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Introduction: Generalized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatment choices for GAD, but which should be considered as first-line treatment still needs to be clarified. Objectives: To examine the most effective and accepted psychotherapy for GAD both in the short and long-term, via a network meta-analysis. Methods: We searched MEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials – CENTRAL, from database inception to January 1st, 2023, to find randomized controlled trials (RCTs) of psychotherapies for GAD. Eight psychotherapies (behaviour therapy, cognitive-behaviour therapy, cognitive restructuring, psychoeducation, psychodynamic therapy, relaxation therapy, supportive psychotherapy, and third-wave CBTs) were compared with each other and two control conditions (treatment as usual, waiting list). We followed Cochrane standards when extracting data and assessing data quality and used PRISMA guidelines for the reporting. We conducted random-effects model pairwise and network meta-analyses. We assessed risk of bias of individual studies through the second version of the Cochrane's Risk of Bias tool and used the Confidence in Network Meta-Analysis (CINeMA) to rate certainty of evidence for meta-analytical results. Severity of GAD symptoms and acceptability of the psychotherapies were our outcomes of interest. Results: We analysed data from 66 RCTs. Effect size estimates on data from 5,597 participants suggest third wave cognitive-behavioural therapies (standardized mean differences [SMDs] =-0.78; 95%CI=-1.19 to -0.37; certainty=moderate), cognitive-behavioural therapy (CBT) (SMD=-0.68; 95%CI=-1.05 to -0.32 certainty=moderate), and relaxation therapy (SMD=-0.54; 95%CI=-1.04 to -0.05; certainty=low) reduced generalized anxiety symptoms more than treatment as usual (TAU). Relative risks for all-cause discontinuation signalled no differences compared with TAU for all psychotherapies. When excluding studies at high risk of bias, relaxation therapy lost its superiority over TAU. When considering anxiety severity at three to twelve months after completion of the intervention only CBT remained significantly more efficacious than TAU (SMD=-0.58; 95%CI=-0.93 to -0.23). Image: Conclusions: Given the evidence for both acute and long-term efficacy, CBT may represent the reasonable first-line psychological treatment for GAD. Third-wave CBT and relaxation therapy have short-term efficacy and may also be offered. Results from this investigation should inform patients, clinicians, and guidelines. This project is funded by the European Union's HORIZON EUROPE research programme under grant agreement No 101061648. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

The Versatile Ion Source (VIS) is a microwave discharge ion source installed at INFN-LNS and here used as test-bench for the production of high intensity low emittance proton beams and for studies on plasma physics. A series of measurements have been carried out with VIS in order to test the source with light ions. In particular a He+ beam has been characterized in terms of plasma discharge parameters. The experiment has been triggered by the observation of X-radiation emission from the plasma for some configuration of the magnetic field profile. The plasma electron energy distribution function is in fact modified when in some regions of the plasma chamber under-resonance discharge takes place, fulfilling the condition that allows the electromagnetic wave to electrostatic wave conversion. These tests allowed obtaining more than 50 mA of He+ beams. [ABSTRACT FROM AUTHOR]

Importance: Generalized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatments for GAD, but which should be considered as first-line treatment needs to be clarified., Objective: To use a network meta-analysis to examine the short- and long-term associations of different psychotherapies with outcomes of effectiveness and acceptability in adults with GAD., Data Sources: MEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials were searched from database inception to January 1, 2023, to identify randomized clinical trials (RCTs) of psychotherapies for adults with GAD., Study Selection: RCTs comparing any type of psychotherapy against another or with a control condition for the treatment of adults (≥18 years, both sexes) with a primary diagnosis of GAD were eligible for inclusion., Data Extraction and Synthesis: This study followed Cochrane standards for extracting data and assessing data quality and used the PRISMA guideline for reporting. Risk of bias of individual studies was assessed using the second version of the Cochrane risk of bias tool, and the Confidence in Network Meta-Analysis was used to rate the certainty of evidence for meta-analytical results., Main Outcomes and Measures: Eight psychotherapies were compared against one another and with 2 control conditions. Primary outcomes were severity of GAD symptoms and acceptability of the psychotherapies. Random-effects model pairwise and network meta-analyses were conducted. For effectiveness, standardized mean differences (SMDs) were pooled, and for acceptability, relative risks with 95% CIs were calculated., Results: Data from 65 RCTs were included. Effect size estimates on data from 5048 participants (mean [SD], 70.9% [11.9%] women; mean [SD] age, 42.2 [12.5] years) suggested that third-wave cognitive behavior therapies (CBTs) (SMD, -0.76 [95% CI, -1.15 to -0.36]; certainty, moderate), CBT (SMD, -0.74 [95% CI, -1.09 to -0.38]; certainty, moderate), and relaxation therapy (SMD, -0.59 [95% CI, -1.07 to -0.11]; certainty, low) were associated with reduced GAD symptoms vs treatment as usual. Relative risks for all-cause discontinuation (indication of acceptability) signaled no differences compared with treatment as usual for all psychotherapies (eg, relative risk, 1.04 [95% CI, 0.64-1.67] for CBT vs treatment as usual). When excluding studies at high risk of bias, relaxation therapy lost its superiority over treatment as usual (SMD, -0.47; 95% CI, -1.18 to 0.23). When considering anxiety severity at 3 to 12 months after completion of the intervention, only CBT remained significantly associated with greater effectiveness than treatment as usual (SMD, -0.60; 95% CI, -0.99 to -0.21)., Conclusions and Relevance: Given the evidence in this systematic review and network meta-analysis for its associations with both acute and long-term effectiveness, CBT may represent the first-line therapy of GAD. Third-wave CBTs and relaxation therapy were associated with short-term effectiveness and may also be offered.

