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BACKGROUND Health literacy is widely recognised as an important social determinant of health, although it is difficult to measure it at national, regional and local level. OBJECTIVE This study aims to measure the level of health information literacy in a sample of elderly people living in the city of Pescara (Central Italy). Besides, the level of health information literacy, as an integral part of health literacy, was checked among the people surveyed. METHODS The study was conducted through a questionnaire during an eye screening in a cohort of elderly people in 2017. The targeted audience included 595 individuals (60 and over years of age); 414 questionnaires were eligible for examination. The questionnaire was organised into two sections, the first one was set up by the authors of this paper, whilst the second one was based on the European Health Literacy Survey (HLS-EU). RESULTS Data collected refer to the number of respondents per question, as a matter of fact not all surveyed people (414) answered to each question. Most respondents (283 out of 411) were women (69 %). The sample revealed low education level: only 9% had a degree and/or post-doc; 25% had a high school diploma, 39% attended only primary school and 27% junior high school. The family doctor was the preferred source to get information from, Internet was the less used source (22%, 91 out of 414). Most participants sought information in Italian. As regards the subject of information retrieved, the answers collected (90) highlighted that the majority of respondents looked for information on diseases in general (94%), on therapies (77%), on nutrition issues (74%), and on diagnosis (69%). A good percentage looks for information on drugs (50%) and on health facilities (44%). Most of them also declared that they easily understand what their practitioner says. Besides, they claimed they did not find any difficulty in understanding medicines’ labels and drug prescriptions, or to cope with other health conditions. CONCLUSIONS This survey addressed a homogeneous group of elderly people living in a small area of Central Italy. Most respondents declared to address family and/or specialist doctors for health information, and just a minor percentage (22%) also declared they surf the Internet, mainly through search engines, claiming to be rather satisfied with results without questioning their reliability. Most respondents declared to have an easy access and understanding of health information. Yet the study results showed that respondents were not aware of that information overload requires critical skills in order to select trusted and updated medical information. Health information literacy is difficult to measure; this survey shows the need of further investigation and the use of standardised measuring tools. It is also fundamental to promote corrective strategies, like prescription of information (Information RX) or creation of quality health portals in native languages (e.g. ISSalute) and to offer professional support (patient’s libraries or information points) for improving health literacy levels.

What do we already know about this subject? • Chronic pain can have negative effects on quality of life. It is associated with a reduced ability to work, quality of life and disability, conditions that should be treated in specialized pain management clinics. In Italy very little information on clinical outcomes after chronic pain treatments is provided. What does our study add to the already existing information • This study is the first to provide clinical data about the impact of chronic pain in terms of quality of life and disability on patients who attended pain management clinics in Italy. • Chronic pain has a negative impact on quality of life and disability and causes presenteeism. • Statistical significant results in pain management do not often correspond to best results in clinical settings

Evidence has recently emerged on the influence of gender on the immune system. In this systematic review and meta-analysis of phase III randomized clinical trials (RCTs), we explored the impact of gender on survival in patients with advanced cancer treated with immune checkpoint inhibitors (ICIs). We performed a comprehensive search of the literature updated to April 2018, including the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE. We extracted data on study characteristics and risk of bias in duplicate. Of 423 unique citations, 21 RCTs were included, inherently to 12,635 patients. Both males and females showed reduced risk of death associated with ICIs use (HR 0.73, p &lt, 0.001 and HR 0.77, p &lt, 0.001, respectively). Subgroup analyses by specific ICI showed similar OS in both genders for anti-PD-1/PDL-1. Anti-CTLA-4 use was associated with longer OS in men only (HR 0.77, p &lt, 0.012), with the exception of melanoma (in women, HR 0.80, p = 0.006). PFS was longer in men than in women (HR 0.67, p &lt, 0.001 and HR 0.77, p = 0.100, respectively). Conclusively, ICIs use was associated with more favorable outcomes in men, particularly for anti-CTLA-4 agents. In melanoma, not gender-related factors may influence the anti-tumor immune response evoked by ICIs.

