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This study was funded by the Compagnia di San Paolo, the Cariplo Foundation and the European Commission (grant number 801520 HP-JA-2017, Innovative Partnership for Action Against Cancer, iPAAC Joint Action). The sources of the funding played no role in designing the study, collecting, analyzing, or interpreting the data, writing the report, or deciding whether or not to submit the article for publication. This research was (partially) funded by Italian Ministry of Health "Ricerca Corrente" funds. Tyrosine kinase inhibitors (TKIs) have been improving the prognosis of patients with chronic myeloid leukemia (CML), but there are still large differences in survival among European countries. This raises questions on the added value of results from population-based studies, which use real-world data, compared to results of randomized controlled trials (RCTs) involving patients with CML. There are also questions about the extent of the findings on RCTs effectiveness for patients in the general population. We compare survival data extracted from our previous systematic review and meta-analysis of CML RCTs with the latest updated population-based survival data of EUROCARE-6, the widest collaborative study on cancer survival in Europe. The EUROCARE-6 CML survival estimated in patients (15-64 years) diagnosed in 2000-2006 vs. 2007-2013 revealed that the prognostic improvement highlighted by RCTs was confirmed in real-world settings, too. The study shows, evaluating for the first time all European regions, that the optimal outcome figures obtained in controlled settings for CML are also achievable (and indeed achieved) in real-world settings with prompt introduction of TKIs in daily clinical practice. However, some differences still persist, particularly in Eastern European countries, where overall survival values are lower than elsewhere, probably due to a delayed introduction of TKIs. Our results suggest an insufficient adoption of adequate protocols in daily clinical practice in those countries where CML survival values remain lower in real life than the values obtained in RCTs. New high-resolution population-based studies may help to identify failures in the clinical pathways followed there.

ObjectiveThe impact of a screening programme on colorectal cancer (CRC) incidence in its target population depends on several variables, including coverage with invitations, participation rate, positivity rate of the screening test, compliance with an invitation to second-level assessment and endoscopists’ sensitivity. We propose a synthetic indicator that may account for all the variables influencing the potential impact of a screening programme on CRC incidence.DesignWe defined the ‘rate of advanced adenoma on the target population’ (AA-TAP) as the rate of patients who received a diagnosis of advanced adenoma within a screening programme, divided by the programme target population. We computed the AA-TAP for the CRC Italian screening programmes (biennial faecal immunochemical test, target population 50–69 year olds) using the data of the Italian National Survey from 2003 to 2016, overall and by region, and assessed the association between AA-TAP and CRC incidence fitting a linear regression between the trend of regional CRC incidence rates in 50–74 year old subjects and the cumulative AA-TAP.ResultsIn 2016, the AA-TAP at a national level was 105×100 000, whereas significant differences were observed between the northern and central regions (respectively 126 and 149×100 000) and the South and Islands (36×100 000). The cumulative AA-TAP from 2004 to 2012 was significantly correlated with the difference between CRC incidence rates in 2013–2014 and those in 2003–2004 (p=0.009).ConclusionThe AA-TAP summarises into a single indicator the potential impact of a screening programme in reducing CRC incidence rates.

In March 2020, when the Government imposed nation-wide lockdown measures to contrast the COVID-19 outbreak, the life of Italians suddenly changed. In order to evaluate the impact of lockdown on lifestyle habits and behavioral risk factors of the general adult population in Italy, we set up the Lost in Italy (LOckdown and lifeSTyles IN ITALY) project. Within this project, the online panel of Doxa was used to conduct a web-based cross-sectional study during the first phase of the lockdown, on a large representative sample of adults aged 18-74 years (N=6003). The self-administered questionnaire included information on lifestyle habits and perceived physical and mental health, through the use of validated scales. As we are working within the Lost in Italy project, we got two additional grants to further research on the medium-term impact of lockdown, a topic of great interest and with anticipated large socio-economic and public health implications. In details: we obtained by the AXA Research Fund support to evaluate the impact of COVID-19 lockdown on physical, mental, and social wellbeing of elderly and fragile populations in the Lombardy region, the area most heavily hit by the pandemic in the country. Moreover, as a fruitful integration, we obtained support by the Directorate General for Welfare of the region to assess health services delivery and access to healthcare in the same study population, combining an analysis of administrative databases with an economic analysis. We are confident that the solid background of our partners, the multi-disciplinary competencies they bring, together with appropriate funding and access to rich data sources will allow us to fulfill our research objectives. (www.actabiomedica.it)

