Institutional health communication and social media: Exploring Italian hospitals' use of social media pages.

Introduction: Hospitals play a potentially crucial role in public health, and social media can be powerful tools to reach their target audiences but are hospitals exploiting them to their full potential? Methods: We retrieved the institutional webpages and the social media profiles (Facebook, Instagram, X (Twitter), YouTube, LinkedIn, WhatsApp and Telegram) of all Italian public hospitals located in regional capitals (N = 194). From 1 March to 30 April 2022, we analysed these profiles, noting the number of followers and of posts published, the date of the last post, and the availability of a social media policy. We selected the most active 53 social media profiles (belonging to 33 hospital facilities) for a closer content analysis. Engagement was measured through numbers of reactions, comments and shares to posts published from 1 to 30 April 2022. Results: About 36.6% of hospitals had a social media profile, and 18.3% had a social media policy. Most (87%) used Facebook as their main platform. They posted most frequently about hospital events and activities (48.3% of the socially active set). Overall, engagement was modest, as on average 0.62% of potential users reacted to a post. The same post often appeared without modifications across different platforms (82.3% of cases for Instagram, 37.8% for X (Twitter) compared to Facebook). Conclusions: Italian public hospitals did not seem to have a clear social media policy nor strategy, and social media remained underused. Italian hospitals, therefore, appeared to be missing valuable opportunities to reach out to their patients and communities.

Cooking Skills, Eating Habits and Nutrition Knowledge among Italian Adolescents during COVID-19 Pandemic: Sub-Analysis from the Online Survey COALESCENT (Change amOng ItAlian adoLESCENTs).

BACKGROUND: Cooking skills (CS) have the potential to improve self-care behaviours and healthy development among adolescents. The COVID-19 pandemic has affected lifestyles worldwide, and the present study aims to investigate the level of CS after the pandemic, as well as its associations with nutrition knowledge and eating behaviours among a cohort of Italian adolescents. METHODS: We submitted an online survey about lifestyle changes to students aged 13-21 years during the pandemic. Based on overall culinary abilities, we divided respondents into high, medium and low CS. Worsening or improvement in diet quality was detected by assigning an eating habit index (EHI; 0-54). RESULTS: Out of the 1686 questionnaires collected, 21.5%, 63.6% and 14.9% reported high, medium and low CS, respectively. The EHI scores were statistically higher among students who were able to cook more than 20 recipes compared to those reporting no cooking abilities (30.2 ± 5.9 vs. 26.6 ± 5.7; p = 0.0001). High CS significantly correlated with better EHI (OR 1.44; p = 0.009), lower consumption of ultra-processed food (OR 1.80; p < 0.0001) and better nutrition knowledge (OR 1.42; p = 0.007). CONCLUSIONS: Adolescents with good CS showed better nutrition knowledge and healthier eating habits, including lower consumption of ultra-processed foods. Projects aimed to improve CS in adolescents can therefore promote healthier development.

Covid-19 vaccination during pregnancy: A mixed-methods study of attitudes in a sample of Italian women and the role of health professionals' communication.

OBJECTIVES: We examined Italian pregnant women's attitudes about the diphtheria, tetanus, and pertussis (DTP) vaccine, seasonal influenza, and Covid-19 vaccines, healthcare professionals' (HP) communication, reasons and potential predictors for non-adherence. METHODS: From August 2021 to January 2022, we carried out a cross-sectional study in Italy using an online self-administered questionnaire addressed to women of age and pregnant, designed using LimeSurvey and disseminated through social media. Questions explored vaccination attitude/perceptions, satisfaction, and trust in HPs' information. Thematic analysis of free-text responses was performed using MaxQDA 2022. Statistical analyses were performed using STATA. RESULTS: 1594 responses were obtained. 52% of women hesitated to be vaccinated against Covid-19 while pregnant. Information received by HPs was deemed incomplete by 56% of participants, unclear by 52%, and untrustworthy by 46%; 49% felt unsupported in their decision-making process. This variable was one predictor of vaccine hesitancy together with concern about vaccine safety in the multivariate model. The analysis of open-ended questions revealed a pervasive feeling of dissatisfaction. CONCLUSION: The perceived lack of adequate communication and support by HPs affected pregnant women's decision-making process on Covid-19 vaccination. PRACTICE IMPLICATIONS: HPs need to understand and communicate the importance of vaccination during pregnancy, learning to better tailor their messages.

