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This study aims to compare the accelerometer-measured daily patterns of PA and sedentary behaviour among participants with and without prevalent/incident depressive symptoms. We used data from 5,582 individuals in The Maastricht Study (59.9 ± 8.6 years, 50.3% women). Daily patterns of sedentary time, light-intensity physical activity (LiPA), moderate-to-vigorous physical activity (MVPA), and sit-to-stand transitions were objectively measured at baseline with the activPAL3 activity monitor. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire, both at baseline and annually (median follow-up: 5.1 years). General linear models were used to compare patterns of physical activity and sedentary behaviour between those with and without prevalent/incident depressive symptoms. Participants with prevalent depressive symptoms had significantly more sedentary time (18.6 min/day) and lower LiPA (26.8 min/day) and MVPA (4.8 min/day) than participants without depressive symptoms. Considering the daily patterns, participants with prevalent depressive symptoms had significantly more sedentary time early in the afternoon (12:00-18:00), early evening (18:00-21:00), and during the night (00:00-03:00), less time in LiPA in all periods between 09:00-21.00 and less MVPA in the morning (09:00:12:00), early afternoon (12:00-15:00), and evening (18:00-21:00), then those without. Similar differences in activity and sedentary behaviour patterns between those and without incident depressive symptoms were observed albeit the differences were smaller Overall, we did not find specific time slots particularly associated with both prevalent and incident depressive symptoms. These findings may indicate that less sedentary time and more intense PA can be important targets for the prevention of depression irrespective of the timing of the day.

Cancer patients are at risk of several comorbid conditions, including nutritional issues and mental health illnesses. The objective of the current study was to estimate the prevalence, upon hospital admission, of depression and malnutrition among adults with cancer. A retrospective chart review was conducted using health information collected as part of routine assistance. Nutritional status was measured through structured tools, including body mass index (BMI), Nutrition Risk Screening (NRS) 2002, and dietary intake needs. Depression was assessed with the Hospital Anxiety and Depression Scale (HAD). Cancer site, disease stage, length of hospitalization, age, and sex were also considered. Multivariate analyses were used to investigate the association between malnutrition and depression. In summary, our study reveals that malnutrition increases the risk of depression among cancer patients. The findings can also be used in clinical oncology for the implementation of appropriate prevention and treatment interventions in order to reduce the extent of depression and thus improve cancer patients’ quality of life and survival rate.

Mental health conditions are a significant contributor to the global burden of disease. The aim of this study was to explore the association between psychological disorders, Mediterranean diet (MD), and chronotype. A total of 344 participants (74% women) with a mean age of 33.5 ± 13 years were recruited. According to the Depression Anxiety Stress Scale (DASS-21) score, 22% of participants had symptoms of depression, 23% anxiety, and 10% stress. The assessment of MD adherence through the Medi-Lite score revealed that participants with psychological disorders had significantly (p < 0.05) lower MD adherence than those without these conditions. Furthermore, less than 10% of the subjects with at least one symptom reported consuming the optimal amount of fruit and vegetables, while 72% showed excessive consumption of meat and meat products. Regarding chronotype, evening subjects reported the lowest MD adherence and the highest prevalence of all three psychological disorders analyzed. A multivariate analysis showed that female gender, age, being unmarried/single, sedentary lifestyle, and low MD adherence were associated with a significantly higher risk of depression, anxiety, and stress. Future studies are needed to explore the relationship between mental health and risk factors to improve personal and global population health.

Objectives At the end of 2019, an acute infectious pneumonia (coronavirus disease 2019 [COVID-19]) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, and subsequently spread around the world starting a pandemic. Globally, to date, there have been >118 million confirmed cases, including >2 million deaths. In this context, it has been shown that the psychological impact of the pandemic is important and that it can be associated with an increase in internet searches related to fear, anxiety, depression, as well as protective behaviours, health knowledge and even maladaptive behaviours. Study design This is a systematic review. Methods This review aims to collect, analyse and synthesise available evidence on novel data streams for surveillance purposes and/or their potential for capturing the public reaction to epidemic outbreaks, particularly focusing on mental health effects and emotions. Results At the end of the screening process, 19 articles were included in this systematic review. Our results show that the COVID-19 pandemic had a great impact on internet searches for mental health of entire populations, which manifests itself in a significant increase of depressed, anxious and stressed internet users’ emotions. Conclusions Novel data streams can support public health experts and policymakers in establishing priorities and setting up long-term strategies to mitigate symptoms and tackle mental health disorders., Graphical abstract Image 1

This study investigated the response to BNT162b2 mRNA COVID-19 vaccine among healthcare workers (HCWs) in an Italian teaching hospital. 444 participants were surveyed with either multiple RT-PCR assays for detection of SARS-CoV-2 nucleic acid in nasopharyngeal swabs or serology testing for the research of virus-specific immunoglobulins. Adverse events following immunization (AEFI) were reported. Two weeks after the first dose anti-SARS-CoV-2 antibodies exceeded reactivity cut-off in 82.5% the participants. Four HCWs tested positive at nasopharyngeal swab after 3 months. More than three-quarters reported AEFIs. Our findings offer an insight regarding the vaccine response after 3 months from its administration, with a special focus on effectiveness data, as well as the type and number of AEFIs complained by HCW recipients. The presented study may serve as reference for future research which will be necessary to explore the long-term safety of this vaccine, especially in population at high risk for infection, such as HCWs.

Background and aim: In Italy, pre-exposure prophylaxis (PrEP) with emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) was authorized for HIV prevention in 2017. This scoping systematic review summarizes current evidence on PrEP implementation in Italy since 2017. Methods: A systematic search was conducted in relevant databases, using a search strategy built upon controlled vocabulary, cross-referencing of the citation lists from included reports, and hand-searching of surveillance documents. Findings were summarized narratively according to key issues and themes. Results: A total of 106 reports were retrieved and six met criteria for inclusion in the review, being three journal articles and three surveillance report by the European Centre for Disease Prevention and Control (ECDC). In Italy, users can obtain in PrEP in specific hospital-or community-based PrEP services, under prescription by specialists. Due to drug costs, the access is limited to those who can afford it. Data and indicators on PrEP use and monitoring are limited. The vast majority of users were men who have sex with men. In this population, PrEP knowledge and attitudes were investigated across two reports, finding a medium to high level to knowledge and a scare use (mostly due to high costs). A health technology assessment on the adoption of PrEP in Italy advised that the most costcontaining strategy would be the use of PrEP as an “add-on” strategy. Conclusions: In conclusion, this scoping review found a relevant evidence gap on PrEP monitoring. Italy needs to implement specific policies and programs for effective and timely delivery of care. (www.actabiomedica.it).

The primary aim of this study was to evaluate the temporal correlation between Wikitrends and conventional surveillance data generated for Chikungunya, Dengue, Zika, and West Nile Virus infection reported by bulletin of Italian National Institute of Health (Istituto Superiore di Sanità in italian, ISS).A cross-sectional study design was used.The reported cases of Dengue and Chikungunya were selected from July 2015 to December 2019. For West Nile Virus, the bulletins are issued in the period June-November (6 months) of the years 2015-2019, and for Zika virus, the data reported in the ISS bulletin start from January 2016. From Wikipedia Trends, we extracted the number of monthly views by users from the July 2015 to December 2019 of the pages Chikungunya, Dengue, Zika virus, and West Nile Virus.A correlation was observed between the bulletin of ISS and Wikipedia Wikitrends, the correlation was strong for Chikungunya and West Nile Virus (r = 0.9605; r = 0.9556, respectively), and highly statistically significant with P-values0.001. The correlation was moderate for Dengue and Zika virus (r = 0.6053; r = 0.5888, respectively), but highly statistically significant with P-values0.001.Classical surveillance system should be integrated with the tools of digital epidemiology that have potential role in public health for the dynamic information and provide near real-time indicators of the spread of infectious disease.

