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Background: A large number of individuals around the world consider themselves to be vegetarians for many individual reasons, and the vegetarian diet appears very heterogeneous. The prevalence of vegetarianism varies widely around the world. Objective: This paper examined the variables associated with the non-consumption of meat and valued trends in the plant-based diet among Italian adults in relation to the level of self-perceived health in this category of people in 4 years (2013-2016). Method: Data were drawn from the survey “Aspects of daily life” conducted by the ISTAT (Istituto Nazionale di Statistica). We considered the data of the 2013-2016 editions to evaluate the trend and attitude of the Italian population towards the non-consumption of meat during 4 years and assessed trends in the plant-based diet among Italian adults in relation to the level of self-perceived health. Results: The results showed an increasing trend from 2013 to 2016. In statistical analysis, vegetarian status was associated to under the age of 45, having a high level of education, being mainly separated or divorced, being resident in the North-West regions, and with a poor self-perceived state of health. Furthermore, vegetarians had shown healthier lifestyles and lower risk factors for non-communicable diseases than non-vegetarians. Conclusion: The results suggest that despite perceiving a worse health status, the long-term health of vegetarians is good and may be better than that of comparable non-vegetarians for some conditions and diseases, such as Obesity and IHD. As for all types of diet, well-designed health educational interventions conveying information on correct eating behavior may significantly contribute to increasing the degree of perceived health. conclusion: The results suggest that despite perceiving a worse health status, the long-term health of vegetarians is good, and may be better than that of comparable non-vegetarians for some conditions and diseases such as obesity and IHD. other: As for all types of diet, well-designed health educational interventions conveying information on correct eating behavior may significantly contribute to increasing the degree of perceived health.

Background: Several socioeconomic conditions may influence subjects’ adherence to healthy eating habits. Food consumption may be influenced by external stress during crisis periods; however, the effects of these events on food habits are difficult to predict. Also, a pandemic crisis like the recent COVID-19 pandemic may have influenced dietary habits and food consumption. The objective of this study was to compare dietary habits in Italian people one year before the COVID-19 pandemic with those belonging to the year 2020 in a nationwide population sample. Materials and methods: Information on dietary habits has been obtained from the multi-purpose survey on families “Aspects of daily life”, carried out in Italy by the Italian National Statistics Institute (ISTAT). We analyzed data coming from 2016 and 2020 editions of the survey (43000 subjects each year). We used population attributable factor (PAF) adjusted for age, defined as the proportional reduction in unhealthy diet that would occur if all participants had had a higher education, assuming higher educated individuals as more socially advantaged. Prevalence association for each dietary exposition has been calculated through logistic regression. Results: both men and women show high prevalence of unhealthy dietary habits. Regarding men, excessive consumption of eggs, pork meat, and bovine meat is characterized by a PAF attributable to socioeconomic conditions to an extent greater than 30%. Women show the same trend. During COVID-19 pandemic men and women show unhealthy profiles of food consumption since men increased consumption of eggs, cooked fats, snacks, sweets, and reduced consumption of fruits and vegetables. Both sexes registered an increase in overweight and obese subjects in 2020. Conclusions: To our knowledge, this study is the first in our country to use a validate yearly questionnaire to analyze dietary habits looking at single kind of different foods at nationwide level and to put in relationship these habits with COVID-19 pandemic. Our results show unbalanced dietary habits of Italian population. Socioeconomic differences influence food choices but in a complex way. Outside stressors like a crisis period as COVID-19 pandemic seem to have an important role in both men and women regarding assumption of so-called “junk food”.

Background Simulation has been recognized as a shift in health care education that can improve skills and patient safety and outcomes. High-fidelity simulation of critical medical situations can be a source of stress among participants that can interferes with students' abilities leading to unexpected emotional response. In the current study, we sought to evaluate stress responses during a session including a high-fidelity simulation dedicated to the management of an emergency and one performing a complex technique such as spinal tap, in a population of medical students during a session including high-fidelity simulation (HF) dedicated to the management of an emergency and one performing a complex technique such as spinal tap (ST). Methods A quasi-experimental before-after study was used including the administration of questionnaires before and after simulation, and biomarkers evaluation by salivary cortisol samples. A total of 148 students 148 were eligible and agreed to participate in the study. We used paired T-test for mean comparison regarding State-trait anxiety for both HF and ST simulations. For NASA-TLX we performed a T-test mean comparison between groups. We used paired T-test mean comparison for cortisol analysis in the HF simulation. Multivariable linear regression has been used to assess variables associated with AUCg Results values of State-Trait Anxiety Inventory scores were relatively higher at the end of the HF and ST simulation sessions. NASA task load index (NASA-TLX) was significantly higher at baseline for the high fidelity simulations, with respect to the ST simulation. Regarding HF simulation, a T-test for paired samples showed a statically significant difference between cortisol levels at 10 minutes after the start of the training and after 30 minutes from the simulation in both groups. Fold increase was similar in the two groups. Linear regression showed that cortisol AUCg was related to the STAI-Y score in both groups. Conclusions This work highlights how our students developed a stress response, testified by psychological and biological outputs more related to their personal attitude rather than complexity of simulated scenario. More studies are needed to confirm this trend and to clarify the role of simulated stress response in a long-term learning scenario.