Evaluating the Effectiveness of Internet-Based Communication for Public Health: Systematic Review.

BACKGROUND: Communicating strategically is a key issue for health organizations. Over the past decade, health care communication via social media and websites has generated a great deal of studies examining different realities of communication strategies. However, when it comes to systematic reviews, there is fragmentary evidence on this type of communication. OBJECTIVE: The aim of this systematic review was to summarize the evidence on web institutional health communication for public health authorities to evaluate possible aim-specific key points based on these existing studies. METHODS: Guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, we conducted a comprehensive review across 2 electronic databases (PubMed and Web of Science) from January 1, 2011, to October 7, 2021, searching for studies investigating institutional health communication. In total, 2 independent researchers (AN and SS) reviewed the articles for inclusion, and the assessment of methodological quality was based on the Kmet appraisal checklist. RESULTS: A total of 78 articles were selected. Most studies (35/78, 45%) targeted health promotion and disease prevention, followed by crisis communication (24/78, 31%), general health (13/78, 17%), and misinformation correction and health promotion (6/78, 8%). Engagement and message framing were the most analyzed aspects. Few studies (14/78, 18%) focused on campaign effectiveness. Only 23% (18/78) of the studies had an experimental design. The Kmet evaluation was used to distinguish studies presenting a solid structure from lacking studies. In particular, considering the 0.75-point threshold, 36% (28/78) of the studies were excluded. Studies above this threshold were used to identify a series of aim-specific and medium-specific suggestions as the communication strategies used differed greatly. CONCLUSIONS: Overall, the findings suggest that no single strategy works best in the case of web-based health care communication. The extreme variability of outcomes and the lack of a unitary measure for assessing the end points of a specific campaign or study lead us to reconsider the tools we use to evaluate the efficacy of web-based health communication.

Exploring the Online Health Information-Seeking Behavior in a Sample of Italian Women: The "SEI Donna" Study.

There is much discussion about the skills of people in understanding and managing online health information. The Italian survey "SEI Donna" aimed to investigate perceptions and use of the web in women regarding health issues considering their health literacy (HL) and healthcare skills. We used an online questionnaire to explore different aspects of online health-related information-seeking behavior. The study participants (n = 7027) were categorized into healthcare workers (HW), healthcare students (HS), and non-healthcare women (non-HW). Half the sample (52%) searched online for a second opinion after the medical examination without statistical difference among HW, HS, and non-HW. Women in the age range of 26−40 years (OR = 1.28, p < 0.001), having chronic illness (OR = 1.48; p < 0.001), and being moderately (OR = 1.58; p < 0.001) or not satisfied (OR = 2.04; p < 0.001) with healthcare professionals were more likely to use the Internet to seek medical insight. Overall, 34% of women had a functional HL, the same being higher in HW (64%) and in HS (43%) than the rest of the women (18%) (p < 0.0001). The suboptimal HL suggests the need to improve HL in the general population to be skilled in surfing the web and, at the same time, to reorganize health training to improve the HL of healthcare professionals, also enriching their communication skills.

Relationships of Nutritional Factors and Agrochemical Exposure with Parkinson's Disease in the Province of Brescia, Italy.