Background Moderate to vigorous physical activity (MVPA) can help to prevent depression, but identification of the most important psycho-biological pathways involved is unclear. The improvement of cardio-respiratory fitness (CRF) in response to MVPA can vary markedly, we therefore examined the association between CRF and the incidence of depressive symptoms. Methods We used data from The Maastricht Study, a large population-based prospective-cohort study. CRF was estimated at baseline from a graded submaximal exercise protocol and MVPA was measured with accelerometry. Depressive symptoms were assessed using the validated Dutch version of the 9-item Patient Health Questionnaire, both at baseline and during annual follow-up over five years. Cox proportional hazards models were used. Results A total of 1,730 individuals without depressive symptoms at baseline were included in the analysis. During the 5-year follow-up, n = 166 (9.6%) of individuals developed depressive symptoms. Compared to individuals with a low CRF, those with a moderate-to-high CRF had a significantly lower risk of developing depressive symptoms, independent of MVPA (medium CRF: HR = 0.49 (95%CI = 0.33–0.72); high CRF: HR = 0.48 (95% CI = 0.30–0.75). These associations were adjusted for age, sex, level of education, diabetes status, smoking status, alcohol use, energy intake, waist circumferences and antidepressant medications. Limitations PHQ-9 is a validated screening instrument, but it is not a diagnostic tool of depression. Conclusions Higher CRF was strongly associated with a lower risk of incident depressive symptoms over 5-year follow-up, independent of the level of MVPA at baseline, suggesting that interventions aimed at improving CRF could reduce the risk of depression.

Recent research suggested that daily pattern of physical activity (PA) may have an important association with depression, but findings are limited and contradictory. Our aim was to conduct a systematic review of the literature to summarize the literature evidence on the association between timing of PA and depression. A comprehensive search of PubMed/Medline and Scopus databases has been performed, and a total of five manuscripts have been thoroughly reviewed. The performed descriptive analysis shows lower levels of PA among individuals with depression or depressive symptoms, although evidence on the 24 h pattern of PA and depression is limited. An interesting finding is the association between lower PA during the morning, higher PA late in the evening (night), and depression or depressive symptoms. However, definitive conclusions could not be drawn due to the observational nature of the studies, their limited number, the high heterogeneity in the sample populations, and the studies’ differing outcome definitions and exposure assessments. Future studies considering not only the level of PA but also its daily variability might be important to further explore this novel area of research.

There is evidence of an association between cancer and certain types of altered eating behaviors, including orthorexia, food cravings, and food addiction. Given the growing interest in the topic throughout the scientific community we conducted a systematic review to summarize current evidence on the development of altered food behavior, including food addiction and cancer. The Cochrane Collaboration and the Meta-analysis Of Observational Studies in Epidemiology guidelines were followed to perform this systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to report the process and results. The structured literature search was conducted on 19 April 2022, on PubMed/Medline and Scopus, combining free-text terms and medical subject headings. A total of seven articles were included once the selection process was completed. Food craving has been associated with different types of cancer in adults and young patients, as well as with orthorexia; conversely, compulsive eating has only been explored in patients with prolactinoma treated with dopamine agonists. This systematic review explored a new area of research that warrants further investigation. More research is required to better understand the relationship between cancer and food behavior.

We obtained data from Google Trends and Wikipedia in order to assess whether an analysis of Internet searches could provide information on the Internet users’ behaviour/interest in diets. Differences in seasonality, year and before/during COVID-19 pandemic were assessed. From Wikipedia, we extracted the number of times a page is viewed by users, aggregated on monthly and seasonal bases. We also used Google Trends to evaluate the frequency of the users’ web searches. The Mediterranean diet was the most frequently (33.9%), followed by the pescatarian diet (9.0%). Statistically, significant seasonal differences were found for the Mediterranean, vegetarian, Atkins, Scarsdale, and zone diets and pescetarianism. The most commonly searched diet and consequent diet-related queries on Google resulted to be: Dukan diet, Dukan and weight loss. Ketogenic, FODMAP and intermittent fasting diets were statistically more frequently searched during the pandemic compared with before. Our data show a different trend of searches based on the seasonality, year and the pandemic. These data could be useful for scientists, practitioners and policy makers because they can inform educational campaigns via the Internet, especially in periods when the population is more receptive.

The urgency of having rapidly safe and efficient COVID-19 vaccines called for the need to shorten trial phases, reduce sample sizes, and speed-up the approval process by the regulatory Agencies. In light of this, monitoring adverse effects (AEFI) (both immediate and at medium-long term) become of great importance. Aim of this cross-sectional study was to explore the associations between several factors and risk of immediate AEFI.Data come from the electronic dataset developed ad hoc to record demographic data, anamnesis and data related to immunization, set-up in the mass vaccination site in Novegro (Milan). Novegro mass vaccination site was one of the mass vaccinations sites with the highest flow in Lombardy Region, with a maximum capacity of 5,000 vaccinations/day. The center opened in April 2021 and closed the 1st of August 2021. A multivariable logistic regression model was used. Odds ratios adjusted (aOR) for age and sex are presented. Statistical significance was set at p0.05. Analyses were conducting using STATA.Among the total of 314,671 subjects vaccinated, 0.5% developed an immediate AEFI, on average 17.0 ± 0.43 minutes after the administration. The three most frequent AEFI recorded were vagal response (30%), anxiety reaction (24%) and dizziness (21%). AEFI were more frequently observed among women [aOR= 2.24 (95%CI= 2.00 - 2.50)], and those with at least one previous disease [aOR= 1.47 (95%CI= 1.22-1.76)].In conclusion, AEFI were less likely to occur for increasing age and after the second dose. Results from this large, complete and representative sample population regarding enrich the interesting scientific debate on potential adverse events following COVID-19 immunization.

After the first cases of COVID-19 detected in Wuhan (China), the virus rapidly spread in the world, so much so that on February 20 the first autochthonous case was officially identified in Italy. However, this person had no apparent history of travel abroad or contact with people tested positive for the virus. For this reason, the aim of this literature review was to reconstruct the epidemiological dynamics of the first wave of SARS-CoV-2 infection in the Lombardy Region.To this end, a systematic review was carried out on PubMed/MEDLINE and EMBASE, and on grey literature. All article assessing incidence, mortality and hospitalizations by Lombardy province and municipality, and the impact of the main containment and organizational measures were considered eligible. In addition, data on general mortality and mortality due to COVID-19, hospital admission, and serological and environmental were also retrieved.From the included studies, it emerged that Lombardy was the first European region in which the virus began to circulate as early as January 2020 (and probably even earlier). Despite the high number of cases and deaths recorded, the reproduction number observed in Lombardy Region was, at the beginning of March 2020, the same (or lower) than in other regions.In conclusion, data of the first epidemic wave in Lombardy, compared to other Italian and foreign regions, highlight the extreme criticality of having had the first autochthonous case (and the first substantial outbreaks) when knowledge was still scarce and individual prevention measures were not widespread.

In Europe, Italy and Lombardy, in autumn 2020, there was a steep increase in reported cases due to the second epidemic wave of SARS-Cov-2 infection. We aimed to evaluate the appropriateness of COVID-19 patients' admissions to the ED of the San Raffaele Hospital.We compared data between the inter-wave period (IWP, from 1st to 30th September) and the second wave period (WP, 1st October to 15th November) focusing on the ED presentation, discharge priority colour code and outcomes.Out of 977 admissions with a SARS-Cov-2 positive swab, 6% were in the IWP and 94% in the WP. Red, yellow and white code increased (these latter from 1.8% to 5.4%) as well as self-presented in yellow and white code. Discharges home increased from 1.8% to 5.4%, while hospitalizations decreased from 63% to 51%.We found a rise in white codes (among self-presented patients), indicating inappropriateness of admissions. The increase in discharges suggests that several patients did not require hospitalization.The pandemic brought out the fundamental role of primary care to manage patients with low-intensity needs. The important increase in ED admissions of COVID-19 patients caused a reduction of NO-COVID-19 patients, with possible inadequate treatment.

