conducted among 428 children aged 6-11 recruited in a primary school of Calderara di Reno (Italy) in 2017. A weekly diary was administered between May and June 2017 to explore the dietary habits of the participants. Every day for each meal (breakfast, morning snack, lunch, dinner) it was required to report what types of food and beverages were consumed, and where (home/school). The adequacy of each meal was determined by using national guidelines. A McNemar test was performed to evaluate the differences in meal adequacy between the WD and WE.

Results

Our analysis showed that meals consumed at school, i.e. morning snacks and lunches, were more adequate during WD than WE (69.6% vs 22.2%, 53.5% vs 32.5%; P-value <0.001), underlying the positive influence of school. On the other hand, breakfasts and dinners were more adequate during WE than WD (64.5% vs 51.4%, 23.8% vs 15.7%; P-value <0.001); this difference might be partially explained by the different amount of time parents have for food preparation during workdays versus weekends.

Conclusions

Further preventive interventions should address childrens' and parents' home dietary routine as a tool to improve meal adequacy at home and therefore reduce childhood obesity. Parental school-based interventions could have a key role in changing childrens' dietary habits.

Key messages

Our study showed a significant difference of healthy dietary habits between meals served at school during weekdays and at home during weekends, highlighting a higher dietary adequacy in the first ones. The results underline the importance of implementing educational programs addressing childrens’ and their parents' home meals routine and dietary habits.

Preliminary data on physical well-being of children and adolescents during the SARS-CoV-2 pandemic

Background

The COVID-19 outbreak has forcibly overshadowed the physical well-being of children and adolescents, of which we will see the consequences in near future. The programs to contain the spread of Sars-CoV-2 resulted in prolonged lockdown periods, discontinuity of educational services and a possible decrease in physical activities (PA) among the youngest. In the local reality of the Metropolitan City of Bologna children and adolescents underwent a radical change in habits and lifestyle, overall predisposing sedentariness and unhealthy behaviors. Our project, “Come te la passi?”, aims to acknowledge lifestyle variations (concerning diet, PA, sleep behavior/quality) to design, in second-phase interventions, individualized school-based educational programs.

Methods

This ongoing study is being conducted using an on-line anonymous questionnaire targeting parents/guardian of children and adolescents aged 6-17 recruited from 26th to 28th of April in Bologna, a city in Northern Italy.

Results

Preliminary data suggested that among adolescents (n = 124) 91.2% used to do PA 2 or more times a week before lockdown, while during lockdown this percentage decreased, reaching 41.1%. In children (n = 38) we observed an even more pronounced difference, with PA decreasing from 89.5% to 26.3%. In children 29% of the participants also reported a weight gain, while 65.8% did not report any variation and only 5.2% reported a weight loss. For the majority of both children's and adolescents' parents (n = 162), the strategies to address the reduction in PA were predominantly having school time dedicated only to PA (53.1%) and being more educated about simple physical exercises (14.5%).

Conclusions

Our preliminary findings suggest that the current pandemic had a strong impact on the well-being of children and adolescents; “Come te la passi?” second-phase interventions could be crucial in addressing the youngest' needs, to educate and promote healthier lifestyles through school-based programs.

Key messages

Children’s and adolescents’ lifestyle behaviors were strongly affected by the current pandemic, with physical activity frequency more than halved.

“Come te la passi?” objectives are to frame the major critical issues detected and to shape educational school programs based on identified needs.

A driving simulation study to examine the impact of available sight distance on driver behavior along rural highways

The available sight distance (ASD) is the maximum length of the roadway ahead visible to the driver. It is a fundamental factor in road geometry principles and is used by road designers to ensure safe driving conditions. However, designers do not know how a specific ASD may affect the longitudinal and transversal behavior of drivers engaged in negotiating curves. This paper focuses on analyzing driver longitudinal behavior along rural highways curves with limited visibility. A number of virtual sight condition scenarios were recreated and tested in the driving simulator. Three tracks were designed with various combinations of radii and sight obstructions (a continuous wall) along the roadside located at various offsets from the lane centerline, combinations which resulted with a minimum ASD of 56.6 m. Roadside factors capable of influencing the risk perception of drivers (e.g., traffic barriers, posted speed limit signs, vegetation) were all excluded from the simulations. Results indicate that speed and trajectory dispersion from the lane centerline depend linearly on ASD in the investigated range of curve radii (from 120 to 430 m). In general, when ASD increases, so does speed and the trajectories tend to be less dispersed around the lane centerline. As a result, in safety terms, any variation in ASD will have the polar opposite effect on safety related parameters. Furthermore, different curves with similar ASD values resulted in different speed and lateral control behaviors. Analysis from ANOVA support the same findings; in addition, radius, curve direction, and distance from trajectory to sight obstruction have been identified as significant independent parameters. Road designers should adjust the ASD and these parameters when seeking to encourage drivers to adopt appropriate behaviors. To optimize safe driving conditions, ASD should be designed so that it is slightly greater than the required sight distance, since excessive ASD values may encourage drivers to drive at inappropriate speeds.