Nitric oxide (NO) produced in the oral cavity is a powerful resource for the human body, especially when NO-syntethase production is not adequate. The role of oral microbiome in determining blood pressure levels has been linked to the active role of some bacterial species involved in the nitro-reducing process. In the present study we investigated the correlation between selected oral microbiome characteristics, nitric oxide (NO) concentration in saliva and their association with hypertension.A case-control study including 48 (25 normotensive and 23 hypertensive subjects), subjects between 50 and 70 years old, was carried out at the dental clinic of an Italian teaching hospital. Characteristics of participants have been evaluated by means of a physical examination, and by an assisted interview. A real-time polymerase chain reaction in samples of saliva and plaque was used to detect Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Tannerella forsythia, Porphyromonas gingivalis, Treponema denticola, Streptococcus mutans, Streptococcus sanguinis, Veillonella dispar and Neisseria subflava as well as total bacterial count. Nitric oxide in saliva was evaluated by the ELISA method.Normotensive subjects, compared with hypertensive subjects, had significantly higher concentration of NO (165.77 ± 61.7 vs 57.49 ± 19.61 μmol/l; p = 0.023), and higher bacterial concentration of the supragingival plaque (4.73E+07 ± 4.33+07 vs 4.02E+07 ± 4.00+07; p = 0.024). Bacterial species, usually associated to good oral health status, such as Neisseria subflava, were significantly more present in normotensive subjects than in hypertensive ones (9090.88 ± 5481.49 vs 4791.35 ± 4349.37; p 0.001). considering the concentration of bacteria as a biomarker of the development of hypertension.The results support the association between hypertension, oral microbiome and salivary nitric oxide, in fact do the results allow us to establish any biomarkers (microbial or biochemical, NO) that allow early therapeutic intervention.

A retrospective study of the epidemiology of vancomycin-resistant enterococci (VRE) in a regional hospital of central Italy in 2001–2018 demonstrated an increased VRE prevalence since 2016. A total of 113 VRE isolates, 89 E. faecium (VREfm) and 24 E. faecalis (VREfs), were collected in the study period. All strains showed high-level resistance to vancomycin; 107 also showed teicoplanin resistance. Altogether, 84 VREfm and 20 VREfs carried vanA, whereas 5 VREfm and 1 VREfs carried vanB. MLST analysis documented that 89 VREfm isolates mainly belonged to ST78, ST80, and ST117. Most strains were isolated from 2001 to 2007, ST78 being the predominant clone. VREfm re-emerged in 2016 with a prevalence of the ST80 lineage. Most VREfs were isolated from 2001 to 2006; although they belonged to 7 different STs, there was a prevalence of ST88 and ST6. Notably, ST88 was sporadically recovered throughout the study period. The increasing rate of VREfm isolation from 2016 to 2018 may be related to the influx of new successful clones and to the renewed and widespread use of vancomycin. Improved infection control measures in hospital wards should be adopted to limit the spread of new epidemic VRE strains.

Hypothalamo-pituitary-adrenal axis activity and cortisol patterns are likely to play a role in shift work tolerance, i.e., ability to adapt to shift work without suffering stress-related consequences. Yet, the evidence is scanty. Here, salivary cortisol output during night shifts and leisure days was assessed in fast-forward rotating shift work nursing staff (

The emerging spread of carbapenemase-producing Enterobacterales (CPE) strains, in particular, Klebsiella pneumoniae and Escherichia coli, has become a significant threat to hospitalized patients. Carbapenemase genes are frequently located on plasmids than can be exchanged among clonal strains, increasing the antibiotic resistance rate. The aim of this study was to determine the prevalence of CPE in patients upon their admission and to analyze selected associated factors. An investigation of the antibiotic resistance and genetic features of circulating CPE was carried out. Phenotypic tests and molecular typing were performed on 48 carbapenemase-producing strains of K. pneumoniae and E. coli collected from rectal swabs of adult patients. Carbapenem-resistance was confirmed by PCR detection of resistance genes. All strains were analyzed by PCR-based replicon typing (PBRT) and multilocus sequence typing (MLST) was performed on a representative isolate of each PBRT profile. More than 50% of the strains were found to be multidrug-resistant, and the blaKPC gene was detected in all the isolates with the exception of an E. coli strain. A multireplicon status was observed, and the most prevalent profile was FIIK, FIB KQ (33%). MLST analysis revealed the prevalence of sequence type 512 (ST512). This study highlights the importance of screening patients upon their admission to limit the spread of CRE in hospitals.