Environmental exposures to agrochemicals and nutritional factors may be associated with Parkinson's Disease (PD). None of the studies to date has examined the combined effects of diet and agricultural chemical exposure together. To address these research gaps, we aimed to assess the association of nutritional factors and agrochemical exposure with the risk of PD. A hospital-based case-control study was conducted. Multivariable logistic regressions were used to estimate the association of nutritional and agrochemical exposures with PD, adjusting for gender, age, socio-economic status, head injury, family history, smoking, metals exposure, and α-synuclein gene polymorphism. Weighted Quantile Sum (WQS) regression was applied to examine the effect of dietary components as a mixture. We recruited 347 cases and 389 controls. Parent history of PD (OR = 4.15, 95%CI: 2.10, 8.20), metals exposure (OR = 2.50, 95%CI: 1.61-3.89), SNCA rs356219 polymorphism (OR = 1.39, 95%CI: 1.04-1.87 for TC vs. TT; OR = 2.17, 95%CI: 1.43-3.28 for CC vs. TT), agrochemical exposures (OR = 2.11, 95%CI: 1.41-3.16), and being born in the Brescia province (OR = 1.83, 95%CI: 1.17-2.90) were significantly associated with PD. Conversely, fish intake and coffee consumption had a protective effect. The study confirmed the role of environmental exposures in the genesis of PD. Fish intake and coffee consumption are protective factors even when agricultural chemical exposures exist. Genetic factors and metals exposure were confirmed as risk factors for PD.

Parents and Mobile Devices, from Theory to Practice: Comparison between Perception and Attitudes to 0-5 Year Old Children's Use.

Pediatrics associations recommend avoiding the use of mobile devices (MDs) in children aged 0-2 years and limiting them to one hour per day for children aged 3-5 years. This study aimed to explore public risk perception on MDs use by children aged 0-5 years and attitudes of parents to children's use. Participants were recruited on a voluntary basis by social media using a self-administered survey. The study included 3115 participants, most of whom were parents of children aged under 5 years (n = 1901; 61%). Most of the respondents (74%) considered that MDs use could be harmful for children's health. The awareness on a correct use did not always translate into avoiding MDs use as recommended, especially in parents of children aged 0-2 years. Half of the sample (54%) received or sought information on risks related to MDs use. The most consulted information sources were the web (78%), and pediatricians in only 22% of cases. Understanding the determinants of parents' risk perception and behavior is necessary to design effective family-based interventions in order to guide parents to a moderate and more careful use of MDs by their children. To do so, public health actions must aim to strengthen awareness about conscious use of MDs.

Metal Exposure and SNCA rs356219 Polymorphism Associated With Parkinson Disease and Parkinsonism.

Objective: In the province of Brescia, Italy, historical neurotoxic metal exposure has occurred for several decades. This study aimed to explore the role of metal exposure and genetics on Parkinson's Disease (PD) and Parkinsonism. Methods: Cases were enrolled from four local clinics for movement disorders. Randomly selected controls non-affected by neurological or psychiatric conditions were enrolled from the same health centers keeping a similar gender ratio and age distribution as for cases. Data on sociodemographic variables, clinical onset and life habits were collected besides accurate occupational and residential history. Blood samples were collected from all participants for genotyping of target polymorphisms in genes linked to PD and/or metal transport. Results: A total number of 432 cases and 444 controls were enrolled in the study, with average age of 71 years (72.2 for cases and 70 for controls). The average age at diagnosis was 65.9 years (SD 9.9). Among the potential risk factors, family history of PD or Parkinsonism showed the strongest association with the diseases (OR = 4.2, 95% CI 2.3, 7.6 on PD; OR = 4.3, 95% CI 1.9, 9.5 for Parkinsonism), followed by polymorphism rs356219 in the alpha-synuclein (SNCA) gene (OR = 2.03, 95% CI 1.3, 3.3 for CC vs. TT on PD; OR = 2.5, 95% CI 1.1, 5.3 for CC vs. TT on Parkinsonism), exposure to metals (OR = 2.4;, 95% CI 1.3, 4.2 on PD), being born in a farm (OR = 1.8; 95% CI 1.1, 2.8 on PD; OR = 2.6; 95% CI 1.4, 4.9 on Parkinsonism) and being born in the province of Brescia (OR = 1.7; 95% CI 1.0, 2.9 on PD). Conditional OR of having PD depending by SNCA polymorphism and metal exposure highlights higher risk of PD among CC SNCA carriers and being exposed to metals. However, the interaction term was not statistically significant. Conclusions: Lifetime exposure to metals and genetic variation in SNCA gene are relevant determinants of PD and Parkinsonism in the highly industrialized area of Brescia, Italy. The lack of evidence of statistical interaction between environmental and genetic factors may be due to the low frequencies of subjects representing the exposure categories and the polymorphism variants and does not rule out the biological interaction.

