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Aim: To catch a representative view of a multicultural population's needs. Design: Qualitative study. Methods: Semi‐structured interviews were conducted from July 2022 to January 2023 with the project's stakeholders, migrants, and residents. Data analysis was performed using a multimethod textual analysis technique. Findings: Territorial barriers, lack of social network, and specific professionals' training emerged as healthcare delivery obstacles. For migrants, language improvement emerged as a health priority. A deep relationship with migrants emerged as a deficiency for residents. Conclusion: A welcoming project equipped with solid leadership and the right resources can be fundamental in mediating health promotion and integration. In this process, the involvement of the resident population is essential. Implications for the Profession and/or Patient Care: Analysing the migrants' needs and the strengths and limitations of a reception system could help identify the challenges for professionals in delivering culturally competent care. In this context, the nurse's role becomes relevant, being responsible for taking charge and caring for the population and the link between professionals and the population. What Problem Did the Study Address?: The study addressed the problem of improving the overall health of migrants, refugees, and asylum seekers, mainly focusing on reception and integration into a new society process. What Were the Main Findings?: Worse health was identified with adaptation, integration, and family problems. Territorial barriers emerged, hindering good health. Where and on Whom Will the Research Have An Impact?: These research findings can be valuable for health professionals who want to improve the reception process and enhance a care model integrated with residents. Patient or Public Contribution: No patient or public contribution. Reporting Method: To describe the research report, we referred to the COREQ checklist (Tong et al., 2007). [ABSTRACT FROM AUTHOR]

Background. Our knowledge regarding the epidemiology of pediatric cardiomyopathy is based on large national population studies reporting an annual incidence of 1 case per 100,000 children, with a higher incidence observed in infancy and among selected populations. The aim here is to document the epidemiology of pediatric cardiomyopathy in a Mediterranean population. Methods. Children younger than 18 years of age living on the Mediterranean island of Crete, Greece, who have been evaluated since the establishment of tertiary pediatric cardiology services (2002–2022) were included in this retrospective study. Results. A total of 40 children were included, corresponding to an average annual incidence of pediatric cardiomyopathy of 1.59 cases (95% CI: 1.4–2.3) and a prevalence of 26 cases per 100,000 children. In decreasing order of frequency, most cases corresponded to dilated (50%), followed by hypertrophic (42.5%), arrhythmogenic (5%), and restrictive (2.5%) cardiomyopathy. An etiology was identified in 40%, including a genetic diagnosis in 22.5%. Conclusions. The incidence of pediatric cardiomyopathy in the Mediterranean island of Crete is higher compared with that reported previously for other Caucasian populations. Further study is needed to investigate the exact prevalence and specific genetic factors associated with the epidemiology of pediatric cardiomyopathy in Mediterranean populations. [ABSTRACT FROM AUTHOR]

School bullying and cyberbullying are serious public health problems that negatively affect the lives of school-aged children. We examined the correlation between risk behaviors and lack of resiliency factors with bullying and cyberbullying across seven Mediterranean countries. The sample consisted of 33,399 adolescents (51.1% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 in Greece, Israel, Italy, Macedonia, Malta, Portugal, and Spain. Bivariate logistic regressions were conducted to test the relationship between risk behaviors, resilience, and bullying. All risk behaviors and lack of resiliency factors examined were related to involvement in bullying as a victim, perpetrator, or bully-victim, both in school and cyberbullying. Moreover, the odds of involvement in school bullying and cyberbullying increased as the number of risk behaviors and the lack of resiliency factors grew. Our results may contribute to the development and implementation of anti-bullying programs. [ABSTRACT FROM AUTHOR]

Socio-relational aspects are essential for mental wellbeing (MWB), especially in the oldest old age. Our study aims to explore the socio-relational aspects related to MWB in accordance with the experiences of the oldest old of four European countries; and to examine how these differ between Mediterranean and Nordic people. A total of 117 participants aged 80+ years old were recruited, and 23 focus groups were performed. Qualitative content analysis identified five main themes. Family seemed to be the most important driver of the MWB of the oldest old, followed by relationships with close friends. Participants felt better when they had a sense of being needed, cared for, and connected. Loneliness and isolation negatively affected MWB, although solitude was appreciated. Differences appeared between Mediterranean and Nordic regions. Initiatives to promote positive interactions with family and friends, as well as social activities within the community, may contribute to strengthening MWB in the oldest old. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to examine the frequency, causes, and predictors of mortality in a cohort of Egyptian systemic lupus erythematosus (SLE) patients and compare mortality causes and the survival rate in our cohort to African, Arabic, and Mediterranean studies. Patients and methods: In this retrospective study, a review of medical records of 563 SLE patients (516 females, 47 males; median of age: 32 [IQR: 26-38 years]; range, 14 to 63 years) fulfilling the 1997 American College of Rheumatology (ACR) criteria between January 2015 and December 2019 was done. The data extracted included demographic, clinical, and laboratory features, treatments used, disease activity as measured by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and damage index as measured by Systemic Lupus International Collaborating Clinics (SLICC) damage index. Causes of mortality were also reported. Results: Out of 563 reviewed medical records, 50 (8.9%) patients died. Infection (28%) and organ damage (18%) were the most commonly reported causes of death. Multivariate Cox regression analysis showed that patients with cardiac manifestations, renal failure, those receiving higher doses of either oral (in their last visit) or intravenous (higher cumulative pulse steroids) steroids were at increased risk of mortality (p=0.011, p<0.001, p=0.01, and p<0.001, respectively; 95% confidence intervals 7.2, 63.9, 1.2, and 1.09, respectively). The overall survival at 5, 10, 15, and 20 years was 96.6%, 93.3%, 91.0%, and 83.2%, respectively, and 56.2% at 25 years until the end of the follow-up. Conclusion: Cardiac manifestations, renal failure, and higher steroid doses were independent predictors of mortality in our cohort. As in most African countries, infection was the main cause of death in our study; however, the mortality rate and the five-year survival among our cohort were better than in African (sub-Saharan) countries and similar to Arabic and Mediterranean countries. [ABSTRACT FROM AUTHOR]