Background Malignant gliomas are the most common primary brain tumors in adults and challenging cancers for diagnosis and treatment. They remain a disease for which non-invasive, diagnostic and/or prognostic novel biomarkers are highly desirable. Altered microRNA (miRNA) profiles have been observed in tumor tissues and biological fluids. To date only a small set of circulating/serum miRNA is found to be differentially expressed in brain tumors compared to normal controls. Here a restricted signature of circulating/serum miRNA including miR-15b*,-23a, −99a, −125b, −133a, −150*, −197, −340, −497, −548b-5p and let-7c were investigated as potential non-invasive biomarkers in the diagnosis of glioma patients. Methods Serum and tissues miRNAs expression in patients with brain cancers (n = 30) and healthy controls (n = 15) were detected by quantitative real-time polymerase chain reaction (qRT-PCR). Relative expression was calculated using the comparative Ct method. Statistical significance (p ≤ 0,05) was determined using the Mann–Whitney rank sum and Fisher’s exact test. Diagnostic accuracy of miRNAs in distinguishing glioblastoma multiforme (GBM) from lower grade cancer was assessed by the Receiver Operating Characteristic (ROC) curve analysis. To validate the role of the identified miRNAs in cancer a comprehensive literature search was conducted using PubMed, Web of Science (Core Collection) and Scopus databases. Results We observed a decrease of miR-497 and miR-125b serum levels depending on tumor stages with reduced level in GBM than lower grade tumors. The ROC curve analysis distinguishing GBM from lower grade cases yielded an area under the curve (AUC) of 0.87 (95 % confidence interval (CI) = 0.712–1) and of 0.75 (95 % CI = 0.533–0.967) for miR-497 and -125b, respectively. GBM patients are more likely to show a miR-497 and -125b down-regulation than the lower grade group (p = 0.002 and p = 0.024, respectively). These results were subsequently compared with evidence from 19 studies included in the final systematic review. Conclusions Although multiple biomarkers are currently leveraged in the clinic to detect specific cancer types, no such standard blood biomolecules are used as yet in gliomas. Our data suggest that serum miR-497 and -125b could be a novel diagnostic markers with good perspectives for future clinical applications in patients with glioma.

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Background: In recent years there has been a proliferation of cancer information available for patients in the Italian language. However, quantity without validation and organization is by no means synonymous with providing good information and a good service. Furthermore, the lack of coordination and cooperation between the various information-providing initiatives results in uncontrolled waste. Materials and methods: To impose order on the vast ocean of cancer information in Italian, and to provide patients with a reliable and comprehensive tool, the Azalea Project was developed whereby a database of information for patients was created. Paper-based and electronic information is validated and stored so that patients can search and retrieve it. Validation is by means of a grid drawn up by the project team with reference to international standards. Results: The nucleus of the database constructed by the Centro di Riferimento Oncologico (Oncology Referral Centre), Aviano, was extended using the wide experience of the Italian Cancer Institutes within the Italian Alliance Against Cancer. The website is at http://www.azaleaweb.it Conclusions: Meetings and courses specially designed for the project enabled evaluation grids to be created and permitted a fruitful interchange of skills and experience from a variety of professional information providers united in the common aim of providing patients with a service that meets their needs and puts them in control at a difficult time in their lives.

