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Manuela Chiavarini,1 Giulia Naldini,2 Irene Giacchetta,2 Roberto Fabiani3 1Department of Medicine and Surgery, Section of Public Health, University of Perugia, Perugia, Italy; 2School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy; 3Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, ItalyCorrespondence: Irene Giacchetta, University of Perugia, Tel +39 3515225514, Email irene.giacchetta@gmail.com; irene.giacchetta@studenti.unipg.it View the original paper by Dr Sun and colleagues

Several studies suggested a negative association between olive oil (OO) consumption and the risk of several chronic diseases. However, an attempt to systematically search, organize, and evaluate the existing evidence on all health outcomes associated with OO consumption is lacking. The objective of this review is to describe the multiple health outcomes associated with OO consumption. The Medline, Scopus, and Web of Science databases were searched through 5 April 2024. The selected studies met all of the following criteria: (1) a meta-analysis of both observational (case-control and cohort studies) and interventional studies (trials), (2) an evaluation of the association between OO consumption, mortality, and/or the incidence of non-communicable/chronic degenerative diseases, and (3) a study population ≥18 years old. Two independent reviewers extracted the relevant data and assessed the risk of bias of individual studies. The PRISMA statement and guidelines for the Integration of Evidence from Multiple Meta-Analyses were followed. The literature search identified 723 articles. After selection, 31 articles were included in this umbrella review. The primary health benefits of OO were observed in cardiovascular diseases and risk factors, cancer, mortality, diabetes, and specific biomarkers related to anthropometric status and inflammation. As a key component of the Mediterranean diet, OO can be considered a healthy dietary choice for improving positive health outcomes.

Introduction: Non-italian citizens experienced less access to anti-COVID-19 vaccination, compared to the native population. Literature has found differences in adherence to anti-COVID-19 vaccination among these groups; however, there are apparently no studies that investigated the role of citizenship. Our objective was to investigate the role of citizenship in vaccine hesitancy toward anti-COVID-19 vaccination and the completion of vaccine cycle, in the non-Italian citizens resident in the Umbria Region., Study Design: This is a population study, performed on resident population in Umbria., Methods: Population data were obtained thanks to a record linkage between the Regional Health Information System and the regional DBCOVID Umbria database. On this dataset, a descriptive and logistic regression analyses were performed., Results: The 19.2% of non-Italian citizens did not take even one dose, 2.1% did not complete it and 40.6% did not take the additional dose. The range of values of which these results are an average, however, is very wide, suggesting important differences in COVID-19 vaccine up taking, among different citizenships. The logistic regression shows that citizenships with the highest probability of non-adherence to vaccination, compared to Philippine, was Romanian (OR=7.8), followed by Macedonian (OR=7.3) and Polish (OR=5.9)., Conclusions: The study provides evidence of differences among citizenships that pinpoint the importance of understanding the reasons behind these behaviours, to support decisions around health policies tailored to each citizenship.

Competing Interests: Competing interests: None declared.

Lung cancer is a leading cause of death with nearly 1.8 million deaths estimated worldwide in 2020. Although benzene is classified as a human carcinogen (Group 1) on the basis of its association with acute myeloid/non-lymphocytic leukaemia, there is still limited evidence that it may influence lung cancer risk. This study examined the potential link between benzene exposure and risk of lung cancer using a systematic review of epidemiological studies and meta-analysis. We searched through PubMed, Web of Science and Scopus databases up to 10 February 2023 to identify all articles on the association between benzene exposure and lung cancer (incidence or prevalence) and/or mortality. We extracted the risk estimates of the highest and the lowest reported categories of benzene exposure and conducted a meta-analysis using a random-effects model. Heterogeneity and publication bias were analysed using an I 2 test and funnel plots asymmetry, respectively. Twenty-one studies were included in the final analysis, with a total of 10,750 lung cancer cases and 2899 lung cancer deaths. Overall, risk estimates of lung cancer prevalence and mortality in association with benzene exposure were 1.20 ( n = 14; 95% CI 1.05-1.37) and 1.15 ( n = 13; 95% CI 1.02-1.30), respectively. In all cases, heterogeneity was quite large, while no significant publication bias was observed. When only studies that adjusted for smoking habit were selected, the risk for lung cancer increased by up to 34% ( n = 9; 95% CI 1.10-1.64). Our data, which show a strong association between benzene exposure and lung cancer risk, may have important public health implications. However, further studies are needed to identify the lung cancer risk associated with benzene exposure considering different smoking conditions., Competing Interests: The authors declare no conflicts of interest.