Background: Early detection tools for eating disorders play an essential role in their prevention. The aim of this study was to analyze different variables associated with the risk of eating disorders and their relation to anthropometric parameters, nutritional status and body self-image. Methods: The Eating Disorder Invetory-3 Referral Form (EDI-3 RF) and the Body Shape Questionnaire (BSQ) were administered to 809 adolescents (413 boys and 396 girls), aged 11 to 17 years, from three randomly chosen schools in a big Mediterranean city. Anthropometric measurements were taken following standardized methods. Overweight and obesity were determined according to the International Obesity Task Force (IOTF). Results: Overweight (23%) prevailed over obesity (9.37%). Girls registered a higher score in the Obsession for Thinness EDI-3 RF subscale and in the body dissatisfaction section of the BSQ. The only statistically significant differences in the Obsession for Thinness and Body Dissatisfaction levels among the different ages were seen in boys. In this series, body dissatisfaction assessed by the EDI-3 RF was not correlated with BSQ body dissatisfaction. Sex and age in adolescence determine the relationship between eating disorder attitudes and body shape dissatisfaction. Conclusions: It is necessary to look for other parameters to investigate to determine body dissatisfaction. [ABSTRACT FROM AUTHOR]

Objectives: Teenage pregnancy and motherhood is a crucial problem in countries of the World Health Organisation Eastern Mediterranean Region (WHO–EMR). The aim of this paper is to describe and analyse the phenomenon of adolescent childbearing in ten countries according to social determinants like milieu (rural–urban), education level, wealth quintiles, territoriality (countries, regions) and nationality. Methods: Inequity in terms of adolescent childbearing was analysed using disaggregated data given by Demographic Health Surveys (DHS), UNICEF Multiple Indicator Cluster Surveys (MICS) and the Pan Arab Project for Family Health (PAPFAM) surveys. Beside the absolute differences (gaps) and relative differences (ratios), the index of dissimilarity (ID) was used to compare the distributions of adolescent pregnancy and motherhood by social determinants in each country. Results: Data analysis indicates that the average percentage of adolescent women aged 15–19 years who have begun childbearing shows a large difference between countries, varying from 0.4% in Tunisia to 15.1% in Sudan, combined with huge gaps within each country as indicated by the values of the index of dissimilarity. Poor, rural and non-educated adolescent girls are more exposed to teenage childbearing than their counterparts—rich, urban and educated girls. Conclusion: According to different social determinants, sensible variations are seen in terms of adolescent pregnancy and motherhood within the ten countries considered in this study. This is a clear appeal to decision makers to reduce child marriage and pregnancy by acting on social determinants of health, targeting disadvantaged girls coming mainly from marginalised groups and poor families living in remote rural zones. [ABSTRACT FROM AUTHOR]

Purpose: There is no evidence of a dietary index that measures not only the quantity but also the quality of protein. The aim is to investigate the association between a new dietary protein quality index (PQI) and micronutrient intake adequacy in a Mediterranean cohort. Design: We assessed 17,535 participants' diet at baseline using a semi-quantitative FFQ. The PQI was calculated according to the ratio of protein (g/d) sources: [fish, seafood, lean meat, pulses, eggs, nuts, low-fat dairy, and whole grains]/[red and ultra-processed meats, whole-fat or semi-skimmed dairy, potatoes and refined grains]. Participants were classified into quintiles of PQI. We evaluated the intakes of Fe, Cr, I, K, Mg, Ca, P, Na, Se, Zn and vitamins A, B1, B2, B3, B6, B12, C, E and folic acid. Micronutrient adequacy was evaluated using DRIs. Logistic regression analysis was used to assess the micronutrient adequacy according to quintiles of PQI. Results: In this cross-sectional analysis, a total of 24.2% and 4.3% participants did not to meet DRIs in ≥ 4 and ≥ 8 micronutrients, respectively. The odds of failing to meet ≥ 4 and ≥ 8 DRI were lower in participants in the highest quintile of protein quality (OR = 0.22; IC 95% = 0.18, 0.26; P-trend < 0.001; and OR = 0.08; IC 95% = 0.05, 0.14; P-trend < 0.001, respectively) as compared to participants in the lowest quintile. Conclusion: Higher PQI was found to be strongly associated with better micronutrient intake adequacy in this Mediterranean cohort. The promotion of high-quality protein intake may be helpful for a more adequate intake of micronutrients. The odds of failing to meet certain numbers of DRIs were lower rather than saying lower risk. [ABSTRACT FROM AUTHOR]

The burden of depression is increasing worldwide, specifically in older adults. Unhealthy dietary patterns may partly explain this phenomenon. In the Spanish PREDIMED-Plus study, we explored (1) the cross-sectional association between the adherence to the Prime Diet Quality Score (PDQS), an a priori-defined high-quality food pattern, and the prevalence of depressive symptoms at baseline (cross-sectional analysis) and (2) the prospective association of baseline PDQS with changes in depressive symptomatology after 2 years of follow-up. After exclusions, we assessed 6612 participants in the cross-sectional analysis and 5523 participants in the prospective analysis. An energy-adjusted high-quality dietary score (PDQS) was assessed using a validated FFQ. The cross-sectional association between PDQS and the prevalence of depression or presence of depressive symptoms and the prospective changes in depressive symptoms were evaluated through multivariable regression models (logistic and linear models and mixed linear-effects models). PDQS was inversely associated with depressive status in the cross-sectional analysis. Participants in the highest quintile of PDQS (Q5) showed a significantly reduced odds of depression prevalence as compared to participants in the lowest quartile of PDQS (Q1) (OR (95 %) CI = 0·82 (0·68, 0·98))). The baseline prevalence of depression decreased across PDQS quintiles (Pfor trend = 0·015). A statistically significant association between PDQS and changes in depressive symptoms after 2-years follow-up was found (β (95 %) CI = −0·67 z-score (–1·17, −0·18). A higher PDQS was cross-sectionally related to a lower depressive status. Nevertheless, the null finding in our prospective analysis raises the possibility of reverse causality. Further prospective investigation is required to ascertain the association between PDQS and changes in depressive symptoms along time. [ABSTRACT FROM AUTHOR]

