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Background In response to the imperative need for standardized support for adolescent Gender Dysphoria (GD), the Italian Academy of Pediatrics, in collaboration with the Italian Society of Pediatrics, the Italian Society for Pediatric Endocrinology and Diabetes, Italian Society of Adolescent Medicine and Italian Society of Child and Adolescent Neuropsychiatry is drafting a position paper. The purpose of this paper is to convey the author's opinion on the topic, offering foundational information on potential aspects of gender-affirming care and emphasizing the care and protection of children and adolescents with GD.Main body Recognizing that adolescents may choose interventions based on their unique needs and goals and understanding that every individual within this group has a distinct trajectory, it is crucial to ensure that each one is welcomed and supported. The approach to managing individuals with GD is a multi-stage process involving a multidisciplinary team throughout all phases. Decisions regarding treatment should be reached collaboratively by healthcare professionals and the family, while considering the unique needs and circumstances of the individual and be guided by scientific evidence rather than biases or ideologies. Politicians and high court judges should address discrimination based on gender identity in legislation and support service development that aligns with the needs of young people. It is essential to establish accredited multidisciplinary centers equipped with the requisite skills and experience to effectively manage adolescents with GD, thereby ensuring the delivery of high-quality care.Conclusion Maintaining an evidence-based approach is essential to safeguard the well-being of transgender and gender diverse adolescents.

The severe impact of global crises, such as COVID-19 and climate change, is plausibly reshaping the way in which people perceive risks. In this paper, we examine and compare how global crises and local disasters influence public perceptions of multiple hazards in Italy and Sweden. To this end, we integrate information about the occurrence of hazardous events with the results of two nationwide surveys. These included more than 4000 participants and were conducted in two different phases of the COVID-19 pandemic corresponding to low (August 2020) and high (November 2020) levels of infection rates. We found that, in both countries, people are more worried about risks related to experienced events. This is in line with the cognitive process known as the availability heuristic: individuals assess the risk associated with a given hazard based on how easily it comes to their mind. Epidemics, for example, are perceived as less likely and more impactful in Italy compared to Sweden. This outcome can be explained by cross-country differences in the impact of, as well as governmental responses to, COVID-19. Notwithstanding the ongoing pandemic, people in both Italy and Sweden are highly concerned about climate change, and they rank it as the most likely threat.

The severe impact of global crises, such as COVID-19 and climate change, is plausibly reshaping the way in which people perceive risks. In this paper, we examine and compare how global crises and local disasters influence public perceptions of multiple hazards in Italy and Sweden. To this end, we integrate information about the occurrence of hazardous events with the results of two nationwide surveys. These included more than 4000 participants and were conducted in two different phases of the COVID-19 pandemic corresponding to low (August 2020) and high (November 2020) levels of infection rates. We found that, in both countries, people are more worried about risks related to experienced events. This is in line with the cognitive process known as the availability heuristic: individuals assess the risk associated with a given hazard based on how easily it comes to their mind. Epidemics, for example, are perceived as less likely and more impactful in Italy compared to Sweden. This outcome can be explained by cross-country differences in the impact of, as well as governmental responses to, COVID-19. Notwithstanding the ongoing pandemic, people in both Italy and Sweden are highly concerned about climate change, and they rank it as the most likely threat.

The severe impact of global crises, such as COVID-19 and climate change, is plausibly reshaping the way in which people perceive risks. In this paper, we examine and compare how global crises and local disasters influence public perceptions of multiple hazards in Italy and Sweden. To this end, we integrate information about the occurrence of hazardous events with the results of two nationwide surveys. These included more than 4000 participants and were conducted in two different phases of the COVID-19 pandemic corresponding to low (August 2020) and high (November 2020) levels of infection rates. We found that, in both countries, people are more worried about risks related to experienced events. This is in line with the cognitive process known as the availability heuristic: individuals assess the risk associated with a given hazard based on how easily it comes to their mind. Epidemics, for example, are perceived as less likely and more impactful in Italy compared to Sweden. This outcome can be explained by cross-country differences in the impact of, as well as governmental responses to, COVID-19. Notwithstanding the ongoing pandemic, people in both Italy and Sweden are highly concerned about climate change, and they rank it as the most likely threat.

