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Background: Chronic pain (CP) and its management are critical issues in the care pathway of patients with breast cancer. Considering the complexity of CP experience in cancer, the international scientific community has advocated identifying cutting-edge approaches for CP management. Recent advances in the field of health technology enable the adoption of a novel approach to care management by developing integrated ecosystems and mobile health apps. Objective: The primary end point of this pilot study is to evaluate patients’ usability experience at 3 months of a new digital and integrated technological ecosystem, PainRELife, for CP in a sample of patients with breast cancer. The PainRELife ecosystem is composed of 3 main technological assets integrated into a single digital ecosystem: Fast Healthcare Interoperability Resources–based cloud platform (Nu platform) that enables care pathway definition and data collection; a big data infrastructure connected to the Fast Healthcare Interoperability Resources server that analyzes data and implements dynamic dashboards for aggregate data visualization; and an ecosystem of personalized applications for patient-reported outcomes collection, digital delivery of interventions and tailored information, and decision support of patients and caregivers (PainRELife app). Methods: This is an observational, prospective pilot study. Twenty patients with early breast cancer and chronic pain will be enrolled at the European Institute of Oncology at the Division of Medical Senology and the Division of Pain Therapy and Palliative Care. Each patient will use the PainRELife mobile app for 3 months, during which data extracted from the questionnaires will be sent to the Nu Platform that health care professionals will manage. This pilot study is nested in a large-scale project named “PainRELife,” which aims to develop a cloud technology platform to interoperate with institutional systems and patients' devices to collect integrated health care

Different inner and external determinants might explain an individual’s willingness to get the vaccine for COVID-19. The current study aims at evaluating the effects of trust in mainstream information sources on individuals’ willingness to get the vaccine and the moderator role of the message framing. Six hundred and thirty-four participants (68.5% females and 31.5% males) were enrolled in an online survey. Participants filled out a questionnaire assessing: trust in mainstream information sources and vaccinal attitude (trust in vaccine benefit, worries over unforeseen future effects, concerns about commercial profiteering, and preference for natural immunity). In addition, participants were randomly exposed to one of four conditions of framing information about the vaccine (gain-probability; gain-frequency; loss-probability; loss-frequency). Results showed that trust in vaccine benefit (b = 9.90; 95% CI: 8.97, 11.73) and concerns about commercial profiteering (b = −4.70; 95% CI: −6.58, −2.81) had a significant effect on the intention to get the vaccine. Further, a significant interaction was observed between loss-gain and trust in vaccine benefit and between frequency-probability and concerns about commercial profiteering. Future vaccination campaigns should consider the individuals’ concerns about vaccine benefit and economic profits to efficaciously deliver frequency-framed or probability-framed information.

Resulting from impaired collagen turnover, fibrosis is a hallmark of adipose tissue (AT) dysfunction and obesity-associated insulin resistance (IR). Prolidase, also known as peptidase D (PEPD), plays a vital role in collagen turnover by degrading proline-containing dipeptides but its specific functional relevance in AT is unknown. Here we show that in human and mouse obesity, PEPD expression and activity decrease in AT, and PEPD is released into the systemic circulation, which promotes fibrosis and AT IR. Loss of the enzymatic function of PEPD by genetic ablation or pharmacological inhibition causes AT fibrosis in mice. In addition to its intracellular enzymatic role, secreted extracellular PEPD protein enhances macrophage and adipocyte fibro-inflammatory responses via EGFR signalling, thereby promoting AT fibrosis and IR. We further show that decreased prolidase activity is coupled with increased systemic levels of PEPD that act as a pathogenic trigger of AT fibrosis and IR. Thus, PEPD produced by macrophages might serve as a biomarker of AT fibro-inflammation and could represent a therapeutic target for AT fibrosis and obesity-associated IR and type 2 diabetes. Obesity-associated AT fibro-inflammation and metabolic disturbances are linked to PEPD activity and PEPD extracellular levels.

Cancer-related chronic pain (CP) represents a critical clinical issue through the disease, severely compromising the quality of life (QoL) of patients and the family environment. The current review employed a narrative method to synthesize the main results about the impact of cancer-related CP on QoL, adopting a multidimensional and threefold vision: patients, caregivers, and patient– caregiver perspective. Evidence emphasizes the importance of considering a bidirectional perspective (patient–caregiver) to understand better the pain experience throughout the cancer continuum and its consequences on QoL of patients and caregivers. Moreover, a holistic and multidimensional approach to cancer-related CP and its impact on QoL of patients and caregivers is still needed, in which the interconnection between physical, psychological, and social factors should be analyzed. Theoretical and methodological issues for orienting future social and family research initiatives were discussed.