Purpose: To assess the association between three different a priori dietary patterns adherence (17-item energy reduced-Mediterranean Diet (MedDiet), Trichopoulou-MedDiet and Dietary Approach to Stop Hypertension (DASH)), as well as the Protein Diet Score and kidney function decline after one year of follow-up in elderly individuals with overweight/obesity and metabolic syndrome (MetS). Methods: We prospectively analyzed 5675 participants (55–75 years) from the PREDIMED-Plus study. At baseline and at one year, we evaluated the creatinine-based estimated glomerular filtration rate (eGFR) and food-frequency questionnaires-derived dietary scores. Associations between four categories (decrease/maintenance and tertiles of increase) of each dietary pattern and changes in eGFR (ml/min/1.73m2) or ≥ 10% eGFR decline were assessed by fitting multivariable linear or logistic regression models, as appropriate. Results: Participants in the highest tertile of increase in 17-item erMedDiet Score showed higher upward changes in eGFR (β: 1.87 ml/min/1.73m2; 95% CI: 1.00–2.73) and had lower odds of ≥ 10% eGFR decline (OR: 0.62; 95% CI: 0.47–0.82) compared to individuals in the decrease/maintenance category, while Trichopoulou-MedDiet and DASH Scores were not associated with any renal outcomes. Those in the highest tertile of increase in Protein Diet Score had greater downward changes in eGFR (β: − 0.87 ml/min/1.73m2; 95% CI: − 1.73 to − 0.01) and 32% higher odds of eGFR decline (OR: 1.32; 95% CI: 1.00–1.75). Conclusions: Among elderly individuals with overweight/obesity and MetS, only higher upward change in the 17-item erMedDiet score adherence was associated with better kidney function after one year. However, increasing Protein Diet Score appeared to have an adverse impact on kidney health. Trial Registration Number: ISRCTN89898870 (Data of registration: 2014). [ABSTRACT FROM AUTHOR]

Aims Psychological factors are among the most suspected indicators which may cause atherosclerosis. Coping strategies modifying psychological stress may be significantly associated with health outcomes. However, little is known about the influence of adaptive and maladaptive coping strategies on major adverse cardiovascular disease (CVD) events. The purpose of this study is to examine this idea among a sample of adults. Design: cohort study. Methods and results The Isfahan cohort study (ICS) is a longitudinal population-based, prospective study. Participants (⁠ N = 6323 individuals aged 35 years or greater at baseline) were selected by multistage random sampling with 6-year intervals (i.e. 2001: 6323 individuals, 2007: 3296 individuals, and 2013: 1706 individuals). Adaptive and maladaptive coping strategies were evaluated by a multicomponent self-administered stress management paper-based questionnaire. All CVD events were confirmed by a blinded panel of experts and a marginal cox regression model was used to model the survival data. Adaptive coping strategies could be protective against CVD events with hazard ratios (95% confidence interval) [0.97 (0.95–0.99)] and maladaptive coping strategies seem to be a risk factor, 1.02 (1.01–1.04) in the whole population. Individuals younger than 60 showed similar results, with 0.96 (0.93–0.98) and 1.04 (1.01–1.07) for adaptive and maladaptive coping strategies, respectively. However, these findings were not replicated among seniors older than age 60. Conclusion Based on our results, coping strategies have an important role in cardiovascular events, particularly among young adults. According to the results, informing patients about adaptive stress management may promote primary prevention of CVD events. [ABSTRACT FROM AUTHOR]

Background: Food frequency questionnaires (FFQ) is an easy and inexpensive tool that can be used to evaluate nutrient and dietary trends of groups and individuals. Few studies in the East Mediterranean region tailored FFQs to describe dietary intakes of older adults. The purpose of the study is therefore to assess the validity and reproducibility of a FFQ, designed for use with older adults living in a Mediterranean Arabic speaking country, Lebanon.Methods: The FFQ is composed of a list of 90 food items, commonly consumed by adults above 60 years of age. Validity of the FFQ was tested using the mean of two 24-hours dietary recalls (24HDR), and reproducibility, by repeating the questionnaire within a one-month period, along the second dietary recall. Our study included 42 and 76 participants, for the repoducibility and validity analysis respectively. Subjects were randomly selected from 2 of the 8 governorates in the country.Results: FFQ reproducibility showed a mean relative difference of 1.03% without any significant difference between all paired components of nutrients. Intra class correlation (ICC) showed good and excellent reliability for caloric intake and all macronutrients, moderate to good reliability for all remaining nutrients, except for poly-unsaturated fatty acids, vitamins A, B12 and fibers. Correlation coefficients for all nutrients were fair to strong. Both administrations of the FFQ showed good internal validity. Validation of FFQ showed a mean relative difference between FFQ and mean 24HDR at 19.5%. Agreements between the 2 methods, for classifying individuals in the same or adjacent quartile, for nutrient intake and nutrient adequacy, were 80 and 78.2% respectively. Mean Kappa coefficient was 0.56 and energy-adjusted correlations were within the recommended values for all items except for vitamin A and B12. Adjusting for nutrient-dense food intake improved the agreement for theses 2 vitamins to 0.49 and 0.56, respectively.Conclusion: The proposed FFQ can be considered a valid tool to help describe nutrient intake of older individuals in an Arabic speaking Mediterranean country. It could serve for possible use in the East Mediterranean region for the evaluation of regular dietary intake of community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Purpose: Inflammation could play a key role in tissue damage and bone metabolism. The modified dietary inflammatory score (M-DIS) is a validated tool to estimate the inflammatory potential of the diet. In the present study, we evaluate the associations between the M-DIS and bone mineral density (BMD) in a senior Mediterranean population with overweight/obesity and metabolic syndrome. Methods: Baseline cross-sectional association between the M-DIS and bone mineral density was assessed in 1134 participants of the multicenter PREDIMED-Plus trial (aged 55–75 with overweight/obesity and metabolic syndrome). BMD was measured using Dual-energy X-ray Absorptiometry scans and participants answered a food frequency questionnaire to determine the M-DIS. BMD was categorized as low BMD when T score was equal or lower than -1 and normal BMD in another case. Associations between BMD and M-DIS were evaluated by using linear and logistic regressions adjusted by other co-variates. Results: Participants in the top tertile of the M-DIS had a lower BMD at total femur [β (95% CI) − 0.02 (− 0.04, − 0.01)], trochanter areas [β (95% CI) − 0.03 (− 0.05, − 0.01)] and lumbar spine area [β (95% CI) − 0.03 (− 0.07, 0.01)] (but in the last case, measures were less precise and hence not statistically significant) compared to those in the lower M-DIS tertile. Multiple logistic regression analyses showed that the odds of the total femur and femoral trochanter osteopenia/osteoporosis were higher in participants in the top tertile compared to those in the lowest tertile of M-DIS [OR (95% CI) 1.71 (1.12, 2.64), P for trend 0.015; 2.02 (1.29, 3.21), P for trend 0.002, respectively]. Conclusion: A high pro-inflammatory diet, measured by the M-DIS, is associated with lower BMD in a senior Mediterranean population with metabolic syndrome. [ABSTRACT FROM AUTHOR]