Comirnaty® was the first COVID-19 vaccine available for the vaccination campaign of healthcare workers in Italy. With the aim of assessing vaccine safety, we conducted a cross-sectional survey administrating a voluntary-based questionnaire on adverse events following immunisation (AEFIs) in San Raffaele Hospital, Milano, Italy.From 4th January 2021 to 27th April 2021, we collected 2,659 questionnaires (response rate: 24,5%). We analyzed data, reporting AEFIs by gender, age, self-reported severity, type, time of insurgence and duration, and estimating relative-risk ratios (RRR) and corresponding 95% confidence intervals (CI).The most reported symptoms were injection site pain, fatigue, headache, myalgia, chills, fever, and arthralgia. Severe systemic reactions were more frequent after receiving the second dose (RRR 6.25, 95% CI 4.57-8.55), in women (RRR 3.33, 95% CI 2.30-4.82), and less frequent in individuals aged 60 or more (RRR 0.26, 95% CI 0.14-0.49). In addition, we noted a wide range of adverse events of special interest (AESIs).Consistently with clinical trials and pharmacovigilance surveillance, AEFIs were frequent, but severe ones were uncommon, supporting the massive implementation of the COVID-19 vaccination campaign and providing valuable data for a risk profiling of vaccinees. (www.actabiomedica.it).

Objectives: To describe the monthly distribution of COVID-19 hospitalisations, deaths and case-fatality rates (CFR) in Lombardy (Italy) throughout 2020.Methods: We analysed de-identified hospitalisation data comprising all COVID-19-related admissions from 1 February 2020 to 31 December 2020. The overall survival (OS) from time of first hospitalisation was estimated using the Kaplan-Meier method. We estimated monthly CFRs and performed Cox regression models to measure the effects of potential predictors on OS.Results: Hospitalisation and death peaks occurred in March and November 2020. Patients aged ≥70 years had an up to 180 times higher risk of dying compared to younger patients [70–80: HR 58.10 (39.14–86.22); 80–90: 106.68 (71.01–160.27); ≥90: 180.96 (118.80–275.64)]. Risk of death was higher in patients with one or more comorbidities [1: HR 1.27 (95% CI 1.20–1.35); 2: 1.44 (1.33–1.55); ≥3: 1.73 (1.58–1.90)] and in those with specific conditions (hypertension, diabetes).Conclusion: Our data sheds light on the Italian pandemic scenario, uncovering mechanisms and gaps at regional health system level and, on a larger scale, adding to the body of knowledge needed to inform effective health service planning, delivery, and preparedness in times of crisis.

Immunization is one of the most important public health interventions to contrast infectious disease; however, many people nowadays refuse vaccination. Vaccine hesitancy (VH) is due to several factors that influence the complex decision-making process. Information technology tools might play an important role in vaccination programs. In particular, immunization information systems (IISs) have the potential to improve performance of vaccination programs and to increase vaccine uptake. This review aimed to present IIS functionalities in order to counter VH. In detail, we analyzed the automatic reminder/recall system, the interoperability of the system, the decision support system, the web page interface and the possibility to record adverse events following immunization. IIS could concretely represent a valid instrument to increase vaccine confidence, especially trust in both health-care workers and decision makers. There are not enough trials aimed to evaluate the efficacy of IIS to counter VH. Further researches might focalize on this aspect.

PubMed/Medline, Excerpta Medica dataBASE (EMBASE) and Scopus were searched in January 2021 in order to retrieve evidence assessing the association between dietary fibre intake and the risk of colorectal adenoma in adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the reporting of results. Only primary observational studies were included. Publication bias was estimated through the Egger’s test and the visual inspection of the funnel plot. Heterogeneity between studies was calculated with I2 statistics. The search strategy identified 683 papers, 21 of which were included in our meta-analysis. Having evaluated a total of 157,725 subjects, the results suggest a protective effect of dietary fibre intake against colorectal adenoma. Effect Size (ES) was [0.71 (95% CI = 0.68–0.75), p = 0.000)]. Moderate statistical heterogeneity (Chi2 = 61.68, df = 23, I2 = 62.71%, p = 0.000) was found. Findings show a statistically significant (p = 0.000) and robust association between a higher intake of dietary fibre and a lower risk of colorectal adenoma, considering both the prevalent and incident risk. Moreover, the meta-regression analysis showed a borderline significant negative linear correlation between the amount of dietary fibre intake and colorectal adenoma. Lastly, we performed a subgroup analysis by sex, showing a higher protective effect for men.

Our aim was to assess the association between a priori defined dietary patterns and incident depressive symptoms. We used data from The Maastricht Study, a population-based cohort study (n = 2646, mean (SD) age 59.9 (8.0) years, 49.5% women, 15,188 person-years of follow-up). Level of adherence to the Dutch Healthy Diet (DHD), Mediterranean Diet, and Dietary Approaches To Stop Hypertension (DASH) were derived from a validated Food Frequency Questionnaire. Depressive symptoms were assessed at baseline and annually over seven-year-follow-up (using the 9-item Patient Health Questionnaire). We used Cox proportional hazards regression analyses to assess the association between dietary patterns and depressive symptoms. One standard deviation (SD) higher adherence in the DHD and DASH was associated with a lower hazard ratio (HR) of depressive symptoms with HRs (95%CI) of 0.78 (0.69–0.89) and 0.87 (0.77–0.98), respectively, after adjustment for sociodemographic and cardiovascular risk factors. After further adjustment for lifestyle factors, the HR per one SD higher DHD was 0.83 (0.73–0.96), whereas adherence to Mediterranean and DASH diets was not associated with incident depressive symptoms. Higher adherence to the DHD lowered risk of incident depressive symptoms. Adherence to healthy diet could be an effective non-pharmacological preventive measure to reduce the incidence of depression.

Aims Social network characteristics may provide a novel non-pharmaceutical target for the prevention of depression. We investigated the temporal association of a broad range of structural and functional social network characteristics with incident depressive symptoms over 5 years of follow-up. Methods We used data from The Maastricht Study, a population-based prospective cohort study (n=2,465, mean age 59.8±8.1 years, 49.1% women, 11,585 person-years of follow-up). Social network characteristics were assessed through a name generator questionnaire. Clinically relevant depressive symptoms (9-item Patient Health Questionnaire score≥10) were assessed at baseline and annually. We used multivariable logistic and Cox regression analyses, adjusted for sociodemographic, lifestyle and cardiovascular risk factors. Results In cross-sectional analyses less emotional support for discomfort and with important decisions, and less informational support were associated with prevalent depressive symptoms (OR[95%CI] 1.19 [1.01-1.40]; 1.22 [1.05-1.43], and 1.20 [1.04-1.39], respectively). Every fewer 10% of family members was associated with prevalent depressive symptoms (1.11 [1.01-1.23]). In longitudinal analyses, less emotional support on important decisions was also associated with higher risk of incident depressive symptoms (HR[95%CI] 1.13 [1.03-1.25]). In addition, every fewer 10% of the network that was a family member was associated with a higher hazard of incident depressive symptoms (1.07 [1.01-1.13]). Conclusions This study shows that less emotional support and fewer family members in the network were associated with higher risk of both prevalent and incident depression. The importance of emotional support and the role that family plays should be considered in treatment and prevention of depression.

COVID-19 is a novel infectious disease which has rapidly spread around the globe, disrupting several aspects of public life over the past year. After numerous infection clusters emerged among travelers hosted in ski resorts in early 2020, several European countries closed ski areas. These measures were mostly upheld throughout the 2020 and 2021 winter season, generating significant economic loss for mountain communities. The aim of this rapid systematic review was to explore the association between recreational skiing and the spread of COVID-19. This review was conducted according to the WHO practical guidelines on rapid reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, MedRxiv and Promed-mail were screened to identify relevant scientific and grey literature published since the emergence of COVID-19. Among the 11 articles included, seven focused on cases recorded during the first epidemic wave, when COVID-19 containment measures were not yet mandatory. Most infection clusters could be directly linked to public gatherings which took place without the enforcement of restrictions. There is currently no evidence to suggest an association between COVID-19 spread and recreational skiing. It may be reasonable to consider the reopening of ski areas in compliance with strict rules and preventive measures.