We aimed to develop and validate the FRActure Health Search (FRA-HS) score for prediction of risk of osteoporotic fractures in primary care in Italy. We selected a cohort of patients aged 40 years between 1999 and 2002. They were followed until the occurrence of osteoporotic fracture, death, end of data registration, or end of data availability (December 31, 2012). Age, sex, history of osteoporotic fractures, secondary osteoporosis, long-term use of corticosteroids, rheumatoid arthritis, body mass index, smoking, and alcohol abuse/alcohol-related diseases, and the interaction terms sex*use of corticosteroids and age*secondary osteoporosis were entered in a competing-risk regression (Fine and Gray method) to predict the risk of hip/femur or overall major osteoporotic fractures. The coefficients were combined to obtain the FRA-HS for individual patients. Explained variance, discrimination, and calibration measures were computed to evaluate the models accuracy. The final model was tested using an independent data source. The FRA-HS explained 47.36 and 20.6% of the variation for occurrence of hip/femur and overall major osteoporotic fractures, respectively. Area Under Curve was 0.77 and 0.73, respectively. Predicted/observed ratios revealed a margin of error lower than 30% in the 80% of the population. After stratifying by sex, prediction models for hip/femur fractures confirmed acceptable accuracy in both sexes, while poor explained variance (<20%) was observed for overall major fractures. These findings indicate that FRA-HS might be implemented in primary care for risk prediction of hip/femur fractures. General practitioners could be therefore supported by this tool in clinical decision making.

Background: Skin hydration is defined as the water content of the epidermis and the dermis. In vivo reflectance confocal microscopy offers the opportunity to determine in vivo the kinetics of the skin after the application of topical products., Objective: To define confocal features associated with dry skin and assess the microscopic effects of different moisturizers., Methods: Ten healthy volunteers were enrolled for the study. Two different formulations were tested: petrolatum and a commercially available emulsion. Measurements were performed from baseline to 3 h after removal of the occlusion at regular time points. Nine confocal features were assessed: furrows' size, overall interkeratinocyte reflectance, furrows' morphology, scales, skin surface irregularity, non-rimmed dermal papillae, exocytosis, dermal inflammation and collagen type. Furrows' size and interkeratinocyte reflectance were also quantitated using a digital analysis. Stratum corneum capacitance was recorded., Results: At baseline, RCM showed the presence of micro-scales and high skin surface irregularity score. After the application of topical products, the scale score decreased significantly; Furrow's size and Digital Furrow's Size had a marked and directly correlated decrement. Furrow's morphology and Epidermal Irregularity scores decreased from baseline to 30 min, the latter reaching a plateau in product application areas. Interestingly, interkeratinocyte reflectance progressively increased with the application of the topical products, while remained stable in the control area, confirmed by Digital Interkeratinocytes reflectance quantitation., Conclusion: RCM revealed that the changes involve the skin surface by reducing the micro-scales and epidermal irregularity. Even more interestingly, RCM showed that higher interkeratinocytes' brightness is seen for moisturizer, but not for the control area. This RCM finding could be linked to keratinocyte membrane protein exposure and/or substance release in the interkeratinocytic space. To sum up, RCM represents a useful imaging tool to analyze the morphologic changes at different time points following the application of topical products., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)