Purpose: To assess the association between a score appraising adherence to the PaleoDiet and the risk of cardiovascular disease (CVD) in a Mediterranean cohort. Methods: We included 18,210 participants from the Seguimiento Universidad de Navarra (SUN) cohort study. The PaleoDiet score comprised six food groups promoted within this diet (fruit, nuts, vegetables, eggs, meat and fish) and five food groups whose consumption is discouraged (cereals and grains, dairy products, legumes, culinary ingredients, and processed/ultra-processed foods). CVD was defined as acute myocardial infarction with or without ST elevation, non-fatal stroke and cardiovascular death. Cox proportional hazards models adjusted for potential confounders were fitted to assess the association between the PaleoDiet score and CVD risk, and the PaleoDiet and MedDiet indices to explore differences between both diets. Results: During 12.2 years of follow-up, 165 incident CVD cases were confirmed. A significant inverse association was found between the PaleoDiet score and CVD (HR Q5 vs. Q1: 0.45, 95% CI 0.27–0.76, P for trend = 0.007). A weaker association that became non-significant was observed when the item for low consumption of ultra-processed foods was removed from the score. Joint analysis of PaleoDiet and MedDiet Trichopoulou scores suggested that the inverse association between PaleoDiet and CVD was mainly present when adherence to the MedDiet was also high (HR for high adherence vs low adherence to both diet scores: 0.22, 95% CI 0.08–0.64). Conclusions: Our findings suggest that the PaleoDiet may have cardiovascular benefits in participants from a Mediterranean country. Avoidance of ultra-processed foods seems to play a key role in this inverse association. [ABSTRACT FROM AUTHOR]

In an ongoing Mediterranean cohort, we compared age-related conditions between 208 HIV-infected persons and 104 matched controls. ≥3 comorbidities were found in 31.0% of HIV-infected patients and 8.7% of controls. Conditions significantly more frequent among the HIV-infected population were: lipid abnormalities, cancer, osteopenia/osteoporosis, liver disease, sexual dysfunction, hearing deficit, sleep disorders, falls, cognitive complaints, being single, living alone, and being elderly at risk. HIV-infected patients aged >70 years had a significantly higher number of cardiovascular risk factors (CVRF) and comorbidities than controls. HIV-infected persons who had never smoked had a higher prevalence of CVRFs, ≥3 comorbidities, liver disease, cancer, and cognitive complaints compared to controls. Factors associated with frailty were being a man who has sex with men, ≥3 CVRFs, nadir CD470 years. The multidisciplinary assessment also revealed concerning findings in social, cognitive, and functional variables among HIV-infected individuals, with a higher prevalence of elderly at risk than among controls. [ABSTRACT FROM AUTHOR]

Background In the last years, evidence that dietary vitamin K could have a role in the cognitive domain has increased. However, data from large trials are limited. The objective of this study was to assess the association of 2 year changes in the dietary intake of vitamin K with cognitive function measured through neuropsychological performance tests. Methods In 5,533 participants of the multicentre PREDIMED-Plus study (48.1% women, age 65.1 ± 4.9 years with overweight/obesity and metabolic syndrome), we assessed the adjusted odds ratios of cognitive function decline according to 2 year changes in vitamin K intake. Participants answered a battery of cognitive function tests and Food Frequency Questionnaires (FFQs) in order to estimate the vitamin K dietary intake. Results After adjusting for potential cofounders, the highest tertile of change of dietary vitamin K intake (median [IQR]; 194.4 μg/d [120.9, 373.1]) was inversely associated with a Mini-Mental State Examination (MMSE) score ≤24 (OR [95% CI]; 0.53 [0.35, 0.79] P for trend = 0.002) compared with a decrease in the intake of vitamin K (median [IQR]; −97.8 μg/d [−292.8, −51.5]). A significant positive association between changes in dietary vitamin K intake and the semantic verbal fluency test scores (OR [95% CI]; 0.69 [0.51, 0.94] P for trend = 0.019) was found. Conclusions An increase of the intake of dietary vitamin K was associated with better cognitive function scores, independently of recognised risk factors for cognitive decline, in an older adult Mediterranean population with high cardiovascular risk. [ABSTRACT FROM AUTHOR]