Background and aim Rapid antigen detection (RAD) tests on nasopharyngeal specimens have been recently made available for SARS-CoV-2 infections, and early studies suggested their potential utilization as rapid screening and diagnostic testing. The present systematic review and meta-analysis was aimed to assess available evidence and to explore the reliability of antigenic tests in the management of the SARS-CoV-2 pandemic.We reported our meta-analysis according to the PRISMA statement. We searched Pubmed, Embase, and pre-print archive medRxiv.og for eligible studies published up to November 5th, 2020. Raw data included true/false positive and negative tests, and the total number of tests. Sensitivity and specificity data were calculated for every study, and then pooled in a random-effects model. Heterogeneity was assessed using the I2 measure. Reporting bias was assessed by means of funnel plots and regression analysis.Based on 25 studies, we computed a pooled sensitivity of 72.8% (95%CI 62.4-81.3), a specificity of 99.4% (95%CI 99.0-99.7), with high heterogeneity and risk of reporting bias. More precisely, RAD tests exhibited higher sensitivity on samples with high viral load (i.e.25 Cycle Threshold; 97.6%; 95%CI 94.1-99.0), compared to those with low viral load (≥25 Cycle Threshold; 43.6%; 95% 27.6-61.1).As the majority of collected reports were either cohort or case-control studies, deprived of preventive power analysis and often oversampling positive tests, overall performances may have been overestimated. Therefore, the massive referral to antigenic tests in place of RT-qPCR is currently questionable, and also their deployment as mass screening test may lead to intolerable share of missing diagnoses. On the other hand, RAD tests may find a significant role in primary care and in front-line settings (e.g. Emergency Departments). (www.actabiomedica.it).

Riassunto. Introduzione. MI NUTRO (MIgrants NUTRition knOwledge per l'integrazione) ha avuto come obiettivi: valutare le conoscenze nutrizionali dei migranti, aumentare le informazioni sulla dieta sana e misurare l'effetto delle lezioni di cucina sulle conoscenze. Metodi. MI NUTRO è uno studio pilota quasi sperimentale. Tutti i partecipanti sono stati inclusi su base volontaria e l'intervento si è basato su seminari teorici e lezioni pratiche. È stato utilizzato un questionario validato. Il test non parametrico di Wilcoxon è stato usato per confrontare il punteggio pre- e post-intervento. Risultati. Il punteggio medio di conoscenza nutrizionale era 11,4 ± 3,8 (deviazione standard - DS) prima e 27,5 ± 5,6 DS dopo l'intervento, con una differenza statisticamente significativa. Discussione. I dati mostrano un aumento significativo delle conoscenze nutrizionali dei migranti dopo l'intervento. Le lezioni di cucina offerte sono state sessioni di apprendimento interattive in cui ogni migrante ha avuto la possibilità di prendere parte al processo di preparazione degli alimenti. Inoltre, alla fine di ogni lezione ricercatori e migranti hanno cenato insieme, favorendo il processo di scambio culturale.

Our study aim has been to investigate if the Umbrian population follows the healthy diet recommendations; mainly we focused on the daily intake of almost 5 portions of fruit and vegetables (five-a-day). Furthermore, we analyzed the relationship between fruits and vegetables consumption and other lifestyles in order to construct the relative health profile.Data were extracted from three national population-based surveillance systems, including children (OKkio alla SALUTE), adults aged 18-69 years (PASSI) and elderly people (PASSI d'Argento). Among the 18-69 year-old people, multivariable analyses were used to compare the fruits/vegetables daily consumption with socio-demographic variables and healthy lifestyles patterns.Fruits/vegetables average intake was less than 5 portions/day in all age groups, and it was significantly lower when compared to the national average. The 5 fruits/vegetables daily portions consumption is more frequent with increasing age, higher education and among women. Moreover among the 18-69 year-old people, five-a-day was significantly associated with no economic difficulties, normal weight, not being sedentary, not being smoker, not alcohol drinking.In Umbria region the 5 portions/day consumption was largely below the guidelines. Moreover, due to the associations, it could be used as a good trace of healthy lifestyles.

Vaccine hesitancy (VH) is a complex and country-specific issue, responsible for the decreasing vaccination rate and subsequent spread of vaccine-preventable diseases. In literature, several questionnaires were developed to assess VH. The aim of this systematic review was to evaluate the published questionnaires assessing parental VH. The search was conducted in PubMed/Medline, Web of Science and The Cochrane Library, in December 2017, following the PRISMA guidelines. The search strategy included 4 types of keywords: parents, vaccine hesitancy/acceptance, immunization and survey. Only English and Italian original papers were included. 17 reviewers independently screened titles and abstracts. Only the included articles were downloaded in full and, after a second screening, data were extracted and recorded in an ad hoc spreadsheet. A total of 5,139 articles were retrieved, after duplicates elimination 3,508 papers were screened. After a screening selection, 334 studies were included in the analysis. Most studies were cross-sectional (92.8%), followed by case-control (4.8%) and cohort studies (2.4%). The population interviewed was mainly parents, without any further details (73.1%); mothers were the only parent surveyed in approximately 20% of the studies, while only 1 study involved selectively the fathers. The sample size ranged from 7 to 59,897. Only 38% of the included studies reported both the number and type of items used. Regarding the type, more than half consisted of closed questions, followed by Likert scales, while open-ended questions were used in 14.8% of the surveys. Frequently, the survey was conducted using a self-reported questionnaire or interview. The questionnaires were mostly administered on paper, while online forms were used in 20.1% of the cases. However, 80.2% of the questionnaires were not attached to the paper. HPV vaccine was the most frequently investigated (39.2%), followed by influenza (13.5%) and measles (10.8%). While 22.4% of the articles referred to paediatrics vaccinations in general. Data about the immunization behaviours were reported in 294 studies: the subjects involved showed a behaviour defined as “acceptance” in 129 studies (38.6%), as “hesitancy/scepticism/doubt” in 145 studies (43.1%) and as “refusal” in 22 studies (6.6%). This information was not reported in 12% of the studies. VH is still a public health challenge, as confirmed by the high number of studies and questionnaires retrieved. This study offers a deeper perspec- tive on the available questionnaires, helping to identify the best one in terms of aim and study setting., Journal of Preventive Medicine and Hygiene, Vol. 61 No. 3 (2020): 2020613

Acute mountain sickness (AMS) is the most common form of illness at high altitude; however, it is still unclear whether age is a protective factor or a risk factor for the development of AMS in travellers. In recent decades, the number of travellers aged 60 years or older is increasing. Thus, the care of older travellers is a long-standing issue in travel medicine. This study aims to systematically review the current state of knowledge related to the effect of old age on the risk of AMS. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used, and the following databases were consulted: PubMed/Medline, Embase, Europe PubMed Central (EuropePMC), World Health Organization Library Database (WHOLIS) and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). The search yielded a total of 532 articles, of which 25 met the inclusion criteria, corresponding to 26 reports. Although the approaches, methods and quality were heterogeneous among the included studies, 12 reported a negative correlation between AMS prevalence and age, 11 detected no relationship and three papers indicated that the age of AMS subjects was significantly higher than controls. Despite these differences, old age does not seem to be a contraindication for travelling at high altitude. Thus, the presented synthesis will be useful for health professionals in travel medicine to better tailor their appropriate care for older adults who travel to destinations at high altitude.