Meningococcal disease in Italy: public concern, media coverage and policy change.

BACKGROUND: Between 2015 and 2017 six deaths due to meningitis in the Lombardy Region, Northern Italy, caught the attention of media and increased concern among the population, with a consequent increase in demand for vaccination. Considering the evidence about the impact of media coverage of health issues on public behaviour, this paper investigates the trend of media coverage and internet searches regarding meningitis in the Lombardy Region. METHODS: Content analysis of online articles published from January 2015 to May 2017 and analysis of Google Trends were carried out. A codebook was created in order to assess the content of each article analysed, based on six areas: article characteristics, information about meningococcal disease and vaccination, Local Health Authority activities, accuracy of information and tone of the message. RESULTS: Both public interest and media attention peaked in December 2016 and January 2017, when the Lombardy Regional Authority changed its policy by offering co-payment to adults with a saving of 50%. The frequency of meningitis coverage decreased after the announcement of policy change. For example, articles containing new information on meningitis or meningococcal vaccine (76 to 48%, p = 0.01) and preventive recommendations (31% down to 10%, p = 0.006) decreased significantly. An alarmist tone appeared in 21% of pre-policy articles that decreased to 5% post-policy (p = 0.03). CONCLUSIONS: The findings suggest a role for the media in fostering public pressure towards health services and policy-makers. A collaboration between Public Health institutions and the media would be beneficial in order to improve communication with the public.

Mutagenic and genotoxic effects induced by PM0.5 of different Italian towns in human cells and bacteria: The MAPEC_LIFE study.

Particulate matter (PM) is considered an atmospheric pollutant that mostly affects human health. The finest fractions of PM (PM2.5 or less) play a major role in causing chronic diseases. The aim of this study was to investigate the genotoxic effects of PM0.5 collected in five Italian towns using different bioassays. The role of chemical composition on the genotoxicity induced was also evaluated. The present study was included in the multicentre MAPEC_LIFE project, which aimed to evaluate the associations between air pollution exposure and early biological effects in Italian children. PM10 samples were collected in 2 seasons (winter and spring) using a high-volume multistage cascade impactor. The results showed that PM0.5 represents a very high proportion of PM10 (range 10-63%). PM0.5 organic extracts were chemically analysed (PAHs, nitro-PAHs) and tested by the comet assay (A549 and BEAS-2B cells), MN test (A549 cells) and Ames test on Salmonella strains (TA100, TA98, TA98NR and YG1021). The highest concentrations of PAHs and nitro-PAHs in PM0.5 were observed in the Torino, Brescia and Pisa samples in winter. The Ames test showed low mutagenic activity. The highest net revertants/m3 were observed in the Torino and Brescia samples (winter), and the mutagenic effect was associated with PM0.5 (p < 0.01), PAH and nitro-PAH (p < 0.05) concentrations. The YG1021 strain showed the highest sensitivity to PM0.5 samples. No genotoxic effect of PM0.5 extracts was observed using A549 cells except for some samples in winter (comet assay), while BEAS-2B cells showed light DNA damage in the Torino, Brescia and Pisa samples in winter, highlighting the higher sensitivity of BEAS-2B cells, which was consistent with the Ames test (p < 0.01). The results obtained showed that it is important to further investigate the finest fractions of PM, which represent a relevant percentage of PM10, taking into account the chemical composition and the biological effects induced.