Background: The increased number of cancer survivors and the recognition of physical and psychosocial challenges, present from cancer diagnosis through active treatment and beyond, led to the discipline of cancer survivorship. Design and methods: Herein, we reflected on the different components of survivorship care, existing models and priorities, in order to facilitate the promotion of high-quality European survivorship care and research. Results: We identified five main components of survivorship care: (i) physical effects of cancer and chronic medical conditions; (ii) psychological effects of cancer; (iii) social, work and financial effects of cancer; (iv) surveillance for recurrences and second cancers; and (v) cancer prevention and overall health and well-being promotion. Survivorship care can be delivered by structured care models including but not limited to shared models integrating primary care and oncology services. The choice of the care model to be implemented has to be adapted to local realities. High-quality care should be expedited by the generation of: (i) focused and shared European recommendations, (ii) creation of tools to facilitate implementation of coordinated care and (iii) survivorship educational programs for health care teams and patients. The research agenda should be defined with the participation of health care providers, researchers, policy makers, patients and caregivers. The following patient-centered survivorship research areas were highlighted: (i) generation of a big data platform to collect long-term real-world data in survivors and healthy controls to (a) understand the resources, needs and preferences of patients with cancer, and (b) understand biological determinants of survivorship issues, and (ii) develop innovative effective interventions focused on the main components of survivorship care. Conclusions: The European Society for Medical Oncology (ESMO) can actively contribute in the efforts of the oncology community toward (a

Background: The increased number of cancer survivors and the recognition of physical and psychosocial challenges, present from cancer diagnosis through active treatment and beyond, led to the discipline of cancer survivorship. Design and methods: Herein, we reflected on the different components of survivorship care, existing models and priorities, in order to facilitate the promotion of high-quality European survivorship care and research. Results: We identified five main components of survivorship care: (i) physical effects of cancer and chronic medical conditions; (ii) psychological effects of cancer; (iii) social, work and financial effects of cancer; (iv) surveillance for recurrences and second cancers; and (v) cancer prevention and overall health and well-being promotion. Survivorship care can be delivered by structured care models including but not limited to shared models integrating primary care and oncology services. The choice of the care model to be implemented has to be adapted to local realities. High-quality care should be expedited by the generation of: (i) focused and shared European recommendations, (ii) creation of tools to facilitate implementation of coordinated care and (iii) survivorship educational programs for health care teams and patients. The research agenda should be defined with the participation of health care providers, researchers, policy makers, patients and caregivers. The following patient-centered survivorship research areas were highlighted: (i) generation of a big data platform to collect long-term real-world data in survivors and healthy controls to (a) understand the resources, needs and preferences of patients with cancer, and (b) understand biological determinants of survivorship issues, and (ii) develop innovative effective interventions focused on the main components of survivorship care. Conclusions: The European Society for Medical Oncology (ESMO) can actively contribute in the efforts of the oncology community toward

Heart Rate Variability (HRV) Biofeedback (BFB) has been shown to improve autonomic balance and wellbeing in chronic diseases. As cardiac variability represents an index of cognitive and emotional regulation, HRV-BFB has been shown to lead to improvements in physiological and psychological adaptability and quality of life. However, knowledge of HRV-BFB in cancer patients is lacking, and available results are diversified according to methods and outcomes. The present paper undertakes a scoping review, exploring the use of HRV-BFB to modulate autonomic balance, cancer symptom management, and quality of life in cancer. This scoping review analyzes empirical evidence considering study designs, BFB methods, and psychophysiological outcomes. Research that focused on HRV-BFB effects in cancer patients was selected (79%). In addition, a systematic review and meta-analysis (31%) focusing on HRV, or BFB in chronic conditions, including cancer, were considered. The studies examined BFB treatment for thyroid, lung, brain or colon cancer, hematologic cancer, and survivors or terminal cancer patients. Retrieved studies reported physiological and psychological indices as primary outcomes: they included HRV values, sleep, pain, fatigue, depression, anxiety, and quality of life. Although the heterogeneity of publications makes it difficult to generalize the effectiveness of HRV-BFB, the training has been proven to improve cancer symptoms and well-being.

Background: Healthcare professionals working in emergency departments commonly experience high work pressure and stress due to witnessing human suffering and the unpredictable nature of the work. Several studies have identified variables that affect burnout syndrome, but poor data are available about the predictors of the different dimensions of burnout (depersonalisation, emotional exhaustion, professional inefficacy and disillusionment). Some research has suggested that alexithymia, coping style and decision-making style may predict burnout. Design: We conducted a noninterventional study to investigate whether and how alexithymia, coping style and decision-making style are associated with the different dimensions of burnout. Methods: We recruited a convenience sample of 93 healthcare professionals working in an Italian emergency departments. Participants completed a questionnaire assessing their level of burnout (the Link Burnout Questionnaire), and possible burnout predictors: decision-making style, alexithymia and the coping style. Four bivariate linear regressions were performed to define the predictors that characterised the dimensions of burnout. Results: We found that an avoidant decision-making style and a difficulty to identify and describe feelings (a difficulty close to alexithymia even though not as severe) are strong predictors of some burnout dimensions. Individuals who experience relational depersonalisation are more likely to turn to religion as a way to cope. Conclusions: Our research shows that, to some extent, difficulties in emotion regulation and the attitude to avoid or postpone decisions characterised burnout. Relevance to clinical practice: These results might be used to develop tailored psycho-educational interventions. This might help healthcare professionals to develop personal skills to cope with the critical conditions that characterise their work and to enable them to recognise potential risk factors that favour burnout. This has pivot