Aims: To describe the characteristics and antidiabetic treatment among type 2 diabetes patients according to the clinical conditions prioritized in the Spanish 2020 RedGDPS (Primary Care Diabetes Study Groups Network) therapeutic algorithm: obesity, older than 75 years, chronic kidney disease, cardiovascular disease, and heart failure.Methods: Retrospective, cross-sectional study. Clinical characteristics, the use of antidiabetic drugs and the KDIGO renal risk categories at 31.12.2016 were retrieved from the SIDIAP (Information System for Research in Primary Care) database (Catalonia, Spain).Results: From a total of 373,185 type 2 diabetes patients, 37% were older than 75 years, 45% obese, 33% had chronic kidney disease, 23.2% cardiovascular disease and 6.9% heart failure. Insulin was more frequently prescribed in chronic kidney disease, cardiovascular disease and heart failure whereas Sodium-Glucose cotransporter 2 inhibitors and Glucagon Like Peptide 1 receptor agonists were scarcely prescribed (2.6% and 1.4%, respectively). Among patients with severe renal failure, contraindicated drugs like metformin (16%) and sulfonylureas (6.1%) were still in use. The 2012 KDIGO renal risk categories distribution was: Low: 60.9%, Moderate: 21.6%, High: 9.8% and Very high: 7.7%.Conclusions: Almost 80% of our T2DM patients meet one of the five clinical conditions that should be considered for treatment individualization. Importantly, a relevant number of patients with severe renal failure were found to use contraindicated drugs. [ABSTRACT FROM AUTHOR]

Experiencing negative emotional states during pregnancy has been linked to adverse outcomes for mother and offspring. Our study aims were to compare the perinatal emotional states and obstetrical variables between pregnant women recruited in Spain (n = 202) and Italy (n = 103), and to investigate prenatal anxiety related factors. The study had two phases. In the 1st phase (3rd trimester of pregnancy), prenatal anxiety was assessed using the State-Trait Anxiety Inventory (STAI); other prenatal and sociodemographic variables were also collected. In the 2nd phase (40 days postpartum), the STAI and the Edinburgh Postnatal Depression Scale were administered. Compared to the Spanish sample, the Italian sample presented higher STAI state and STAI factor 1 mean scores (22.5 vs. 18.6 and 10.0 vs. 7.2), shorter gestations (mean gestation weeks: 39.1 vs. 39.8), more unplanned pregnancies (31.1% vs. 16.4%), and more cesareans deliveries (42.5% vs. 16.0%). Low socioeconomic levels, younger ages, previous miscarriages and unplanned pregnancies were related to prenatal anxiety. Postpartum depression rates was 31.3% and there were no differences between countries. Our results suggested that it may be interesting in both countries to create a prenatal monitoring protocol that attaches more importance to emotional wellbeing both during pregnancy and in the long term. [ABSTRACT FROM AUTHOR]

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This article considers the Anglo-Norman romance Boeve de Haumtone through a Mediterranean lens, arguing that being attentive to the setting to the romance offers a more nuanced understanding of its investments than readings that focus on the representation of proto-nationalisms in the romance. [ABSTRACT FROM AUTHOR]

Abstract Stature is a fundamental anthropometric character to trace the biological profile of a person. In some cases, when dismembered or mutilated bodies are discovered in a forensic context, it is essential to estimate stature from single districts of the body. Nevertheless, to date and worldwide, there are only few population-specific studies on stature estimation from leg length and none of them concerns modern populations in southern Europe. We attempted to fill this gap, focusing on the estimation of stature from the length of the tibia in a Mediterranean population (Italians). We carried out the current study on a sample of 374 Italian university students of both sexes (age range: 19.9–34.4). Both, actual stature and percutaneous length of tibia were measured and new equations were developed for stature estimation. We tested separate regression equations for each sex, as well as an equation for remains, whose sex is unknown. To assess their reliability, the equations were tested on a holdout sample of 30 individuals from the same population. Moreover, results of new specific linear regression equations were compared to others from the literature. We demonstrated that the newly proposed formulae (for males and combined sexes) and the ones by Olivier (for females) provided the most reliable estimations of stature for southern Europeans. Highlights • Tibia percutaneous length is highly correlated with stature. • New regression equations for stature estimation from tibial length have been developed. • The new formulae provide a reliable estimation of stature for southern Europeans. [ABSTRACT FROM AUTHOR]

The article talks about the controversy over Black Athena written by Martin Bernal and Afro-Asiatic roots of the Greek culture, background of Europe's Indo-Aryan or Phoenician-Semitic to be the reason behind the the rise of Mediterranean powers, European civilization and Hellenism. It talks about Edmund Dickinson's work Delphi Phoenizantes as a contribution to the debate of oriental roots of European culture, the Book of Joshua and significance of Greek mythology.

This study contributes to international research on geographies of health and wellbeing in Mediterranean cultures. The paper draws upon evidence from qualitative research in three localities in Malta, a country where previous research on this topic is quite limited. Through in-depth interviews with people from some of the most disadvantaged and socially marginalised groups in Maltese society, this research illustrates how psychosocial health and wellbeing of the inhabitants within this Mediterranean region are strongly influenced by wider social determinants, particularly the powerful dynamics of social norms involving roles of extended family, traditional attitudes towards marriage as an institution, family honour, gender roles and religious beliefs and practices. This research explores how these social determinants of health within a Maltese context are complex and contingent on personal and local socio-geographical conditions, so that while for some individuals they are beneficial for health and wellbeing, for others the effects are detrimental. The discussion considers how to interpret the 'Mediterranean model' of social determinants of health in light of the experiences of this group of inhabitants. [ABSTRACT FROM AUTHOR]