Do polychlorinated biphenyls cause cancer? A systematic review and meta-analysis of epidemiological studies on risk of cutaneous melanoma and non-Hodgkin lymphoma.

In 2015 a IARC Working Group upgraded the classification of PCBs to Group 1 "Carcinogenic to humans", also on the basis of evidence from epidemiological studies showing an excess risk for melanoma. Increased risks for non-Hodgkin lymphoma (NHL) and breast cancer were also reported though the evidence was limited. However, some recent reviews of studies on PCB exposure and risk of cancer provided discrepant findings. Therefore, we re-evaluated the association between exposure to PCBs and risk of melanoma and NHL by a systematic review and meta-analysis. We retrieved 11 independent cohort studies on occupationally exposed workers. About half of them showed increased standardized mortality or incidence ratios (SMRs or SIRs) for melanoma and none for NHL. The pooled SMRs were 1.32 (95% CI: 1.05-1.64) for melanoma and 0.94 (0.73-1.23) for NHL. Among population-based cohort and case-control studies with individual measures of PCB exposure, one only study was carried out on PCB exposure and melanoma, showing an odds ratio (OR) of 6.0 (2.0-18.2) for the highest compared to lowest quartile of PCB distribution. 13 cohort and case-control studies evaluated the association between NHL and PCB concentration in blood or subcutaneous fat, with summary OR = 1.5 (1.1-1.7) for the highest vs lowest quantile of PCB distribution. However, two cohort studies on people intoxicated by rice oil containing PCBs found no excess of deaths for skin cancer and inconsistent results for NHL. In conclusion, these findings do not provide a strong evidence that PCB exposure can increase the risk of melanoma and NHL in humans.

What arguments on vaccinations run through YouTube videos in Italy? A content analysis.

BACKGROUND: The suspension of compulsory scheduling of some pediatric vaccines has been discussed for a long time by health authorities in Italy but the current decrease of vaccination rates is a matter of concern. YouTube is the most popular video-based social media website. Considering the demonstrated impact of internet on vaccination decision-making and the increasing use of social media to share and disseminate health information, the aim of this study was to explore the message available on YouTube videos about vaccination. METHODS: An observational study was conducted searching for YouTube videos in September 2015 and updated in January 2016, by using the keyword "vaccinations." We included recently posted videos in Italian on child vaccination (2014-2015). Videos were classified according to the message tone. RESULTS: A total of 123 videos were selected. Pro-vaccination videos were 62 (50%), anti-vaccination 28 (23%), neutral or without a clear position in favor or against vaccination 33 (27%). Focusing on the first 2 groups, pro-vaccination videos had a higher number of views compared with those unfavorable (1602 ± 6544 vs 1482 ± 2735) (p < 0.001). However, anti-vaccination videos were liked more by viewers (17.8 ± 31.3) than positive ones (13.2 ± 44.7) (p < 0.001) in addition to being more shared (23 ± 22.6 vs 3.8 ± 5.5, p < 0.001). CONCLUSIONS: Most of the videos were positive in tone, but those that disapproved of immunization were the most liked and shared. Considering the growing number of viewers, it is important to monitor the web to understand audience characteristics and what influences public opinions to use communication strategies more effectively.

Internet-Based Direct-to-Consumer Genetic Testing: A Systematic Review.