Background: Incidence rates of thyroid cancer have increased. Recent studies findings suggest that women who underwent a hysterectomy have an elevated relative risk of thyroid cancer. The aim of our meta-analysis is to summarize the evidence about the association between hysterectomy and thyroid cancer risk., Methods: PubMed, Web of Science, and Scopus database were searched for studies published up to 5 September 2023. The PRISMA statement was followed. Heterogeneity was explored with Q statistic and the I2 statistic. Publication bias was assessed with Begg's and Egger's tests., Results: Sixteen studies met the criteria. The pooled analysis showed a significantly 64% increment of thyroid cancer risk in association with any hysterectomy (OR 1.64, 95% CI 1.48-1.81; I2 = 28.68%, p  = 0.156). Hysterectomy without oophorectomy was a stronger predictor of risk than hysterectomy with oophorectomy. The pooled analysis of data regarding hysterectomy without oophorectomy showed a statistically significant increment of thyroid cancer risk by 59%. Hysterectomy with oophorectomy was associated with an increase of thyroid cancer risk of 39% (OR 1.39, 95% CI 1.16-1.67; I2 = 42.10%, p  = 0.049). Significant publication bias was not detected., Conclusions: Our findings help with decision making around these surgeries., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Socio-demographic factors are responsible for health inequalities also in vaccination. The aim of this study was to evaluate their role at the population level through a population-based study performed on the whole population entitled to receive COVID-19 vaccines in the Umbria Region, Italy, and registered to the Regional Healthcare Service as of 28 February 2021. Socio-demographic characteristics and vaccination status in terms of uptake of at least one dose of any available vaccine, completion of the primary vaccination cycle and uptake of the booster doses as of 28 February 2022 were collected from the Umbria regional database. The percentage of eligible population who did not initiate the COVID-19 vaccination, complete the full vaccination cycle and get the booster dose was 11.8%, 1.2% and 21.5%, respectively. A younger age, being a non-Italian citizen, and not holding an exemption for chronic disease/disability and a GP/FP were associated with all the endpoints. Females, as compared to males, were more likely to not initiate the vaccination but less likely to not receive the booster dose. On the contrary, the findings did not show a significant association between the deprivation index and the vaccine uptake. The findings, beyond confirming current knowledge at the population level, provide new inputs for better tailoring vaccination campaigns.

Context: Overweight/obesity is one of the most important health problems. Birth by cesarean section has been shown to influence long-term health outcomes including obesity., Objective: The aim of this systematic review-meta-analysis is to update acknowledgment of the increased risk of cesarean section on offspring's overweight/obesity., Methods: This study follows the PRISMA guidelines. A systematic literature search was conducted on Scopus, PubMed, and Web of Science; we have selected all the articles published until January 2, 2022. For inclusion, studies must have reported either (i) both birth by cesarean section and adult (≥18 years) offspring's body mass index; (ii) cohort or case-control study design; and (iii) a risk estimate. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by the Egger test and the Begg test. Meta-analysis was performed through a random-effects model., Results: Twelve studies with a combined population of 180 065 subjects were included in the meta-analysis. The overall analysis (N = 19) yielded a combined risk estimate for overweight/obesity of 1.19 (95% CI, 1.08-1.30) and the test of heterogeneity resulted into Q = 57.44 ( I2 = 68.67%, P ≤ .001). The risk of offspring obesity is 1.23 (95% CI, 1.09-1.39) and the test of heterogeneity resulted into Q = 39.55 ( I2 = 69.66%, P ≤ .001). Children born by cesarean section have an increased risk of obesity in adulthood., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Vaccine hesitancy is a major public health issue and a challenge for the implementation of COVID-19 immunization campaigns. The objective of this study was to address the determinants of COVID-19 vaccination acceptance or hesitancy in the Italian population., Materials and Methods: We conducted a rapid systematic review by searching PubMed until May 3rd, 2022, according to Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Articles assessing determinants of Italians' attitudes towards COVID-19 vaccination in terms of hesitancy and/or acceptance were considered eligible. Quality and risk of bias assessment was performed through the Newcastle Ottawa Scale appraisal tool. Determinants were grouped in three categories: contextual, individual and group, and vaccine/vaccination specific influences., Results: Out of 606 articles, 59 studies were included in the analysis. Included studies demonstrated that, in Italy, COVID-19 vaccination acceptance or hesitancy is mostly influenced by perceived safety, efficacy and usefulness of the vaccine., Conclusion: These findings should be considered to plan tailored interventions for counteracting COVID-19 vaccination hesitancy in Italy.