In the field of behavioral sciences, a crisis of the replicability of data took place. Among the reasons of the crisis, there is the difficulty of replicating some classical experimental settings and the lack of reproduced studies. Nowadays, digital contents might provide valuable opportunities to recreate specific environmental situations and manipulations in a safe and cost-saving way. The present study is a preliminary attempt to replicate the relationship between arousal manipulation and sexual attraction as it was assessed in the classical study by Dutton and Aron in 1974. Here, 30 male subjects will be randomly assigned to high or low arousal condition (induced with digital contents) and then asked to rate attractiveness of a female brief video. The objective of this preliminary study is to assess whether the same pattern of results from the classical study of Dutton and Aron will be confirmed with a virtual reprise of the experiment. Theoretical and practical implications will be discussed.

Europe's forests provide vital habitat for biodiversity and essential ecosystem services whose provision must be sustained or enhanced over the coming century. However, the potential to secure or increase forest ecosystem services, while securing the habitat requirements of taxa remains unclear, especially within the context of uncertain climate and socio-economic developments. To tease out the associated trade-offs and synergies, we used 10 case study landscapes within nine countries throughout Europe. Starting with the current status of the forests in the case study landscapes, we simulated forest development 100 years into the future. Simulations were embedded in three combined climate and socio-economic frame scenarios based on global and European policies which varied in their climate change mitigation efficiency. Scenarios were translated into country specific projections of climate variables, and resultant demands for wood products. Forest management regimes were projected to vary in response to these scenarios at local scales. The specific combinations of alternative forest management practices were based on parallel research and input from local forest stakeholders. For each case study, a specific forest growth simulator was used. In general, the climate scenarios applied did not cause fundamentally different ecosystem service outputs at the case study level. Our results revealed almost no reduction in outcomes for biodiversity indicators with an increase in wood production, and in some cases synergistic results occurred when diversity was actively promoted as part of the management concept. Net carbon uptake was not strongly correlated with biodiversity, indicating that biodiversity-friendly forest management doesn't need to curtail carbon sequestration. Notably, we obtained heterogeneous results for the relation between sustainable wood production and net carbon uptake. Most scenarios resulted in a more or less reduced net carbon uptake over the long term

Background: Chemotherapy-induced alopecia (CIA) is a distressing side effect of cancer therapy. The trial aimed to assess feasibility and effectiveness of scalp-cooling system DigniCap® to prevent CIA in primary breast cancer patients receiving an anthracycline containing adjuvant chemotherapy (CT). Methods: Hair loss (HL) was evaluated by patient self-assessment and by the physician according to the Dean’s scale at baseline and after each cycle of CT. The primary efficacy endpoint was the patient self-assessment HL score evaluated at least 3 weeks after completing CT. A Dean's scale score of 0–2 (i.e. HL ≤50%) was considered a success. Results: From July 2014 to November 2016, 139 consecutive breast cancer patients were enrolled and received at least one treatment with scalp cooling. Fifty-six out of 131 evaluated patients successfully prevented HL (43%, 95% CI: 34–51%). Twenty-four patients (32%) discontinued the scalp cooling because of alopecia or scalp-cooling related AE, three patients had missing information on CIA, and 48 patients (64%) had a HL greater than 50% after CT. No serious AEs were reported. Conclusions: DigniCap® System resulted as a promising medical device to be safely integrated in supportive care of early breast cancer patients. Longer follow-up is needed to assess long-term safety and feasibility. Clinical trial registration number: NCT03712696.

Sustainable forest management is driving the development of forest decision support systems (DSSs) to include models and methods concerned with climate change, biodiversity and various ecosystem services (ESs). The future development of forest landscapes is very much dependent on how forest owners act and what goes on in the wider world; thus, models are needed that incorporate these aspects. The objective of this study is to assess how nine European state-of-the-art forest DSSs cope with these issues. The assessment focuses on the ability of these DSSs to generate landscape-level scenarios to explore the output of current and alternative forest management models (FMMs) in terms of a range of ESs and the robustness of these FMMs in the face of increased risks and uncertainty. Results show that all DSSs assessed in this study can be used to quantify the impacts of both stand- and landscape-level FMMs on the provision of a range of ESs over a typical planning horizon. DSSs can be used to assess how timber price trends may impact that provision over time. The inclusion of forest owner behavior as reflected by the adoption of specific FMMs seems to be also in the reach of all DSSs. Nevertheless, some DSSs need more data and development of models to estimate the impacts of climate change on biomass production and other ESs. Spatial analysis functionality needs to be further developed for a more accurate assessment of the landscape-level output of ESs from both current and alternative FMMs.