We analyzed the spread of the COVID-19 epidemic in 9 metropolitan regions of the world with similar socio-demographic characteristics, daytime commuting population and business activities: the New York State, Bruxelles-Capital, the Community of Madrid, Catalonia, the Île-de-France Region, the Greater London county, Stockholms län, Hovedstaden (Copenhagen) and the Lombardy Region. The Lombardy region reported the highest COVID-19 crude mortality rate (141.0 x 100,000) 70-days after the onset of the epidemic, followed by the Community of Madrid (132.8 x 100,000) New York State (120.7 x 100,000). The large variation in COVID-19 mortality and case-fatality rates for COVID-19 in different age strata suggested a more accurate analysis and interpretation of the epidemic dynamics after standardization of the rates by age. The share of elder populations (>70 years) over total population varies widely in the considered study settings, ranging from 6.9% in Catalonia to 17.0% in Lombardy. When taking age distribution into consideration the highest standardized mortality rate was observed in the State of New York (257.9 x 100,000); with figures in most of the European regions concentrated between 123.3 x 100,000 in Greater London and 177.7 x 100,000 in Bruxelles-Capital, lower in French and Danish regions. We also report and critical appraise, when available, COVID-19 mortality figures in capital cities, nursing homes, as well as excess mortality at country level. Our data raise awareness on the need for a more in-depth epidemiological analysis of the current COVID-19 public health emergency that further explores COVID-19 mortality determinants associated with health services delivery, community-level healthcare, testing approaches and characteristics of surveillance systems, including classification of COVID-19 deaths. (www.actabiomedica.it)

Introduction: This study aimed to assess if the frequency of the Italian general public searches for influenza, using the Wikipedia web-page, are aligned with Istituto Superiore di Sanità (ISS) influenza cases. Materials and Methods: The reported cases of flu were selected from October 2015 to May 2019. Wikipedia Trends was used to assess how many times a specific page was read by users; data were extracted as daily data and aggregated on a weekly basis. The following data were extracted: number of weekly views by users from the October 2015 to May 2019 of the pages: Influenza, Febbre and Tosse (Flu, Fever and Cough, in English). Cross-correlation results are obtained as product-moment correlations between the two times series. Results: Regarding the database with weekly data, temporal correlation was observed between the bulletin of ISS and Wikipedia search trends. The strongest correlation was at a lag of 0 for number of cases and Flu (r=0.7571), Fever and Cough (r=0.7501). The strongest correlation was at a lag of -1 for Fever and Cough (r=0.7501). The strongest correlation was at a lag of 1 for number of cases and Flu (r=0.7559), Fever and Cough (r=0.7501). Conclusions: A possible future application for programming and management interventions of Public Health is proposed.

Purpose The PRison NUtrition Surveillance (PRuNUS) questionnaire aimed to assess the eating behaviour, diet knowledge and lifestyle of Italian prisoners. The purpose of this paper is to present both data from the validation process and from the cross-sectional study. Design/methodology/approach In order to perform the validation process, the authors evaluated the reproducibility and the consistency of the questionnaire, using Cohen’s k and Cronbach’s α, the agreement between the two administrations was evaluated by the Landis and Koch score. The authors performed the study in the “Capanne” Prison, Perugia. A multivariable logistic regression model adjusted for age and gender was used. Findings Out of 300 men, 11 participated in the validation process and 68 in the survey. Among 47 women, 11 participated in the validation and 17 in the survey, with a 26.2 per cent (85/325) cumulative response rate. The questionnaire obtained a good concordance with a k-value=0.61 and 74.48 per cent of agreement and a high level of inter-correlations among items with α=0.8452. Half of the prisoners were overweight/obese and 68.6 per cent were smokers. Moreover, smoking habits were statistically associated with a low educational level, duration of conviction, body mass index and coffee consumption. Originality/value The results highlighted the need for an educational programme in prison. Detention period could be a good opportunity to promote healthy habits.

Introduction. Seasonal influenza epidemics represent a cost that affects companies in terms of sick leave and lost productivity, therefore vaccination can improve occupational health. The vaccination of Healthcare Workers (HCW) has a dual function because in addition to protecting the workers, it also protects the most fragile patients. The students of medical and nursing degree courses, as well as other health professions, attend the workplace daily and are similar to workers in Legislative Decree 81/08. The purpose of this research is to assess the prevalence of students who are in favor of the introduction of a mandatory vaccination for healthcare workers, and to investigate what factors predispose them to be favorable. Methods. We performed a multi-center cross-sectional study using a validated questionnaire in a sample of students from different university courses from October 10th, 2017 to September 30th, 2018. For qualitative variables, absolute and relative frequencies, and for categorical variables Pearson's Chi-square test (χ2) were calculated. A multivariable logistic regression model was used. Results. A total of 3131 questionnaires were completed by 2132 women and 999 men. The prevalence of students who are favorable to the introduction of a mandatory flu vaccination is 87.3% and that this data is linked to the female gender (aOR 1.52 CI 95% 1.12-2.06), being a medical student compared to nursing (aOR 2.14 CI 95% 1.45-3.17), coming from central Italy (aOR 3.08 CI 95% 2.11-4.51) and northern Italy (aOR 3.09 CI 95% 2.12-4.49) compared to Southern Italy and the Islands, wanting to get vaccinated for the next season (aOR 6.37 CI 95% 3.73-10.88), declaring to have a good/excellent level of knowledge on vaccine-preventable diseases (aOR 1.44 CI 95% 1.04-1.99), planning a recommendation based on ministerial indications (aOR 2.12 CI 95% 1.28-2.30) and having received requests for clarification on vaccinations (aOR 2.02 CI 95% 1.44-2.85). Discussion. The sample of university students showed to be largely in agreement with the introduction of mandatory vaccination for HCW, which is important for the prevention of influenza virus in the workplace. To increase adherence of healthcare workers to vaccination campaigns against seasonal influenza in the workplace, it is necessary that operative strategies are implemented with educational messages.Introduzione. le epidemie influenzali stagionali rappresentano un costo per le aziende in termini di congedi per malattia e perdita di produttività e la vaccinazione può migliorare nei luoghi di lavoro. La vaccinazione dei lavoratori nel settore sanitario ha una doppia funzione perché oltre a proteggere il lavoratore protegge anche i pazienti più fragili. Gli studenti dei corsi di laurea in medicina e infermieristica e altre professioni sanitarie frequentano i luoghi di lavoro e assimilati a lavoratori nel Decreto legislativo 81/08. Lo scopo di questa ricerca è valutare la prevalenza di studenti che sono favorevoli all’introduzione di un obbligo vaccinale per i professionisti sanitari e quali fattori li predispongono a essere favorevoli. Metodi. Abbiamo eseguito uno studio cross-sectional multicentrico utilizzando un questionario validato in un campione di studenti di corsi diversi nel periodo dal 10 ottobre 2017 e al 30 settembre 2018. Per le variabili qualitative, le frequenze assolute e relative e per le variabili categoriali è stato calcolato il test chi quadrato di Pearson (χ2). È stato utilizzato un modello di regressione logistica multivariabile. Risultati. 3131 questionari sono stati completati da 2132 donne e 999 uomini, la prevalenza degli studenti favorevoli all’introduzione di una vaccinazione antinfluenzale obbligatoria per i lavoratori è dell’87,3%. Questa predisposizione è legata al genere femminile (aOR 1,52 IC 95% 1,12-2,06), all’essere studente di medicina rispetto allo studente di scienze infermieristiche (aOR 2,14 IC 95% 1,45-3,17), all’essere dell’Italia Centrale (AOR 3.08 CI 95% 2.11-4.51) e Nord Italia (aOR 3.09 CI 95% 2.12-4.49) rispetto al Sud e alle Isole, al dichiarare di vaccinarsi per la prossima stagione (aOR 6.37 CI 95% 3.73-10.88),di avere un buon/eccellente livello di conoscenza delle malattie prevenibili con vaccino (aOR 1.44 CI 95% 1.04-1.99), di dare raccomandazione basate su indicazioni ministeriali (aOR 2.12 CI 95% 1.28-2.30), di aver ricevuto richieste di chiarimento sulle vaccinazioni (aOR 2.02 CI 95% 1.44-2.85). Discussione. Il campione di studenti universitari ha mostrato di essere in gran parte d’accordo con l’introduzione dell’obbligo di vaccinazione per i lavoratori nel settore sanitario, questo fatto è di buon auspicio per la prevenzione del virus dell’influenza sul posto di lavoro. Per aumentare l’aderenza alle campagne di vaccinazione contro l’influenza sul posto di lavoro degli operatori sanitari è necessario che le strategie operative siano implementate con messaggi educativi.