Over the past ten years the number of studies regarding outdoor thermal comfort has been progressively increasing. However, the existing works are characterized by a certain variety of instruments and methods. An example can be found in the indexes and evaluation scales used to estimate thermal perception. This is why this paper proposes the Global Outdoor Comfort Index (GOCI), which is obtained thanks to the combination of the empirical relations provided by the existing literature. Its independent variables are: air temperature (according to the reported F test value it is the most significant influencing parameter in the new proposed index), mean radiant temperature, relative humidity, wind velocity, latitude, mean annual temperature, mean temperatures of the hottest and coldest months. The index performances were compared to those of the Predicted Mean Vote (PMV), the Physiological Equivalent Temperature (PET), the Mediterranean Outdoor Comfort Index (MOCI) and the Universal Thermal Climate Index (UTCI) by means of an experimental field survey carried out in Rome (Italy). The GOCI reported a total percentage of correct predictions of 27.8%, higher than the PMV (27.7%), PET (25.4%) and UTCI (23.0%) but lower than the MOCI (32.2%). The higher predictive ability of this last index is due to the fact that it was specifically meant for the Mediterranean population. According to Spearman's rho measure of correlation and symmetrical measure of association Gamma calculations, the GOCI was the most sensitive index and it can be used to predict outdoor thermal comfort in areas devoid of studies about specific indexes. [ABSTRACT FROM AUTHOR]

Background and aims The main aim of this study is to describe the differences in the cardio-ankle vascular index (CAVI) in individuals with metabolic cardiovascular risk factors or a previous history of vascular diseases (WCVRF) compared to healthy individuals (free of risk factors and previous history of vascular diseases; FCVRF) in a general Mediterranean population. The secondary aim is to describe the proportion of CAVI≥9 depending on the cardiovascular risk category in both CVRF groups by sex. Methods The study is a descriptive analysis of 2613 participants randomly selected in the Girona province (Catalonia, Spain). Results CAVI mean differences between sexes and age categories in both CVRF groups followed the same pattern, the FCVRF group (men 25.2%; women 14.4%) in turn had a lower prevalence of CAVI≥9 than the WCVRF group (men 57.9%; women 51.8%). The percentage of men and women with CAVI≥9 with low risk was 13.9% and 11.3% in the FCVRF group, and 31.8% and 42.0% in the WCVRF group; with moderate risk, it was 55.8% and 10.0% in the FCVRF group and 60.3% and 49.0% in the WCVRF group. Conclusions In both sexes, FCVRF groups had a lower prevalence of CAVI≥9 as well as lower mean CAVI scores, across all 10 year-age categories from 40 to 69 years, than WCVRF groups. Moreover, CAVI≥9 was frequent in individuals with low and moderate coronary risk in the WCVRF group but also in the FCVRF group. These results suggest that CAVI assessment to detect asymptomatic arteriosclerosis could be a useful tool to improve cardiovascular risk stratification. [ABSTRACT FROM AUTHOR]

Aim: To assess trends in the biases of self-reported versus measured weight, height, and body mass index (BMI) in adults over the period 2000-2010 in a Mediterranean adult population. Methods: The sample population consisted of young (18-35) and middle-aged (36-55) adults living in the Balearic Islands, Spain. The data represent 1,089 people during 1999-2000 and 1,081 people during 2000-2010. Weighted-based frequency estimates were used. Results: While no differences between self-reported and measured weight, height and BMI were found in the respondents, it was seen that a decreasing percentage of the population knows their own weight and/or height. A rise in awareness was found in normal-weight men (from 95.0% to 98.9%), and also in normal-weight men and in the middle-aged obese category whose self-reported BMI was not defined as "correct" (from 41.2% to 85.7% and from 41.0% to 67.6% respectively). Conclusions: A substantial proportion of the population does not know their own weight or height. The obtained results suggest the need to develop strategies to enhance awareness of own weight and height. [ABSTRACT FROM AUTHOR]

The survival rate is a key parameter for population management and the monitoring of populations. Thus, an analysis of survival rate variations and the factors influencing the same is essential for understanding population dynamics. Here, we study the factors determining the survival and the causes of mortality of the Eurasian eagle owl ( Bubo bubo) in two Spanish Mediterranean populations (Murcia and Seville) where the species has a high population density and breeding success; yet its survival rates and the factors that affect them are unknown. Between 2003 and 2010, 63 breeding owls were captured and radio-tracked. Three monthly (quarterly) survival rates were estimated using known-fate models in the program MARK. The mean overall annual survival rate was 0.776 (95 % CI: 0.677, 0.875). We observed survival differences between sexes, and between the breeding and non-breeding periods, although no overwhelming support was found for any particular model. We concluded that (i) females have a lower survival rate than males, probably due to their larger home ranges, which increase the risk of mortality; (ii) the survival rates of both sexes were lower during the non-breeding period; and (iii) the causes of mortality differed significantly between the two populations, gunshot being the main cause in Seville and electrocution in Murcia. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency and clinical parameters, of clinically significant depressive symptoms among a type 2 diabetes (T2DM) sample from a Mediterranean area without an established diagnosis of depressive disorder (DD). Methods: 320 subjects with T2DM were recruited randomly from Primary-Care settings and the Endocrine Department from a tertiary center in Mallorca (Spain). 91 healthy individuals matched by age, gender and BMI were used as controls. All participating patients graded by the presence of DD by using the “Beck Depression Inventory” (BDI), considering pathological a cut-off score equal or greater than 16. Results: 27.2 % T2DM subjects had significant symptoms of DD compared with 12.1 % in the control group (p < 0.01). BDI score was higher among T2DM when compared with controls (12 ± 9.6 vs. 7.4 ± 5, p < 0.0001). The proportion of females (68 % vs. 37 %, p < 0.0001), subjects without an active job (68 % vs. 45 %, p = 0.01) and singles (38 % vs. 18 %, p = 0.007) was greater among T2DM with a BDI ≥ 16. Subjects with criteria for DD had a higher BMI (31.99 ± 5.96 vs. 30.53 ± 5.62, p = 0.03). Fasting plasma glucose was higher among T2DM with a BDI ≥ 16 (162 ± 70 vs. 147 ± 45 mg/dl, p = 0.02) as well as HbA1c levels (7.9 ± 1.8 % vs. 7.4 ± 1.4 %, p = 0.01), triglycerides (203 ± 183 vs. 161 ± 103 mg/dl; p = 0.03) and LDL-cholesterol (112 ± 31 vs. 104 ± 35 mg/dl; p = 0.03). Gender, marital status, BMI and triglycerides were independently related to the presence of DD after a logistic regression model. Conclusions: Relevant depressive symptoms are more prevalent among Mediterranean T2DM subjects than in general population. Main clinical correlators of significant depressive symptoms are gender, marital status and BMI. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine if Bolton's tooth size ratios can be applied to Mediterranean, Japanese and Japanese-Brazilian populations. Materials and methods: The sample comprised 90 pairs of dental casts of untreated individuals with normal occlusion, divided into 3 groups according to ethnical characteristics: White (30 Mediterranean descendant subjects, with a mean age of 13.64 years), Japanese (30 subjects with Japanese ancestry, with a mean age of 15.63 years) and Japanese-Brazilian (30 Japanese-Brazilian subjects, with a mean age of 13.96 years). A digital caliper was used to measure the maxillary and mandibular mesiodistal widths from first molar to first molar on each dental cast. The anterior and overall tooth size ratios were calculated. T test was applied for comparisons between Bolton standards and the ethnical groups for anterior and overall ratios. Results: Only the Japanese-Brazilian group showed significantly greater ratios than Bolton standards. Conclusion: It was concluded that Bolton's ratios are not applicable to the Japanese-Brazilian population. Therefore, it is suggested that Bolton's ratios may not be suitable for different populations. [ABSTRACT FROM AUTHOR]