Objective The incidence of colorectal cancer (CRC) declines among subjects aged 50 years and above. An opposite trend appears among younger adults. In Europe, data on CRC incidence among younger adults are lacking. We therefore aimed to analyse European trends in CRC incidence and mortality in subjects younger than 50 years. Design Data on age-related CRC incidence and mortality between 1990 and 2016 were retrieved from national and regional cancer registries. Trends were analysed by Joinpoint regression and expressed as annual percent change. Results We retrieved data on 143.7 million people aged 20–49 years from 20 European countries. Of them, 187 918 (0.13%) were diagnosed with CRC. On average, CRC incidence increased with 7.9% per year among subjects aged 20–29 years from 2004 to 2016. The increase in the age group of 30–39 years was 4.9% per year from 2005 to 2016, the increase in the age group of 40–49 years was 1.6% per year from 2004 to 2016. This increase started earliest in subjects aged 20–29 years, and 10–20 years later in those aged 30–39 and 40–49 years. This is consistent with an age-cohort phenomenon. Although in most European countries the CRC incidence had risen, some heterogeneity was found between countries. CRC mortality did not significantly change among the youngest adults, but decreased with 1.1%per year between 1990 and 2016 and 2.4% per year between 1990 and 2009 among those aged 30–39 years and 40–49 years, respectively. Conclusion CRC incidence rises among young adults in Europe. The cause for this trend needs to be elucidated. Clinicians should be aware of this trend. If the trend continues, screening guidelines may need to be reconsidered.

Introduction: Selective mutism (SM) is characterized by the persistent inability to speak in some specific contexts (i.e. school, home, social contexts) or within interaction with peer group and/or adults when a normal verbal linguistic competence may be expected, according to DSM5 criteria. The main sleep disorders in children with neurodevelopmental disorders are represented by difficulty in falling asleep at night (51%) and nocturnal awakenings (67%).The main goal of the present study is verify the putative relationship between sleep disorders and selective mutism in children.Materials and methods: 30 children were diagnosed with SM (13 males and 17 females) with mean age 9.47 (SD +/- 129). The case-control group was composed by 30 typically developing children (TDC) (12 males and 18 females) (mean age 8.95; SD +/- 2.01; p = 0238). All the subjects of both groups were recruited within the same urban area, Caucasian and homogeneous in socio-economic level. SDSC questionnaire was used in order to assess the sleep habits in both groups.Results: The two groups (SM and TDC) were similar for age and gender. About the presence of reported sleep disorders, SM children show a significantly higher prevalence of reported sleep troubles than TDC subjects (Graph 1).Conclusion: The present pilot restrospective case control-study has shown the presence of sleep disorders in children with SM. This new comorbidity has not been previously reported in clinical literature.

Nocturnal parasomnias are a group of sleep complex manifestation that don't alter the sleep macrostructure, but when persistent during adulthood may be assume violent aspects with relevant forensic implications about the guiltiness.

Eating and feeding disorders are common in pediatric age and may be important to discover and recover the early symptoms in order to optimize the treatment and management.

Background: Headache is the most common painful manifestation in the developmental age, often accompanied by severe disability such as scholastic absenteeism, low quality of academic performance and compromised emotional functioning. The aim of the study is to evaluate praxic abilities in a population of children without aural migraine. Materials and methods: The test population consists of 10 subjects without migraine without aura (MwA), (8 Males) (mean age 8.40, SD ± 1.17) and 11 healthy children (7 Males) (mean age 8.27; SD ± 1.10; p = 0.800). All subjects underwent evaluation of motor coordination skills through the Battery for Children Movement Assessment (M-ABC). Results: The two groups (10 MwA vs 11 Controls) were similar for age (8.40 ± 1.17 vs 8.27 ± 1.10; p = 0.800), sex (p = 0.730), and BMI (p = 0.204). The migraine subjects show an average worse performance than the Movement ABC; specifically, migraineurs show significantly higher total score values (31.00 ± 23.65 vs 4.72 ± 2.61; p = 0.001), manual dexterity (12.10 ± 11.20 vs 2.04 ± 2.65; p = 0.009) and balance (14.85 ± 10.08 vs. 1.04 ± 1.05; p