The severe impact of global crises, such as COVID-19 and climate change, is plausibly reshaping the way in which people perceive risks. In this paper, we examine and compare how global crises and local disasters influence public perceptions of multiple hazards in Italy and Sweden. To this end, we integrate information about the occurrence of hazardous events with the results of two nationwide surveys. These included more than 4000 participants and were conducted in two different phases of the COVID-19 pandemic corresponding to low (August 2020) and high (November 2020) levels of infection rates. We found that, in both countries, people are more worried about risks related to experienced events. This is in line with the cognitive process known as the availability heuristic: individuals assess the risk associated with a given hazard based on how easily it comes to their mind. Epidemics, for example, are perceived as less likely and more impactful in Italy compared to Sweden. This outcome can be explained by cross-country differences in the impact of, as well as governmental responses to, COVID-19. Notwithstanding the ongoing pandemic, people in both Italy and Sweden are highly concerned about climate change, and they rank it as the most likely threat.

The severe impact of global crises, such as COVID-19 and climate change, is plausibly reshaping the way in which people perceive risks. In this paper, we examine and compare how global crises and local disasters influence public perceptions of multiple hazards in Italy and Sweden. To this end, we integrate information about the occurrence of hazardous events with the results of two nationwide surveys. These included more than 4000 participants and were conducted in two different phases of the COVID-19 pandemic corresponding to low (August 2020) and high (November 2020) levels of infection rates. We found that, in both countries, people are more worried about risks related to experienced events. This is in line with the cognitive process known as the availability heuristic: individuals assess the risk associated with a given hazard based on how easily it comes to their mind. Epidemics, for example, are perceived as less likely and more impactful in Italy compared to Sweden. This outcome can be explained by cross-country differences in the impact of, as well as governmental responses to, COVID-19. Notwithstanding the ongoing pandemic, people in both Italy and Sweden are highly concerned about climate change, and they rank it as the most likely threat.

Anna Di Sessa, Grazia Cirillo, Stefano Guarino, Pierluigi Marzuillo, Emanuele Miraglia del GiudiceDepartment of Woman, Child and General and Specialized Surgery, University of Studies of Campania “Luigi Vanvitelli”, Napoli 80138, ItalyCorrespondence: Pierluigi MarzuilloDepartment of Woman, Child and General and Specialized Surgery, University of Studies of Campania “Luigi Vanvitelli”, 80138 Napoli, ItalyTel +39 081 566 5465Email pierluigi.marzuillo@gmail.comAbstract: Non-alcoholic fatty liver disease (NAFLD) represents the most common cause of chronic liver disease in childhood. To date, the “multiple-hit” hypothesis is largely recognized as an explanation of NAFLD pathogenesis and progression. Obesity and features of the metabolic syndrome have been closely linked to NAFLD development. Due to the increased prevalence of obesity worldwide, NAFLD has reached epidemic proportions over time. Given its unfavorable cardiometabolic burden (such as cardiovascular and metabolic consequences), it represents a worrying phenomenon needing a more comprehensive and successful management. Laboratory tests and classical imaging techniques play a pivotal role in NAFLD diagnosis, but novel noninvasive alternative methods to diagnose and monitor NAFLD have been investigated. Currently, lifestyle modifications remain the mainstay treatment, although its efficacy is poor because of the lack of compliance. Pediatric research is focusing on multiple alternative treatments targeting the main pathogenic factors such as insulin-resistance, dyslipidemia, gut-liver axis and microbiota, oxidative stress, and proinflammatory pathways. Results from these studies are promising but larger validation is needed. Innovative therapeutic approaches might add an important piece in the complex knowledge of pediatric NAFLD. We aimed to summarize recent insights into NAFLD diagnosis and treatment in children, with a focus on possible future perspe

Non-alcoholic fatty liver disease (NAFLD) comprises a spectrum of disease ranging from simple steatosis to inflammatory steatohepatitis (NASH) with different degrees of fibrosis that can ultimately progress to cirrhosis. Accumulating evidence suggests the involvement of the endocannabinoid-system in liver disease and related complications. In particular, hepatoprotective properties for Cannabinoid Receptor type 2 (CB2) have been shown both through experimental murine models of liver injury and association study between a CB2 functional variant, Q63R, and liver enzymes in Italian obese children with steatosis. Here, in order to clarify the role of CB2 in severity of childhood NAFLD, we have investigated the association of the CB2 Q63R variant, with histological parameters of liver disease severity in 118 Italian children with histologically-proven NAFLD. CB2 Q63R genotype was assigned performing a TaqMan assay and a general linear model analysis was used to evaluate the association between the polymorphism and the histological parameters of liver damage. We have found that whereas CB2 Q63R variant is not associated with steatosis or fibrosis, it is associated with the severity of the inflammation (p = 0.002) and the presence of NASH (p = 0.02). Our findings suggest a critical role for CB2 Q63R variant in modulating hepatic inflammation state in obese children and in the consequent increased predisposition of these patients to liver damage.