The influence of exogenous female hormones on the risk of developing malignant melanoma in women remains controversial. The aim of our review and meta-analysis is to summarize the evidence and derive a more accurate estimation of the association between oral contraceptives (OCs) or menopausal hormone therapy (MHT) and the risk of developing malignant melanoma in women. PubMed, Web of Science, and Scopus database were searched for studies published up until October 2021. The PRISMA statement and MOOSE guidelines were followed. Studies were pooled using a random effects model. Heterogeneity was explored with the chi-square-based Cochran's Q statistic and the I 2 statistic. Publication bias was assessed with Begg's test and Egger's test. Forty-six studies met the eligibility criteria. The pooled analysis (26 studies) on OC use and the risk of developing cutaneous malignant melanoma (CMM) showed no significant association, but demonstrated significant association for cohort studies (OR 1.08, 95% CI 1.01-1.16; I 2 = 0.00%, p = 0.544). The pooled analysis (16 studies) showed a significantly increased risk of CMM in association with MHT (OR 1.15, 95% CI 1.08-1.23; I 2 = 25.32%, p = 0.169). Stratifying the results by study design showed that a significant increased risk of CMM was associated with MHT in the cohort studies (OR 1.12; 95% CI 1.04-1.19; I 2 = 0%, p = 0.467). No significant publication bias could be detected. Further studies are needed to investigate the potential association with formulation, duration of use, and dosage of use, and to better understand the role of possible confounders.

Background: The elderly, commonly defined as subjects aged ≥65 years, are among the at-risk subjects recommended for annual influenza vaccination in European countries. Currently, two new vaccines are available for this population: the MF59-adjuvanted quadrivalent influenza vaccine (aQIV) and the high-dose quadrivalent influenza vaccine (hdQIV). Their multidimensional assessment might maximize the results in terms of achievable health benefits. Therefore, we carried out a Health Technology Assessment (HTA) of the aQIV by adopting a multidisciplinary policy-oriented approach to evaluate clinical, economic, organizational, and ethical implications for the Italian elderly., Methods: A HTA was conducted in 2020 to analyze influenza burden; characteristics, efficacy, and safety of aQIV and other available vaccines for the elderly; cost-effectiveness of aQIV; and related organizational and ethical implications. Comprehensive literature reviews/analyses were performed, and a transmission model was developed in order to address the above issues., Results: In Italy, the influenza burden on the elderly is high and from 77.7% to 96.1% of influenza-related deaths occur in the elderly. All available vaccines are effective and safe; however, aQIV, such as the adjuvanted trivalent influenza vaccine (aTIV), has proved more immunogenic and effective in the elderly. From the third payer's perspective, but also from the societal one, the use of aQIV in comparison with egg-based standard QIV (eQIV) in the elderly population is cost-effective. The appropriateness of the use of available vaccines as well as citizens' knowledge and attitudes remain a challenge for a successful vaccination campaign., Conclusions: The results of this project provide decision-makers with important evidence on the aQIV and support with scientific evidence on the appropriate use of vaccines in the elderly.