Background Obesity is an independent risk factor for developing flu-related complications. Objective The aim of this study was to analyze influenza vaccine uptake (VU) in the Italian obese, before and after the introduction of obesity among the national recommendations, and to evaluate factors associated to VU. Methods The comparison of two editions of the national survey carried out in 2004–2005, before the inclusion of obese people among the specific high risk categories for flu complications, and in 2013, reaching a sample of 21,857 persons who declared to have a BMI > 30. Multilevel logistic regression was used to evaluate potential independent predictors of influenza immunization. Results Influenza vaccination coverage was 27.16% in 2013, versus 31.61% in 2005. A significant reduction of VU was registered after the introduction of obesity among the high risk conditions, for which flu VU was recommended. Regression modeling, both in adults and in older people, confirmed that barriers to VU in 2013 were younger age, medium level of education, absence of chronic disease, smoking habit, and reporting no contacts with GPs during the previous 12 months. Among those aged 65 or more, the role of regional policies was associated to VU. Conclusions Immunization rates among young obese population are low, especially if not affected by comorbidities. Moreover, a reduction was registered in 2013 with respect to 2005. Flu vaccine uptake among the older population seems to be influenced by regional vaccination strategies. The development of novel strategy is warranted, especially among the young adults.

Catheter-associated urinary tract infections (CAUTIs) are the most common cause of hospital-acquired infections, especially in elderly patients. Data on CAUTIs in older persons in acute care settings are lacking, however. This study aimed to describe the epidemiology of CAUTIs and related outcomes (ie, length of stay and mortality), in patients admitted to an acute geriatric care hospital in central Italy.A CAUTI surveillance program was implemented from October 2011 to April 2012, according to the Centers for Disease Control and Prevention's National Healthcare Safety Network methodology.A total of 2773 patients aged ≥65 years were included in the study, and 483 catheterized patients were monitored for the risk of CAUTI. The catheterization rate was 16.7% (95% confidence interval [CI], 15.3%-18.2%), and the overall CAUTI incidence rate was 14.7/1000 device-days (95% CI, 11.7-18.3/1000). Mortality was significantly higher in catheterized patients with a CAUTI compared with noncatheterized patients (19.2% vs 10.5%; P.05). Female sex (odds ratio [OR], 1.31; 95% CI, 1.06-1.67), increasing age (≥90 years: OR, 2.76; 95% CI, 2.00-3.83), and longer hospital stay before catheter insertion (≥15 days: OR, 2.90; 95% CI, 2.20-3.83) were independent risk factors for catheterization; increasing age (90 years: OR, 2.75; 95% CI, 1.03-7.35), and duration of hospital stay before catheter insertion (OR, 2.41; 95% CI, 1.12-5.51) were associated with CAUTIs.These results underscore the importance of the proper choice of patients for catheterization, particularly in individuals aged90 years.

Quitting smoking has several health benefits, including an improvement in health-related quality of life. It is not well established if there is a relationship between the age when people stop smoking and health-related quality of life in older adults. The primary aim was to investigate the relationship between health-related quality of life and the age when people quit smoking in a national representative sample of community-dwelling older Italian adults. The secondary aim was to describe the characteristics of older former smokers according to their age when they stopped smoking. Data were drawn from the “Health and use of health care in Italy”, a national cross-sectional survey (2004–2005). Seven thousand five hundred and sixty-two former smokers, aged 65 years and older, were evaluated by age of smoking cessation. Socio-demographic characteristics, physical activity, the 12-Item Short-Form Health Survey (SF-12) score and its physical (PCS-12) and mental (MCS-12) component summary scores, disability and comorbidities were analyzed. Educational level, marital status and area of residence were associated with a different age of smoking cessation, as a higher level of disability and comorbidity. PCS-12 (β −0.144; p