BACKGROUND: Direct-to-consumer genetic tests (DTC-GT) are easily purchased through the Internet, independent of a physician referral or approval for testing, allowing the retrieval of genetic information outside the clinical context. There is a broad debate about the testing validity, their impact on individuals, and what people know and perceive about them. OBJECTIVE: The aim of this review was to collect evidence on DTC-GT from a comprehensive perspective that unravels the complexity of the phenomenon. METHODS: A systematic search was carried out through PubMed, Web of Knowledge, and Embase, in addition to Google Scholar according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist with the key term "Direct-to-consumer genetic test." RESULTS: In the final sample, 118 articles were identified. Articles were summarized in five categories according to their focus on (1) knowledge of, attitude toward use of, and perception of DTC-GT (n=37), (2) the impact of genetic risk information on users (n=37), (3) the opinion of health professionals (n=20), (4) the content of websites selling DTC-GT (n=16), and (5) the scientific evidence and clinical utility of the tests (n=14). Most of the articles analyzed the attitude, knowledge, and perception of DTC-GT, highlighting an interest in using DTC-GT, along with the need for a health care professional to help interpret the results. The articles investigating the content analysis of the websites selling these tests are in agreement that the information provided by the companies about genetic testing is not completely comprehensive for the consumer. Given that risk information can modify consumers' health behavior, there are surprisingly few studies carried out on actual consumers and they do not confirm the overall concerns on the possible impact of DTC-GT. Data from studies that investigate the quality of the tests offered confirm that they are not informative, have little predictive power, and do not measure genetic risk appropriately. CONCLUSIONS: The impact of DTC-GT on consumers' health perceptions and behaviors is an emerging concern. However, negative effects on consumers or health benefits have yet to be observed. Nevertheless, since the online market of DTC-GT is expected to grow, it is important to remain aware of a possible impact.

Frequency of infectious diseases in immigrants in a Western European country: a population-based study.

The aim of this population-based study was to assess the incidence rates of infectious diseases in native- (Italian) and foreign-born (immigrants) populations in a North Italy area, in 2006-2010. Crude, age-specific incidence rates (IRs) and age-standardised rate ratios (SRRs) between foreign- and native-born subjects and their 95% confidence intervals (95% CI) were estimated. A total of 32,554 cases of infectious diseases were found (9.9% in foreign-born subjects). The highest SRRs between foreign- and nativeborn subjects were found for tuberculosis (SRR = 27.1; 95% CI 21.3-34.3), malaria (SRR = 21.1; 14.6-30.4), scabies (SRR = 8.5; 7.6-9.4), AIDS (SRR = 2.5; 1.8-3.4) and viral hepatitis B (SRR = 3.3; 2.1-5.2). The highest IR was found for AIDS in people from the Americas (IR = 4.57; 95% CI 2.2-8.4), for malaria and tuberculosis in people from Africa (IR = 13.89; 11.6-16.5 and IR = 11.87; 9.8-14.3 respectively). Therefore immigrants are at a higher risk of acquiring some common infectious diseases compared to the native population in Western European countries.

Progression to cirrhosis, hepatocellular carcinoma and liver-related mortality in chronic hepatitis B patients in Italy.

BACKGROUND: The natural history of chronic hepatitis B is variable. We evaluated some of the risk factors for cirrhosis, hepatocellular carcinoma and liver-related mortality in Italian patients with chronic hepatitis B. METHODS: A cohort of 105 untreated patients with chronic hepatitis B without cirrhosis at diagnosis was followed prospectively for a mean period of 23 years. Clinical, histological and ultrasound examinations, biochemical and virological tests, and causes of death were analyzed. RESULTS: Forty-two (40%) patients became inactive carriers and 63 (60%) showed persistent alanine aminotransferase elevation: 13 (13%) associated with HBeAg persistence, 35 (33%) with detectable serum HBV-DNA but HBeAg-negative, 11 (10%) with concurrent virus infection and 4 (4%) with non-alcoholic fatty liver disease. Cirrhosis incidence was 1.56/100 person-years. Older age and sustained HBV replication predicted cirrhosis occurrence independently. Hepatocellular carcinoma incidence was 2.1/100 person-years in patients who developed cirrhosis and 0.06 in those who did not. Cirrhosis occurrence was associated with an increased risk of hepatocellular carcinoma (hazard ratio 20.4, 95% confidence interval 2.54-167.5) and liver-related death (16.5, 2.0-138.8). CONCLUSIONS: In Italian patients with chronic hepatitis B cirrhosis strongly predicts hepatocellular carcinoma occurrence and disease-related mortality, thus indicating that early antiviral treatment should be instituted before cirrhosis occurrence.