Objectives: To provide a new value-based immunization approach collating the available scientific evidence on the topic., Methods: Four value pillars (personal, allocative, technical, and societal) applied to vaccination field were investigated. A systematic literature review was performed querying three database from December 24th, 2010 to May 27th, 2020. It included studies on vaccine-preventable diseases (VPDs) that mentioned the term value in any part and which were conducted in advanced economies. An in-depth analysis was performed on studies addressing value as key element., Results: Overall, 107 studies were considered. Approximately half of the studies addressed value as a key element but in most of cases (83.3%) only a single pillar was assessed. Furthermore, the majority of papers addressed the technical value by looking only at classical methods for economic assessment of vaccinations whereas very few dealt with societal and allocative pillars., Conclusions: Estimating the vaccinations value is very complex, even though their usefulness is certain. The assessment of the whole value of vaccines and vaccinations is still limited to some domains and should encompass the wider impact on economic growth and societies., Competing Interests: GEC, EC, AT, IG, EB, MM, and CdW received a fee by VIHTALI (Value in Health Technology and Academy for Leadership & Innovation, Spin-Off of Università Cattolica del Sacro Cuore, Rome, Italy) for the scientific activities of the project entitled “The value (s) of vaccination: building the scientific evidence according to a Value-Based Healthcare approach.” WR was not paid for his time by him. The project was funded by MSD. The funders had no role in the design of the study, the collection, analysis and interpretation of data, or the writing of the manuscript., (Copyright © 2022 Calabro', Carini, Tognetto, Giacchetta, Bonanno, Mariani, Ricciardi and de Waure.)

Reliable country-specific data on influenza burden play a crucial role in informing prevention and control measures. Our purpose was to provide a comprehensive summary of the available evidence on the burden of seasonal influenza in Italy. We performed a systematic literature review of articles published until July 31, 2020. PubMed, Embase, and Web of Science were searched using terms related to burden, influenza, and Italian population. We included studies investigating seasonal influenza-related complications, hospitalizations, and/or mortality. Sixteen studies were included: eight (50%) analyzed influenza-related complications, eight (50%) hospitalizations, and seven (43.8%) influenza-related deaths. Only three studies (19.7%) concerned pediatric age. The synthesis of results showed that patients with chronic conditions have an increased risk for complications up to almost three times as compared with healthy people. Hospitalizations due to influenza can occur in as much as 5% of infected people depending on the study setting. Excess deaths rates were over sixfold higher in the elderly as compared with the rest of population. Although there are still gaps in existing data, there is evidence of the significant burden that influenza places each year especially on high-risk groups. These data should be used to inform public health decision-making., (© 2021 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Background: Nowadays minimal residual disease (MRD) and log-reduction of leukemic cells are poorly investigated in elderly patients with acute myeloid leukemia (AML) treated with hypometilating agents (HMAs). Studies focusing on MRD in elderly AML patients who received HMAs are scant and devoid of rigorous criteria for both enrollment and monitoring. Log-reduction has never been investigated in these patients. Thus, the purpose of our study was to compare the prognostic impact of MRD and log-reduction of leukemic cells at the optimal time of assessment in older AML patients., Methods: Elderly patients who completed at least six cycles of HMAs and showed suitable leukemia-associated immunophenotypes (LAIPs) for the MRD and log-reduction assessment by flow cytometry were enrolled in the study., Results: After comparing the times of assessment C4 (4-cycles) and C6 (6-cycles), C6 has been chosen as optimal. Patients who achieved MRD negativity or 2-log-reduction of leukemic cells at C6 had a significantly longer DFS. Particularly, results of 2-log-reduction were confirmed a multivariate analysis. Patients with MRD negativity or 2-log reduction of leukemic cells showed an improvement of their OS, although not significantly., Conclusions: Our data confirmed the predictive role of MRD and 2-log reduction also in older AML patients treated with HMAs., (© 2021 International Clinical Cytometry Society.)