Depression is one of the leading causes of disability worldwide, with more than 264 million people affected. On average, depression first appears during the late teens to mid-20s as result of a complex interaction of social, psychological and biological factors. The aim of this systematic review with meta-analysis is to assess the association between red and processed meat intake and depression (both incident and prevalent). This systematic review was conducted according to the methods recommended by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant papers published through March 2020 were identified by searching the electronic databases MEDLINE, Embase and Scopus. All analyses were conducted using ProMeta3 software. A critical appraisal was conducted. Finally, 17 studies met the inclusion criteria. The overall effect size (ES) of depression for red and processed meat intake was 1.08 [(95% CI = 1.04; 1.12), p-value < 0.001], based on 241,738 participants. The results from our meta-analysis showed a significant association between red and processed meat intake and risk of depression. The presented synthesis will be useful for health professionals and policy makers to better consider the effect of diet on mental health status.

Background: Antineoplastic drugs (ANDs) are a broad group of chemicals showing, at the same time, carcinogenic effects. The potential, albeit true, risk of side effects cannot be accepted, especially if resulting from occupational exposure. The aim of this study was to evaluate the association between occupational exposure to ANDs and the extent of primary DNA damage in health professionals. Methods: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/Medline, Web of Science, and Scopus were used to perform the literature search. The databases were examined in July 2019. Sub-group, moderator, and cumulative analyses were conducted. The trim and fill method was used in the case of potential publication bias. Results: Twenty studies were included in the qualitative analysis, and 19 in quantitative evaluation. The pooled effect size was 1.27 [(95% confidence interval (CI) = 0.66–1.88), p = 0.000] based on 1569 subjects. The moderator analysis by duration of exposure showed a positive association between duration of exposure and primary DNA damage. Conclusions: This systematic review clearly shows a significant association between occupational exposure to ANDs and the extent of primary DNA damage in health professionals. Considering these results, health professionals should be warned against this potential occupational risk.

Background:Despite the free-of-charge offer of influenza vaccines to at-risk subgroups, vaccine coverage remains low and far from the target, probably due to the false myths and misperceptions. We aimed to explore the healthcare students’ vaccination behavior and beliefs to find any association between vaccination uptake during the last 5 years and future vaccination acceptance.Study design:A multicentre cross-sectional study.Methods:From Oct 2017 to Nov 2018, the Italian healthcare students from 14 different universities in 2017/2018 were enrolled, through an online and anonymous questionnaire previously validated. Absolute and relative frequencies were calculated and Pearson's Chi-square test was used. A multinomial logistic regression model was performed. Results are expressed as relative Risk Ratio (RR) with 95% Confidence Intervals (95% CI). The level of significance chosen was P-value Results:A total of 3137 students were enrolled and 3131 questionnaires were analysed. 82.7% of the sample declared they had not received any flu vaccination during the last 5 years. Students who received flu vaccination 4 times or more during the last 5 years were more likely to do it again next year as well (95.1% vs 4.9%). The regression model showed that having received flu vaccination over the last 5 years was statistically associated with the intention of getting vaccinated during next season.Conclusions:Frequency of flu vaccination is predictive for future acceptance among healthcare students. This association could have both implications for the organization of vaccination campaigns and improve educational strategies for this category of students.

The role of vaccination in reducing the incidence, morbidity and mortality of vaccine preventable diseases is well-known; however, vaccination uptake for some vaccine-preventable diseases remains low among Italian healthcare workers. The aim of this study was to evaluate knowledge attitudes and practice regarding mandatory vaccinations among Italian health science university students.A multi-center study was conducted in 14 Italian universities. A standardized, previously validated and anonymous questionnaire consisting of 21 questions was administered to health science students. The students were informed on the questionnaire during a Hygiene and Preventive Medicine lesson of their degree course, so they were asked to fill it out. A multivariable logistic regression model was used, the results are expressed as adjusted Odds Ratio (aOR).A total of 3131 students completed the questionnaire, of whom 90% were found to be in agreement with the introduction of a mandatory vaccination law for children and 87% with the potential introduction of mandatory vaccination for health care workers. Having an insufficient/sufficient/fair level of knowledge related to vaccine preventable diseases and vaccinations, compared with having a good/excellent level of knowledge, was associated with being less supportive towards the mandatory childhood vaccination law (OR 0,64; IC 95% 0.44-0.93).We found that having good/excellent knowledge regarding vaccine preventable diseases and their related vaccinations is associated in a statistically significant manner to the propensity towards supporting mandatory vaccinations. This is probably due to a greater awareness of the importance of immunization and its value.

The burden of pancreatic cancer varies greatly across countries, with the number of deaths, incident cases, and disability-adjusted life years more than doubling in recent years, and with high-income countries having the highest incidence and mortality rates. We conducted this systematic review with meta-analysis with the goal of summarizing the current evidence on dietary fiber intake and its role in reducing the risk of pancreatic cancer, given the importance of identifying risk factors. This systematic review followed the guidelines of the Cochrane Collaboration and the Meta-analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. The structured literature search was conducted on PubMed/Medline and Scopus, combining free text words and medical subject headings. Our review contained 18 records at the end of the process. Our results show that dietary fiber intake reduces the risk of pancreatic cancer. When the analysis was differentiated according to the type of fiber considered, sub-grouped by gender (reduction of around 60% among women), and when case-control studies were conducted, the strength of the association increased. Clinicians and policymakers should improve interventions to raise the population’s awareness regarding the consumption of high-fiber diets, both in practice and in terms of public health policy.

Much of the recent research in neoplasia has been focusing on the epigenetics of cancer cells, particularly as regards the search for potential molecular biomarkers that could be used for early diagnosis, effective treatment, and prognosis of several types of cancer. Carcinogenesis often starts with mutations in oncogenes and tumor suppressor genes, and it leads to anomalies in cellular processes as vital as cell cycle regulation and apoptosis. Because malignant changes arise as a result of genetic as well as epigenetic mechanisms, one possible means of intervention involves reprogramming gene expression, so as to-at least in part-revert the molecular alterations. DNA methylation and demethylation, acetylation and deacetylation of histones, and microRNAs are a few examples of the epigenetic mechanisms responsible for tumor development and progression. Many biologically active compounds present in food-including sulforaphane, curcumin, and epigallocatechin-have been found to modulate those processes. We here systematically review information on the effects of such bioactive dietary compounds on human breast cancer cell lines, and explore the mechanisms underlying those effects with a view to their potential therapeutic application.

Influenza is an infectious disease with a high burden, for which a safe and efficacy vaccine is available. However, vaccination coverage is generally low, also among Health Care Workers (HCW). Health Professions students are comparable to HCW in terms of workplace exposure.The study aim was to identify predictive factors of flu vaccination acceptance among Italian students of Health Professions.A cross-sectional study was performed using a validated, on-line, anonymous questionnaire. Data were analyzed performing both univariable and multivariable logistic analysis.The results showed a statistically significant association between intention to vaccinate next year and: geographical distribution, considering themselves at higher risk due to their profession, having been vaccinated last year, having recommended the vaccination last year, and being willing to recommend it next year and being favorable to mandatory vaccination. In conclusion, identifying an effective vaccination strategy and including students in flu vaccination campaigns might have positive effect on vaccination acceptance.