The article offers information on the epigraphic and archaeological evidence that proves higher-educated layers of society in Gandhara art school in India were familiar with the Mediterranean culture of their day in terms of literature and the performing arts. Topics discussed include immediate attraction of Gandharan art to the European recipient; stylistic vocabulary of the visual arts; and paintings on the chamber walls and on urns and sarcophagi.

Introduction: High levels of serum urate has been associated to a neuroprotective effect in Parkinson's disease (PD) as an antioxidant agent. However, the relation between gout and PD remains contradictory.Objective: To study if the neuroprotective effect of serum urate is maintained in patients with gout in a large urban Mediterranean population.Methods: Primary care based matched case-control study, carried out using an electronic health record database from the public primary care health system of Barcelona. The database contains anonymous data from 1,520,934 patients. All patients, over 40 years old, with a new diagnostic record of PD, or a new prescription of dopaminergic drugs were included (incident cases). We randomly selected four controls for each case, matched by gender and age, with the frequency matching approach. Retrospective data of PD risk factors were also collected for each individual. A multivariate logistic regression model was used to evaluate the association of gout and PD, adjusted by the presence of other risk factors.Results: A new PD diagnosis was found in 17,629 individuals (incident diagnosis rate of 2.2 per 1000 individuals). Multivariate logistic regression model showed for gout: aOR=0.83 (0.76-0.91). When stratified by age, aOR for those under 75years was 0.99 (0.85-1.16) and 75 or over OR=0.77 (0.70-0.86). Dyslipidemia, hypertension and diabetes mellitus were associated with an increased risk of PD. Tobacco consumption was protective.Conclusion: Our study, the first one made in a Mediterranean population, shows a PD protective effect of gout in both men and women over 75years old. [ABSTRACT FROM AUTHOR]

Objectives: To assess systemic, environmental and lifestyle risk factors for dry eye disease (DED) in a Mediterranean Caucasian population.Methods: A cross-sectional study was performed on 120 Caucasian participants aged between 18 and 89 years (47.0 ± 22.8 years). Medical history, information regarding environmental conditions and lifestyle, Ocular Surface Disease Index, Dry Eye Questionnaire-5, non-Invasive (Oculus Keratograph 5 M) breakup time, tear film osmolarity and ocular surface staining parameters were assessed in a single clinical session to allow DED diagnosis based on the guidelines of the Tear Film and Ocular Surface Society Dry Eye Workshop II Diagnostic Methodology Report. A multivariate logistic regression model was constructed including those variables with a p-value less than 0.15 in the univariate analysis.Results: A prevalence of 57.7 % for DED was found. No age differences were found between those with and without DED (U = 1886.5, p = 0.243). Nevertheless, the DED group had more females (X2 = 7.033, p = 0.008). The univariate logistic regression identified as potential risk factors for DED the following: female sex, sleep hours per day, menopause, anxiety, systemic rheumatologic disease, use of anxiolytics, daily medication, ocular surgery, poor diet quality, more ultra-processed food in diet, not drinking caffeine and hours of exposure to air conditioning per day. Multivariate logistic regression revealed that hours of sleep per day, menopause and use of anxiolytics were independently associated with DED (p ≤ 0.026 for all).Conclusions: DED is associated with systemic, environmental and lifestyle risk factors. These findings are useful to identify potentially modifiable risk factors, in addition to conventional treatments for DED. [ABSTRACT FROM AUTHOR]

This paper is the first updated review of the scope, depth and problems related to the current radiocarbon chronology of the late prehistory of southern Iberia. The aim is twofold. First, it critically analyses the quantity and quality of radiocarbon dates used to interpret the diverse trajectories of western Mediterranean societies throughout more than four millennia. Secondly, it reviews a set of three different and prominent archaeological phenomena from an inter-regional comparative perspective: primary and secondary burial practices, domestic stone architecture and ditched enclosures. Our long-term, geographically wide-ranging approach locates similarities while highlighting the effects of local and historical conditions in certain divergent circumstances. [ABSTRACT FROM AUTHOR]

Due to its claim of contemporary exceptionalism, the notion of superdiversity raises suspicion among historians. However, historians would do well to not dismiss the entire superdiversity debate as more hype that does not concern them. As a multidimensional perspective on diversity, encouraging researchers to examine the interplay of many different factors that condition people's lives and to move beyond an ethno-focal perspective, superdiversity could be of interest to historians as well. This article shows how the notion can help historians debunk some of the homogenizing categories that tend to characterize the representation of past immigrant populations. The paper uses a superdiversity lens to examine migration to the city of Ghent from 1960 to 1980. It is an open invitation to historians to accept the challenges that superdiversity poses and to provide a proper historicization of the concept, thus furthering its theoretical development. [ABSTRACT FROM AUTHOR]