Objectives: To investigate the prevalence of obesity among different types of employment status in the Italian working population, and to examine associated risk factors. Material and Methods: Cross-sectional survey of 36 814 people that declared to have been occupied with the same type of contract for at least 5 years was analyzed. Multivariable logistic regression models were built considering workers’ sex, age, education, family body mass index (BMI) category, leisure time and occupational physical activity, weight control habits, smoking habit, use of drugs, number of working hours per week, and type of working contract. Results: After adjusting for covariates, the importance of temporary-employment was confirmed by multivariate analysis, with odds ratio (OR) = 1.32 for obesity (95% confidence interval (CI): 1.07–1.63) with respect to employed persons; the association was even more important in workers occupied for more than 40 h/week (OR = 1.69, 95% CI: 1.07–2.66); moreover, shiftwork was confirmed as a risk factor for obesity in workers (OR = 1.06, 95% CI: 0.94–1.2). Dealing with different occupational group, some categories were associated with obesity; in particular, this phenomenon involved people employed in agriculture (OR = 1.44, 95% CI: 1.22–1.7), transportation (OR = 1.53, 95% CI: 1.26–1.85), and public administration (OR = 1.31, 95% CI: 1.1–1.55). Conclusions: Our analysis suggest that obesity is strongly correlated with temporary employment. Maybe the way out this pathway to obesity in the future might be working better, choosing organizational flexibility rather than fixed term. Int J Occup Med Environ Health 2016;29(6):903–914

Introduction Complementary and Alternative Medicine (CAM) is attracting attention within the context of health care provision in western countries. Patterns of CAM use and related satisfaction were analysed in Italy according to socio-demographic and health variables. Materials and methods 104,544 individuals (aged > 18) were interviewed by the cross-sectional ISTAT survey on “Health status of the population and use of health services” (2004–2005). CAM use and related satisfaction were evaluated by bivariate analysis and logistic regression models. Results 14.4% ( n = 14,963) of sample used at least one CAM typology in the three years before the interview; manual treatments were the most widespread (7.6%), followed by homeopathy (7.0%), herbal medicine (4.1%), and acupuncture (2.1%). Factors associated with CAM use included gender, age, educational level, social class and area of residence: use was more frequent among women, middle-aged, highly educated and upper-middle class persons, living in Northern Italy. People with chronic diseases used CAM more frequently. Most CAM users reported complete satisfaction (60.6% acupuncture; 69.2% herbal medicine; 70.8% homeopathy; 77.8% manual treatments), with high satisfaction also among subjects with chronic conditions. A higher education level predicted satisfaction more than social class while refusing to combine conventional medicine and CAM was the strongest determinants of complete satisfaction. Conclusion One out of seven adult Italians had used CAM the last three years. Users are mainly highly educated persons, belonging to the upper social class, and people affected by chronic conditions. Levels of self-rated satisfaction are generally high, both in the absence and in the presence of chronic diseases.

Introduction Qi-gong, a mind–body practice combining meditation, physical movement and controlled breathing, is reported to improve psychological well-being and physical function in older adults. However, the effects of Qi-gong on hypothalamic–pituitary–adrenal (HPA) axis activity and reactivity to stress in older people are elusive. An uncontrolled, before-and-after study in a group of healthy older adults was conducted to investigate the possible benefits of 12-week Qi-gong training on self-rated distress symptoms and cortisol secretion under basal and stimulated conditions. Methods Before (T0) and after (Tf) Qi-gong training, participants ( n = 28), men and women, mean age 65 years;(smokers, obese subjects, persons with chronic diseases and oral pathologies, and subjects reporting major stressful events in their recent past were excluded) answered the PSS-10 questionnaire. Salivary samples were collected for cortisol detection at various times of the day during a challenging mental task. Results Qi-gong training reduced basal cortisol output across the day, notably in the morning. In subjects who responded to the stressor at T0 ( n = 16, baseline-to-peak increment >1.5 nmol/l), cortisol response to cognitive challenge was markedly blunted after training, accompanied by a decreasing trend of PSS-10 score. Conclusion Qi-gong practice in elderly people appears to improve control on HPA axis activity, reducing daytime cortisol levels and attenuating cortisol responses to mental stress. Ameliorating the profile of basal and stimulated HPA activity, may reflect better adaptation to stress, and may favor successful aging and positive health outcomes. Present findings encourage the implementation of programs aimed at further disseminating Qi-gong practice among the older population.