Background The paper intends to help scientific authors to make the best choice of journals in which to publish, by describing and comparing journal features in the area of oncology. For this purpose, the authors identified impact factor (IF) ranking, cost options and copyright conditions offered to authors wishing to publish in full open access (OA), subscription-based or hybrid journals. Methods Data referring to articles published in 2010 by three Italian research institutions (National Institute of Health – Rome (ISS), Regina Elena National Cancer Institute – Rome (IRE), National Cancer Institute – Milan (INT) in journals (78) managed according to different business models, all listed in the Journal Citation Reports, subject category Oncology, were collected and analysed. The journals surveyed were ranked according to IF, position in quartiles, publication charges, usage rights in published articles, self-archiving conditions in OAI-compliant repositories digital archives. Results Almost half (34) the journals surveyed were included in the first quartile, thus revealing authors’ preference for journals with a high IF. The prevalent journal business model was the hybrid formula (based on subscriptions but also offering a paid OA option) with 51 journals, followed by subscription-based only journals accounting for 22, while just 5 full OA journals were identified. In general, no relationship was found between IF and article publication charges, in terms of correspondence between more expensive fees and higher IF. Conclusions The issue of OA journals as compared with traditional subscription-based journals is highly debated among stakeholders: library administrators facing financial restrictions, authors seeking to locate the best outlet for their research, publishers wishing to increase their revenues by offering journals with wider appeal. Against this background, factors such as the quest for alternatives to high-cost business models, investments in setting up institutional repositories hosting the published versions of articles and efforts to overcome copyright barriers and gain free access to scientific literature are all crucial.

Background The Open Archive Initiative (OAI) refers to a movement started around the '90s to guarantee free access to scientific information by removing the barriers to research results, especially those related to the ever increasing journal subscription prices. This new paradigm has reshaped the scholarly communication system and is closely connected to the build up of institutional repositories (IRs) conceived to the benefit of scientists and research bodies as a means to keep possession of their own literary production. The IRs are high-value tools which permit authors to gain visibility by enabling rapid access to scientific material (not only publications) thus increasing impact (citation rate) and permitting a multidimensional assessment of research findings. Methods A survey was conducted in March 2010 to mainly explore the managing system in use for archiving the research finding adopted by the Italian Scientific Institutes for Research, Hospitalization and Health Care (IRCCS) of the oncology area within the Italian National Health Service (Servizio Sanitario Nazionale, SSN). They were asked to respond to a questionnaire intended to collect data about institutional archives, metadata formats and posting of full-text documents. The enquiry concerned also the perceived role of the institutional repository DSpace ISS, built up by the Istituto Superiore di Sanità (ISS) and based on a XML scheme for encoding metadata. Such a repository aims at acting as a unique reference point for the biomedical information produced by the Italian research institutions. An in-depth analysis has also been performed on the collection of information material addressed to patients produced by the institutions surveyed. Results The survey respondents were 6 out of 9. The results reveal the use of different practices and standard among the institutions concerning: the type of documentation collected, the software adopted, the use and format of metadata and the conditions of accessibility to the IRs. Conclusions The Italian r esearch institutions in the field of oncology are moving the first steps towards the philosophy of OA. The main effort should be the implementation of common procedures also in order to connect scientific publications to researchers curricula. In this framework, an important effort is represented by the project of ISS aimed to set a common interface able to allow migration of data from partner institutions to the OA compliant repository DSpace ISS.

For centuries the physician’s main attitude towards patients was one of examining with cold scientific determination ever smaller parts of the human body, without considering the patient as a person. Nowadays the patient is considered as a whole, psyche and body together, in a developing relation with the environment and other beings. Historically, this approach is in accordance with the holistic Hippocratic view that man cannot be considered only as a sum of anatomical parts. Because the patient is no longer a passive object of studies and therapies the relationship between physician and patient has changed accordingly. In the 70s, the prevailing attitude of the phycisian towards the seriously ill patients was to conceal the truth. Gradually modified to the opposite, there is today a growing concern towards the patient’s rights to information according to his/her potentiality to understand it.

In 1971 the National Cancer Act assigned NCI the task of collecting, analyzing, and disseminating all data useful in the prevention, diagnosis, and treatment of cancer, including the establishment of an International Cancer Research Data Bank to collect, catalogue, store, and disseminate, insofar as feasible, the results of cancer research undertaken in any country for the use of any person involved in cancer research in any country.“ [1]