Pregnancy is a physiological state during which the woman's body undergoes profound modifications. During this time, every woman must be nourished in such a way as to maintain herself in good health and at the same time allow the fetal tissues to form and develop in the best way. Proper nutrition is one of the fundamental prerequisites for the normal evolution of both pregnancy and fetal growth: the quantity and quality of food and drinks must be scrupulously controlled. Contrariwise, it is important to avoid the excess calories and macronutrients. In fact, during pregnancy, it may be just as harmful as their shortage, especially in overweight and obese women, for which the risk of miscarriage, gestational diabetes, fetal growth disorders and preeclampsia increases. The pasta constitutes the foundation of the Mediterranean diet food. The dough can be seen, therefore, so it represents an excellent ally of the diet from a nutritional point of view. The nutritional values of the pasta change depending on the type, based on the fact that the dough is traditional or integral semolina. It also contains Vitamin B and has an abundance of minerals, among which potassium. The pasta is an easily digestible food, ensuring energy ready to use (such as all carbohydrates); moreover, it possesses a great satiating power. In case of overweight, however, it is possible to reduce the number of carbohydrates in the diet, taking care not to make them ever miss. In conclusion, the consumption of pasta is very important during pregnancy: a diet without carbohydrates can be dangerous for all physiological pathways.

Stuttering is a common language alteration in pediatric age consisting in repetitions and blocks, which entail a break in the rhythm and melody of the speech. According to the WHO it is a disorder of the rhythm of the word, the subject knows precisely what he would like to say, but at the same time he is not able to say it. It is a great inconvenience for those affected, also because the slowing down of speaking is not about thought or cognitive skills.

The sphincterial control problems in childhood are very common, with relevant comorbidities (i.e.: difficulty in academic performance, sleep disturbances, minor neurological signs) involved in the complex process of maturation and learning, such as to cause a great deal of discomfort and related disorders in affected subjects. Enuresis is characterized by the involuntary urination in the absence of a physical disorder, socially unacceptable in places and at one stage of life where such control is acquired by the majority of subjects (about 5 years). The present study aims to evaluate the visuospatial skills in children affected by primary monosymptomatic nocturnal enuresis (PMNE). 31 PMNE children (16 males and 15 females) (mean age 10.87, SD ± 1.68) and 61 healthy children (32 males, 29 females) (mean age 11.03, SD ± 1.85, p = 0687) were evaluated for visuomotor skills with the Visual-Motor Integration Scale (VMI). PMNE subjects show a worse performance on average to VMI, especially in the total visual-motor integration test. This finding emphasizes the importance of a framework for global and more complex than is commonly implemented, across the border but framing the subject of enuretic symptoms in a more global perspective.

In rehabilitative setting, the presence of animals can be considered as an important stimulus for verbal and social communication, and for mood regulation. Interaction with an animal is beneficial for children's development and numerous psychological tests have revealed that growing up with pets has a beneficial effect on children's self-esteem and self-confidence, can improve empathy, a sense of responsibility and cognitive development, as well as social status within the peer group.

Background: Migraine is a chronic, progressive, and debilitating disorder that has an impact on the lives of millions of individuals. The origins of the disability can be traced into childhood and adolescence for most adult migraine sufferers. The group of periodic syndromes consists in symptoms related to migraine, thought to be migraine equivalent or precursors. Aim of this study is to assess the role of MS as risk factors for childhood migraine. Materials and methods: 441 subjects (211 Females) aged 6-13 years (mean 9.20; SD 2.42), consecutively referred between October 2007 to March 2009 for primary headaches to pediatric Centers for Headache in Childhood. Control group consisted of 365 subjects (175 F) aged 7-13 years (mean 9.08; SD 3.02). Results: Two groups were not different for age (F=0.390; p=0.539) and sex ratio (Chi-square=0.002; p=0.966). Headache percentage distribution was the following: MoA 38.32%, MA 11.11%, FETTH 16.78%, CTTH 20.63%. Logistic regression shows a greater OR for CVS and MS associated for migraine group (MoA and MA patients), respectively 8.28 (IC95% 2.35 - 29.16) for CVS and 5.22 (IC95% 3.5 - 7.77); moreover, CVS cause a consistent increase in OR of 3.69 (IC95% 2.21 - 6.17) also for headache group (CTTH and FETTH patients). Discussion: Periodic syndromes could be considered the natural precursors of migraine almost but not only in children, as reported in some studies in adulthood.

The attachment theory was proposed and elaborated by John Bowlby. Over the last ten years the attachment theory has attracted considerable interest in the field of mental health as it emphasizes how relationships that are established in the earliest stages of development have an impact on man in an indefinable and lifelong manner.