A web search on environmental topics: what is the role of ranking?

BACKGROUND: Although the Internet is easy to use, the mechanisms and logic behind a Web search are often unknown. Reliable information can be obtained, but it may not be visible as the Web site is not located in the first positions of search results. The possible risks of adverse health effects arising from environmental hazards are issues of increasing public interest, and therefore the information about these risks, particularly on topics for which there is no scientific evidence, is very crucial. The aim of this study was to investigate whether the presentation of information on some environmental health topics differed among various search engines, assuming that the most reliable information should come from institutional Web sites. MATERIALS AND METHODS: Five search engines were used: Google, Yahoo!, Bing, Ask, and AOL. The following topics were searched in combination with the word "health": "nuclear energy," "electromagnetic waves," "air pollution," "waste," and "radon." For each topic three key words were used. The first 30 search results for each query were considered. The ranking variability among the search engines and the type of search results were analyzed for each topic and for each key word. The ranking of institutional Web sites was given particular consideration. RESULTS: Variable results were obtained when surfing the Internet on different environmental health topics. Multivariate logistic regression analysis showed that, when searching for radon and air pollution topics, it is more likely to find institutional Web sites in the first 10 positions compared with nuclear power (odds ratio=3.4, 95% confidence interval 2.1-5.4 and odds ratio=2.9, 95% confidence interval 1.8-4.7, respectively) and also when using Google compared with Bing (odds ratio=3.1, 95% confidence interval 1.9-5.1). CONCLUSIONS: The increasing use of online information could play an important role in forming opinions. Web users should become more aware of the importance of finding reliable information, and health institutions should be able to make that information more visible.

Nutritional supplements for diabetes sold on the internet: business or health promotion?

BACKGROUND: Diabetes is one of the most widespread chronic disease. Although many medications are available for the treatment and prevention of diabetes, many people turn to nutritional supplements (NSs). In these years, the online sales have contributed to the growth of use of nutritional supplement. The aim of the research was to investigate the type of information provided by sales websites on NSs, and analyse the existence of scientific evidence about some of the most common ingredients found in available NSs for diabetes. METHODS: A web search was conducted in April 2012 to identify web sites selling NSs in the treatment of diabetes using Google, Yahoo and Bing! and the key word used was "diabetes nutritional supplements". Website content was evaluated for the quality of information available to consumers and for the presence of a complete list of ingredients in the first NS suggested by the site. Subsequently, in order to analyze the scientific evidence on the efficacy of these supplements a PubMed search was carried out on the ingredients that were shared in at least 3 nutritional supplements. RESULTS: A total of 10 websites selling NSs were selected. Only half of the websites had a Food and Drug Administration disclaimer and 40% declared clearly that the NS offered was not a substitute for proper medication. A total of 10 NS ingredients were searched for on PubMed. Systematic reviews, meta-analyses or randomized control trials were present for all the ingredients except one. Most of the studies, however, were of poor quality and/or the results were conflicting. CONCLUSIONS: Easy internet access to NSs lacking in adequate medical information and strong scientific evidence is a matter of public health concern, mainly considering that a misleading information could lead to an improper prevention both in healthy people and people suffering from diabetes. There is a clear need for more trials to assess the efficacy and safety of these NSs, better quality control of websites, more informed physicians and greater public awareness of these widely used products.

Adrenergic receptor gene polymorphism and left ventricular reverse remodelling after cardiac resynchronization therapy: preliminary results.