Violence in the workplace is now universally recognized as a significant global public health issue and is one of the most serious issues affecting the healthcare sector.To assess the prevalence of workplace violence.We performed a multicenter cross-sectional study using an anonymous questionnaire submitted to doctors from Northern Italy. The survey investigates socio-demographic information, the number of years of work in the health sector and the physical and verbal aggressions that occurred in the workplace in the last 12 months.The sample consists of 4545 healthcare workers, of whom 2603 (57.27%) are females. The mean age of the sample is 49.79 years (SD ± 12.63). The risk of being victim of physical aggression at work in the last 12 months is significantly associated with the following independent variables: male gender (aOR 2.09, 95% CI 1.51-2.88), work in the public sector (aOR 2.57, 95% CI 1.72-3.85), being victim of verbal aggression at work in the last 12 months (aOR 22.52, 95% CI 10.97-46.20), work in the operational units of the Medical area (aOR 2.36, 95% CI 1.33-4.21) and the Territorial area (aOR 1.97, 95% CI 1.04-3.74).The prevalence of violent behaviour is difficult to assess, because violent incidents are underreported or unreported. The results of the study suggest that increased awareness is necessary to develop effective control strategies at individual, hospital and national levels.

The aim of this systematic review and meta-analysis was to evaluate the association between dietary fibre intake and rectal cancer (RC) risk. In January 2019, a structured computer search on PubMed/Medline, Excerpta Medica dataBASE (EMBASE) and Scopus was performed for studies reporting the results of primary research evaluating dietary fibre intake in women and men as well as the risk of developing RC. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were followed. Highest vs. lowest fibre concentrations was compared. The Egger test was used to estimate publication bias. Heterogeneity between studies was evaluated with I2 statistics. The search strategy identified 912 papers, 22 of which were included in our meta-analysis. Having evaluated a total of 2,876,136 subjects, the results suggest a protective effect of dietary fibre intake on RC prevention. The effect Size (ES) was [0.77 (95% CI = 0.66−0.89), p-value = 0.001)]. Moderate statistical heterogeneity (Chi2 = 51.36, df = 21, I2 = 59.11%, p-value = 0.000) was found. However, no publication bias was found, as confirmed by Egger’s linear regression test (Intercept −0.21, t = −0.24, p = 0.816). The findings suggest that dietary fibre intake could be protective against RC, with a clinically relevant reduction of RC risk. Identifying preventive measures to avoid the development of RC, especially by following a healthy lifestyle including healthy diet, is pivotal.

he number of people travelling internationally increases year after year, mainly due to the more and more affordable cost of travelling and to the evergreater ease of transportation. Nowadays, any destination can be reached within 24 hours by plane, and the improvement of economic conditions facilitates both business and leisure travelling, as a matter of fact, according to data from the World Tourism Organization, the number of international trips is expected to increase by 3% to 4% per year.1 However, international travelling poses various health risks depending on travelers’ health conditions and the type of trip undertaken. Indeed, travelers may experience sudden changes in altitude, humidity, and temperature that can cause illness. Furthermore, serious health risks can result from poorquality housing, poor sanitary conditions, inadequate medical services, and the unavailability of drinking water. Potential risks strictly depend on the destination and the characteristics of the travel, and for this reason, anybody planning a trip should seek advice on the potential risks related to their destination and understand the protective measures needed to minimize the risk of contracting a disease. The risk of infection is linked to the epidemiology of the single country and to the different climatic conditions, which could expose travelers to etiological agents and vectors which are different from those which can be found in their countries of origin, but also to lower sanitary levels. Although doctors and tour operators can provide great help and good advice, it is crucial that travelers seek further information, understand the risks associated with travelling, and take the necessary precautions during their journey in order to travel safely. New technologies and application for smartphone (also known as app) might help more and more in promoting healthy behaviors.2 The greatest strength of health-related apps is that information is provided through channels already used by the citizen and perceived as “friendly.” Moreover, apps are a great way to communicate in “one-to-many” mode, in contrast to the standard “one-to-one” healthcare approach; this exponentially increases the quantity of educational content sent. Furthermore, by using the app, users produce new electronic data and make it available to researchers and policy makers, thus creating a new field of big-data-based research.3, 4 The aim of this study was to develop an applications for smartphones (“iViaggio: the travel app, traveling in safety”) (Figure 1), designed to provide information about the main risks associated with travelling, also taking into consideration the kind of trip (health risks related to environment, accidents, traumas, and violence, potential risks of infectious diseases).

PILATES study aims are to assess the main characteristics related to food habits, diet behaviors, and nutrition knowledge and how and where gym-goers get information on dietary supplementation. We present evidence for the reliability, feasibility, and construct validity of the PILATES questionnaire. Cohen's kappa statistic (k) for dichotomous variables was used to assess the agreement between the two administrations (interrater agreement). The nutrient composition and energy of food were derived from the Food Composition Database for Epidemiological Studies in Italy (Banca Dati di Composizione degli Alimenti per Studi Epidemiologici in Italia - BDA). Because of energy intake, waist circumference and weight are continuous variables; we calculate the agreement between the two interviews using Spearman's rho coefficient (nonparametric measure of rank correlation). An Italian 21-item self-administered questionnaire was designed and pretested on 28 students in food science and human nutrition at the University of Perugia who were enrolled on a voluntary basis. After verifying the feasibility of the questionnaire, pretest evaluation showed a generally high concordance with an 87.32% of agreement and k value = 0.71 ± 0.23. In addition, weight, daily energy intake, and waist circumference confirmed a statistically significant agreement (p

Introduction: DianaWeb is a community-based participatory project open to Italian breast cancer patients. The aim of the study was to assess the effectiveness of a lifestyle intervention in improving the prognosis after patients received diagnosis and surgery/chemotherapy. The DianaWeb study uses an interactive Web site (www.dianaweb.org) to monitor patients’ lifestyles, and to obtain clinical and anthropometric data. Although detailed instructions for measuring height, body weight, waist circumference, and blood pressure (BP) are provided, individuals might tend to overestimate or underestimate those parameters. The aims of the present study were: (1) to compare self-recorded data with those from standardized ambulatory measurements; (2) to determine the trueness of a subject classification in the overweight/obesity or hypertensive subgroup on the basis of the patients’ own measurements and estimates; and (3) to identify confounding variables. Patients and Methods: We compared self-reported with ambulatory measurements in a subgroup of 200 randomly selected women of approximately 1000 enrolled in the DianaWeb study (from September 2016 to March 2018). Results: Bland–Altman analysis showed a close agreement for self-reported and ambulatory-measured height, weight, and body mass index (BMI). On the contrary, women overestimated waist circumference and underestimated BP. Cohen κ statistics showed fair agreement only for hypertension. Binary logistic regression analysis showed that BMI and diastolic BP self-measurements were biased according to age. Conclusion: The results suggest that self-reported height, weight, and BMI are satisfactorily accurate for patients in the DianaWeb study, such as accuracies of overweight/obese and central obesity classification, and that these data can be useful for our research. We evaluated the validity of self-reported anthropometric measures in 200 women of approximately 1000 participating the DianaWeb study, a community-based participatory research offered to Italian breast cancer patients. Self-reported height, weight, and body mass index resulted to be satisfactorily accurate, and self-reported weight, height, and waist circumference were appropriate to estimate overweight/obese and central obesity in participants of the DianaWeb study.