The paper presents an unnoticed "rule" governing the presence or absence of the article with ővoμα in naming-constructions of the type "the name of x is JV." It arises from the survival of an archaic pattern with the dative and no article, alongside a newer pattern with the genitive and the article. The "rule" is shown to operate not only in the LXX and NT but in ancient Greek generally, from Homer to Koine Greek. Observance of the "rule" indicates the LXX translators' and the NT authors' familiarity with idiomatic Greek. The "rule" can also contribute to resolving textual questions, notably Luke 1:63. [ABSTRACT FROM AUTHOR]

Social-scientific interpretation started more than thirty years ago based on the insight that the Bible was written by, for and about people in the ancient Mediterranean world whose culture, worldview, social patterns, and daily expectations differed sharply from those of the modern West. Therefore, insights from the social and human sciences are utilised in order to identify and apply the social and cultural scripts of ancient Mediterranean life to biblical texts. But in doing so metatheoretical assumptions about the aim of interpretation inadvertently play a role in characterising the interpretive enterprise. The work of John Pilch on visions, heavenly journeys and other peak experiences in the biblical world, Flights of the Soul, offers a useful example for examining such assumptions and their impact on interpretation. The secular study of out-of-body experiences is used to illustrate that social-scientific interpretation of the New Testament is confronted with a choice between merely translating first-century Mediterranean practices and experiences into social scientific jargon or to offer comparative analyses based on a critical understanding of such practices and experiences. [ABSTRACT FROM AUTHOR]

This paper examines Herodotus' characterization of the sexual customs and habits of barbarians (i.e., non-Greeks) in the Histories. The argument to be advanced in this study is that Herodotus describes non-Greek populations as sexually promiscuous and implies that, at least by Greek standards, their marital relations constitute a sort of μoıXεiα (i.e., adultery/corruption). Moreover, since the μoıXóç (adulterer/corrupter) was typically seen as an unmanly or emasculated figure in the Classical Greek imagination, this paper further argues that Herodotus is utilizing prevailing notions of gender and sexuality as a way of more broadly articulating non- Greek cultures as essentially unmanly in general. [ABSTRACT FROM AUTHOR]

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AIMS: Investigation of paraoxonase-1 (PON1) activity with oxidative status parameters and the increased susceptibility to atherogenesis in β-thalassaemia-trait (BTT) subjects. METHODS: Sixty BTT subjects and 20 age- and sex-matched healthy controls were enrolled in the study. Serum PON1, total antioxidant capacity (TAC), malondialdehyde (MDA) and carotid artery intima-media thickness (CIMT) were determined. Qualitative detection of β-thalassaemia mutations was carried out. RESULTS: Serum PON1 activity and TAC were significantly lower in BTT subjects than in controls (p<0.001), while MDA and CIMT were significantly higher (p<0.001). In BTT subjects, TAC, MDA, and CIMT levels were significantly correlated with serum PON1 (r=0.945, –0.900, 0.940 and –0.922 respectively). Serum TAC and MDA were significantly correlated (r=–0.979). CONCLUSIONS: Oxidative stress is increased, while serum PON1 activity is decreased in BTT subjects. Decrease in PON1 activity is associated with the degree of oxidative stress, anaemia and increase in CIMT. Therefore, BTT subjects may be more prone to development of atherosclerosis. [ABSTRACT FROM AUTHOR]

Most of the data reported on sudden cardiac death has been from studies of Anglo-Saxon patients. We conducted a study to ascertain the relation between sudden death (SD) and some epidemiologic, clinical, and biochemical parameters and to assess the coronary histopathologic aspects of subjects in a Spanish population who had died suddenly. A total of 204 subjects (86% men), aged 12 to 80 years (mean 54 ± 15), who had died from out-of-hospital natural SD were evaluated. Only 15% of subjects had been previously diagnosed with heart disease. Pathologic evidence of underlying cardiovascular disease was found in 90% of cases, with coronary heart disease (CHD) the most frequent (58%). The CHD was acute coronary thrombosis in 41% and a stable plaque with luminal narrowing of ≥75% in 59%. An old myocardial infarction was found in 31% of the SD victims. Cardiac hypertrophy was found in 48%, with no relation between the presence of cardiac hypertrophy and CHD. Patients with stable plaques had a greater heart weight than did those with acute coronary thrombosis (p = 0.02). Male gender, older age, smoking, and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio of ≥3 were associated with CHD. A greater percentage of patients with an eroded and/or ruptured plaque than patients with a stable plaque were smokers. Only smoking and a low-density lipoprotein/high-density lipoprotein cholesterol ratio of ≥3 were associated with an eroded and/or ruptured plaque. In conclusion, compared with the findings from studies of Anglo-Saxon patients, a lower incidence of CHD and acute coronary thrombosis and a greater incidence of cardiac hypertrophy were found in SD victims of a Mediterranean Spanish population. [ABSTRACT FROM AUTHOR]

Australia has welcomed migrants and refugees from many countries in the Mediterranean region over many years -Italian, Spanish, Portuguese, Greek, Serbian, Croatian, Bosnian, Maltese, Turkish and French to the most recent arrivals speaking Arabic and its many dialects. Examples of best practice services in NSW public libraries demonstrate how public libraries support these culturally and linguistically diverse communities and how libraries and museums are preserving the cultural heritage and memories of communities. Their current challenges include providing resources for the ageing populations of some of the language groups and sourcing resources for the newest arrivals. Edited version of a paper presented at the Ifla satellite meeting Palermo Sicily 31 August-1 September 2009. [ABSTRACT FROM AUTHOR]

Copyright of Relações Internacionais is the property of Relacoes Internacionais and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)