The Dynamic-Maturation Model (DMM) was developed by Patricia Crittenden (1-4), which focused its studies on attachment to different ethnic, socio-cultural and dangers as families in which episodes of Maltreatment and abuse or families with high psychosocial risk. Crittenden proposes new protocols of the Strange Situation (SS) and the Adult Attachment Interview (AAI) based on a coding and classification system derived from the model proposed by Ainsworth, but modified and enriched with that of Main, Goldwyn and Hesse. The SS procedure, adopted for children aged between 10 and 18 months, is valid until all preschool age, assuming This way the name of the Preschool Assessment of Attachment (PAA).

The synactive theory of development may be considered the keyword for neurodevelopmental disorders, considering that each one presents constantly autonomic troubles such as sleep disorders, feeding problems.

this paper is based upon work from COST Action ICSHNet. Children's environmental health is on the 2030 Agenda for Sustainable Development. The incidence of childhood cancer is increasing worldwide and in Europe. Yet, the aetiology of most childhood cancers, including the role of environmental carcinogens, is still largely unknown. Contaminated areas, especially of industrial origin, are of high concern due to complex mix of hazardous pollutants and their potential health impacts on human populations, notably in children.to describe cancer risk in children and young adults (YA) residing in national priority contaminated sites (NPCSs) in Italy and to provide a suitable framework for a development of cancer surveillance in industrially contaminated sites (ICSs) in Europe.this study is based on a collaborative work of the Italian Institute of Health (ISS) and the Italian Association of Cancer Registries (AIRTUM), in the context of the SENTIERI project (Epidemiological study of residents in National Priority Contaminated Sites). Incidence rates were standardised according to the European standard population. The number of observed cases was compared to the expected cases derived from the age-, sex-, and cancer-specific incidence rates of the national pool of AIRTUM registries for the period 2006-2013. Standardized incidence ratios (SIRs) and 90% confidence intervals (CIs) were computed. The study reports the cancer profile in all combined 28 NPCSs covered by 22 cancer registries.1,050 cases of malignant tumours (MTs) were recorded among 3,161,786 person-years in people aged 0-29 years in 28 NPCSs (SIR: 1.03; 90%CI 0.98-1.09), with an age-standardised incidence rate of 317 per million. Excess risks were observed for: MT of the central nervous system in the age-group1 year (SIR: 3.2; 90%CI 1.4-6.3); soft tissue sarcoma in the age-group 0-14 years (SIR: 1.6; 90%CI 1.1-2.3); acute myeloid leukaemia in the agegroup 0-14 years (SIR: 1.7; 90%CI 1.1-2.4); non-Hodgkin lymphoma in the age-group 20-24 years (SIR 1.5; 90%CI 1.1-2.1), and germ cell tumours of male gonads in the age-group 20-29 years (SIR: 1.33; 90%CI 1.1-1.5). A deficit of cases was observed for Hodgkin lymphomas in the age-group 20-29 years (SIR 0.8; 90%CI 0.6-1.0).this study, which is based on standardized methods and accredited information sources, supports the hypothesis that living in an NPCS increases the risk of some cancer types in children and young adults. Further work will concern groups of NPCSs characterised by common sources of contamination/key carcinogenic pollutants. In fact, in a novel project proposal we aim to monitor the cancer profile in children living in ICSs in Europe. The new project, based on the SENTIERI-AIRTUM methodology, will build on the networking activities of the COST Action on Industrially Contaminated Sites and Health Networking (ICSHNet) and childhood cancer studies coordinated by the International Agency for research on Cancer (IARC).

Introduction: Autistic Spectrum Disorder (ASD) is a permanent and complex disability arising within the first three years of life characterized by a socio-communicative disorder and by fixed interests and repetitive behaviors. The present pilot study aims to evaluate behavioral aspects in a small population of siblings of ASD children. Material and methods: Population: 5 school-aged children (2 males, 3 females) (mean age 9.235 ± 2.041) were enrolled, as siblings of ASD children, and for comparison, 12 healthy (7 males, 5 females) children (average age 9,528 ± 3,351). All subjects underwent evaluation of the behavioral with Child Behavior Checklist (CBCL) scale. Results: The two groups were statistically comparable by age (p = 0.86) and gender distribution (p = 0.87). From the behavioral point of view evaluated with the CBCL scale, siblings of ASD have a higher degree of overall problem (Total problems) compared to control children (p=0.003), in addition they have significantly higher scores in the subscales of behavior examined (Anxious/Depressed, Withdrawn, Somatic Complaints, Social, Thought, Attention, Delinquent, Aggressive) as well as a greater share of disturbances both internalizing (p=0.004) and externalizing (p = 0.007) (Table 1). Conclusions: The present preliminary data confirm the need for a global management of the entire family structure for the correct management of Autistic Disorders.