Background and aim of the work: Since several years, Italy is facing an important flow of immigration. Umbria is not a region of disembarkation of refugees, nevertheless is one of the Italian regions with the highest rate of foreign population compared to the total resident population. Aim of this paper is to collect data on migrants and refugees’ health care services access, focusing on migrants’ characteristics arrived and living in Umbria. Methods: We conducted a retrospective cohort study at the Local Health Unit Umbria of Perugia, Italy. Descriptive analysis was performed in order to identify the characteristics of the migrants living in Perugia area. Data analysis was performed using Excel® software. All frequencies are expressed as percentage. Results: Between 2015-2017, 2,688 migrants came to Umbria Region. The mean age is 23.6 years, almost all are male, and however the majority of female comes from Nigeria. Only 25.5% of migrants durably sojourned in Umbria Region, and only half of them are residents and received the assignment of general practitioner. Conclusions: Unplanned migration may cause an abrupt rupture of the social-cultural supports that sustain both psychological and physical well-being. Regional Health Service should collect data on migrants and refugees’ health and their health care services access, in order to offer an efficient and appropriate regional health system. (www.actabiomedica.it)

Many studies have reported the occurrence of work-environment contamination by antineoplastic drugs (ANPD), with significant incorporation of trace amounts of these hazardous drugs in hospital personnel. Given the ability of most ANPD to actively bind DNA, thus inducing genotoxic effects, it is of pivotal importance to assess the degree of genotoxic damage (i.e., residual genotoxic risk) in occupationally exposed subjects. The lymphocyte cytokinesis-block micronucleus (L-CBMN) assay is largely used for biological effect monitoring in subjects occupationally exposed to ANPD. In this study, we identified and analyzed the studies published reporting the use of the L-CBMN assay as biomarker of genotoxic risk in health care workers exposed to ANPD with the aim of performing meta-analysis and providing a meta-estimate of the genotoxic effect of exposure. We retrieved 24 studies, published from 1988 to 2015, measuring MN in peripheral blood lymphocytes in health care workers occupationally exposed to ANPD. In 15 out of the 24 studies (62.5%), increased MN frequencies were recognized in exposed subjects as compared to controls. The meta-analysis of MN frequency of the combined studies confirmed an association between occupational exposure to ANPD and cytogenetic effects with an overall meta-estimate of 1.67 [95% CI: 1.41-1.98]. In 16 out of the 24 studies (66.6%) at least one other genotoxicity biomarker, besides L-CBMN assay, was employed for biological effect monitoring. In several studies the effect of exposure to ANPD was evaluated also in terms of MN in exfoliated buccal cells. Other studies focused on genotoxicity endpoints, such as sister chromatid exchanges (3 studies), chromosome aberrations (6 studies), or primary DNA damage investigated by comet assay (7 studies). Overall, there was good agreement between other genotoxicity tests employed and L-CBMN assay outcomes.

Depression is a major contributor to the overall global burden of disease, with high prevalence and relapse rate. Several factors have been considered in order to reduce the depression burden. Among them, physical activity (PA) showed a potential protective role. However, evidence is contrasting probably because of the differences in PA measurement. The aim of this systematic review with meta-analysis is to assess the association between objectively measured PA and incident and prevalent depression. The systematic review was conducted according to methods recommended by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant papers published through 31 August 2019 were identified searching through the electronic databases PubMed/MEDLINE, Excerpta Medica dataBASE (Embase), PsycINFO, Scopus, Web of Science (WoS), and the Cochrane Library. All analyses were conducted using ProMeta3. Finally, 42 studies met inclusion criteria. The overall Effect size (ES) of depression for the highest vs. the lowest level of PA was −1.16 [(95% CI = −1.41; −0.91), p-value < 0.001] based on 37,408 participants. The results of the meta-analysis showed a potential protective effect of PA on prevalent and incident depression.

Communication in health is an emerging and constantly evolving topic, taking more and more new aspects and concepts over time. The objective of this work is to present, through a narrative review, the most important aspects of communication in health field. Communication in health traditionally is known as interpersonal communication between health care workers and patients. In reality, it also includes the community one with the population (e.g., through the media), as well as with users of health service (e.g., complaint management). Moreover, it promotes both social responsibility and citizen's empowerment because communication directs the institutions, the third sector and the profit companies towards the values of social cohesion and sustainable development. Adequate communication strategies can contribute to reduce the environmental, cultural and socio-economic barriers that hinder the knowledge and the conscious adoption of behaviours that promote health.

Vaccines are an important tool to prevent communicable diseases. Despite their importance, vaccines seem to be victims of their own success and declining levels of vaccination uptake have been recorded in Europe and Italy. For this reason, Italy introduced a new mandatory vaccination law on July 31, 2017. We aimed to validate a questionnaire to assess the opinions and knowledge of Public Health residents about this issue.A team of public health residents developed a questionnaire and validated it by administering it to a panel of 10 Public Health residents, members of the Vaccines and Vaccine Hesitancy Working Group of the Public Health residents Assembly of the Italian Society of Hygiene and Preventive Medicine. Cronbach's Alpha and Cohen's Kappa tests were used to analyse results.The final version of the questionnaire consisted in 23 items. The validation process showed a high level of internal consistency (alpha=0,82). The tests showed a relevant level of agreement (k= 0,75 ± 0,07). Finally, the feasibility test pointed out that 80% of respondents declared the questions were clear and easy to understand.The designed questionnaire is a valid and useful tool.

Colorectal cancer is the third most common cancer worldwide. Growing evidence shows that about 47% of cases of colorectal cancer can be prevented by a healthy lifestyle. We performed a systematic review and meta-analysis aimed to evaluate the association between dietary fibre intake and the risk of colon cancer. We performed a structured computer search on PubMed, including epidemiological studies reporting results of dietary fibre intake and risk of colon cancer in women or men. We compared subjects exposed to the highest versus the lowest consumption. The search strategy identified 376 papers. After screening, 25 datasets were included in our meta-analysis. Results suggest a protective role of dietary fibre intake on colon cancer risk ES = 0.74 (95% CI = 0.67–0.82), p value = .000, but, moderate statistical heterogeneity (χ2 = 42.73, p value = .011) was found. Due to the high mortality of colorectal cancer, it is important to identify effective preventive measures, especially those of a healthy lifestyle, such as a healthy diet.

Breast cancer (BC) is the most common cancer in women and several factors are involved in its onset. Green tea (GT) has been shown to have potential beneficial effects on different types of cancer. The aim of this review was to evaluate the association between GT regular consumption and risk of BC in women. The risk of BC recurrence and risk of BC in relation to menopausal status were also evaluated. A literature search of PubMed, Scopus, and Web of Science was conducted. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to perform the systematic review and meta-analysis. Full texts were downloaded for 40 studies; however, only 13 records were included in the meta-analysis. Eight were cohort studies and five were case-control studies. The pooled sample consisted of 163,810 people. An inverse statistically significant relationship between GT and BC risk, with an Odds Ratio (OR) = 0.85 ((95% CI = 0.80⁻0.92), p = 0.000)), was found. Egger’s linear regression test did not show a potential publication bias (intercept 0.33, t = 0.40, p = 0.695), which was also confirmed by the symmetry of the funnel plot. Moreover, no high statistical heterogeneity (Chi2 = 31.55, df = 13, I2 = 58.79%, p = 0.003) was found. The results of this meta-analysis showed a potential protective effect of GT consumption on BC, especially for BC recurrence.

Vaccines recommendations are available for both healthcare professionals and the general public, but although the vaccination is the most effective method to prevent infectious diseases, the coverage is still behind the recommended rate. In Italy, according to a recent study, the anti-flu vaccination rate among healthcare worker range between 9% to 30%. The aim of our study was to identify knowledge, attitude and behaviours regarding influenza vaccination among community pharmacists in order to increase the coverage rate among healthcare professional. “PErCEIVE (Pharmacist pERCEption on Influenza VaccinE) in Umbria” was a cross sectional survey among community pharmacists in Umbria conducted between 16th November 2015 to 29th February 2016. The questionnaire was anonymous, on-line self-administered survey.Statistical analysis were performed using STATA/SE 12 software. The response rate was 28.91% (n= 72/249). Among the studied population 76.39% (n=55) had never performed influenza vaccine during the previous 5 years. Regarding source of information, only 15.28% of the subjects (n=11) consulted the scientific publications, vs 52.78% (n=38) who did not show any kind of interest upon the influenza vaccine. Our results show a low attitude to be vaccinated among pharmacists together with a low grade of awareness regarding the important role that pharmacists might play in order to reduce influenza burden, to promote health literacy among their patients and to decrease the risk of patients infection. Pharmacists might be crucial healthcare workers involved in health promotion, in vaccines’ uptake and practices progression., Journal of Preventive Medicine and Hygiene, Vol 59, No 1 (2018): 2018591