Context Meditation is proposed as an anti-stress practice lowering allostatic load and promoting well-being, with brief formats providing some of the benefits of longer interventions. Objectives PsychoNeuroEndocrinoImmunology-based meditation (PNEIMED) combines the teaching of philosophy and practice of Buddhist meditation with a grounding in human physiology from a systemic and integrative perspective. We evaluated the effects of four-day PNEIMED training (30h) on subjective and objective indices of stress in healthy adults. Design A non-randomized, controlled, before-and-after study was conducted. Participants ( n = 125, mostly health practitioners) answered a questionnaire rating stress symptom before (T0) and after (Tf) a PNEIMED course. In an additional sample ( n = 40; smokers, overweight persons, women taking contraceptives, and subjects with oral pathologies were excluded), divided into PNEIMED-attending (intervention, n = 21) and non-meditating (control, n = 19) groups, salivary cortisol was measured upon awakening and during a challenging mental task. Results Self-rated distress scores were highly reduced after the PNEIMED course. In the intervention group, improvement of psychological well-being was accompanied by decrease in cortisol levels at awakening. No T0-vs-Tf changes in distress scores and morning cortisol were found in controls. Based on baseline-to-peak increment of cortisol response at T0, 26 subjects ( n = 13 for each group) were classified as task-responders. The amplitude and duration of the cortisol response decreased after PNEIMED, whereas no effects were found in controls. Conclusions Brief PNEIMED training yields immediate benefits, reducing distress symptoms and adrenocortical activity under basal and stimulated conditions. PNEIMED may represent an effective practice to manage stress and anxiety, particularly among subjects facing a multitude of job-related stressors, such as healthcare workers.

Besides objective efficacy, the choice between an antiseptic-based liquid soap, or an alcohol-based hand rub for surgical hand preparation technique is based on personal preference. Glycerol is often added to the formulations in order to enhance tolerability; however, it has been recently reported as a factor reducing the sustained effect of surgical hand rubs.To compare the efficacies of three commercial products for hand decontamination.The in vivo efficacy of an alcohol-based hand rub (isopropyl alcohol 40%; N-propyl alcohol 25%; glycerin 1.74%; triethanolamine salt of carbomer1%) was compared with other widely used products in surgical hand antisepsis (chlorhexidine and povidone-iodine). All products were used according to the manufacturers' instructions.The best results were achieved with the alcohol-based hand rub and these were sustained for a period of 3h. Some volunteers experienced skin peeling off the hands when using alcohol-based hand rub; in this group of participants, the bacterial count was reduced only by 0.91 ± 1.67 log10 compared with 2.86 ± 1.22 log10 in the group who did not show this phenomenon.Besides confirming the importance of alcohol-based hand rubs for surgical hand decontamination, the results suggest the value of assessing the characteristics, and response of healthcare workers' skin, that may contribute to the development of skin peeling, and the subsequent possibility of a paradoxical overcolonization of hands after surgical preparation with alcohol-based hand rub.

Behavioral distress and dysfunctions of hypothalamic-pituitary-adrenocortical (HPA) axis play a central role in alcohol abuse. Omega-3 fatty acids are proposed as having antistress, regulatory effects on HPA responsiveness, but a possible protective role in ethanol addiction is unexplored.A randomized, doubleblind, placebo-controlled trial was performed in male alcoholics undergoing residential rehabilitation program, to evaluate the effects of 3-week supplementation with fish-oil providing eicosapentaenoic (60 mg/day) and docosahexaenoic acid (252 mg/day) on perceived stress/anxiety and HPA activity, assessed by measuring saliva basal cortisol levels at various daytimes (0730 h, 1130 h, 1600 h, 2000 h, and 2400 h) and the acute cortisol response to Trier Social Stress Test.Results showed that in supplemented subjects, before versus after decrease of stress/anxiety ratings was accompanied by reduction of cortisol basal levels throughout the day; no changes were observed in placebo group. At the end of intervention, amplitude, and duration of stress-evoked cortisol response did not differ between groups; however, the peak of cortisol response was temporally anticipated in supplemented subjects. In conclusion, an elevated omega-3 intake may reduce distress symptoms and basal cortisol secretion in abstinent alcoholics, thus providing a valid subsidiary measure to increase the efficacy of rehabilitation programs in ethanol addicts.

Aims: To evaluate the nutritional status and the impact of an educational intervention on nutritional behaviour in alcohol-dependent patients. Methods: A pre-and post-intervention questionnaire and a follow-up interview were administered to 58 patients of a residential alcohol treatment service. Results: Females were at lower risk of being overweight than males, even after adjusting for amount and preferred type of alcohol beverage. Before intervention, 19% consumed 3 meals/day. Following the edu- cational intervention, 22.2% of participants improved their knowledge. After 6 months, when 45 patients agreed to a telephone inter- view of whom 80% reported continued abstinence, 70.7% reported eating more than 3 meals/day. Conclusions: Nutritional behaviour of alcohol patients after residential treatments improved during follow-up, and it is possible that an educational interven- tion to increase knowledge on healthy nutrition style may have contributed.