AIMS: Several factors can influence the extent of left ventricular (LV) reverse remodelling after cardiac resynchronization therapy (CRT) in patients with heart failure (HF). Polymorphism in genes involved in cardiac remodelling, namely beta-adrenergic receptors (ARs), may have a role. We studied the influence of beta-1 Arg389Gly, beta-2 Arg16Gly, and beta-2 Gln27Glu ARs gene polymorphisms on the magnitude of reverse remodelling response to CRT and its possible correlations with the incidence of appropriate implantable cardioverter-defibrillator (ICD) shocks. METHODS AND RESULTS: Beta-ARs were assessed in 101 patients with HF due to idiopathic (50.5%) or ischaemic (49.5%) dilated cardiomyopathy, undergoing CRT for standard indications [left ventricular ejection fraction (LVEF) 23.5 ± 7.5%, QRS ≥ 120 ms]. Left ventricular ejection fraction was measured by echocardiography at baseline, 6 months after CRT, and periodically afterwards. The LVEF change from baseline was of 3.1 ± 11 units among Gln27Gln, 8.3 ± 10.4 units among Gln27Glu, 11 ± 6.4 units among Glu27Glu carriers (P = 0.018 for Gln27Gln vs. Glu27Glu carriers), and 8.8 ± 9.8 units among Gln27Glu + Glu27Glu carriers (P = 0.006 vs. Gln27Gln). Gln27 homozygotes had a higher incidence of appropriate ICD shocks for fast ventricular tachycardia/ventricular fibrillation. CONCLUSION: Beta-2 Gln27Glu ARs gene polymorphism may influence LV reverse remodelling after CRT with Glu27Glu carriers showing the greatest improvement. It may also influence the incidence of malignant ventricular tachyarrhythmias.

How has the flu virus infected the Web? 2010 influenza and vaccine information available on the Internet.

BACKGROUND: The 2009-10 influenza pandemic was a major public health concern. Vaccination was recommended by the health authorities, but compliance was not optimal and perception of the presumed associated risks was high among the public. The Internet is increasingly being used as a source of health information and advice. The aim of the study was to investigate the characteristics of websites providing information about flu vaccine and the quality of the information provided. METHODS: Website selection was performed in autumn 2010 by entering eight keywords in two of the most commonly used search engines (Google.com and Yahoo.com). The first three result pages were analysed for each search, giving a total of 480 occurrences. Page rank was evaluated to assess visibility. Websites based on Web 2.0 philosophy, websites merely displaying popular news/articles and single files were excluded from the subsequent analysis. We analysed the selected websites (using WHO criteria) as well as the information provided, using a codebook for pro/neutral websites and a qualitative approach for the adverse ones. RESULTS: Of the 89 websites selected, 54 dealt with seasonal vaccination, three with anti-H1N1 vaccination and 32 with both. Rank analysis showed that only classic websites (ones not falling in any other category) and one social network were provided on the first pages by Yahoo; 21 classic websites, six displaying popular news/articles and one blog by Google. Analysis of the selected websites revealed that the majority of them (88.8%) had a positive/neutral attitude to flu vaccination. Pro/neutral websites distinguished themselves from the adverse ones by some revealing features like greater transparency, credibility and privacy protection. CONCLUSIONS: We found that the majority of the websites providing information on flu vaccination were pro/neutral and gave sufficient information. We suggest that antivaccinationist information may have been spread by a different route, such as via Web 2.0 tools, which may be more prone to the dissemination of "viral" information. The page ranking analysis revealed the crucial role of search engines regarding access to information on the Internet.

Occult hepatitis B virus and the risk for chronic liver disease: a meta-analysis.

BACKGROUND: The role of occult hepatitis B virus infection as a cause of liver disease is still debated although many studies found a higher prevalence of this condition in subjects than those without liver disease compared. A recent meta-analysis showed an increased risk of hepatocellular carcinoma for occult hepatitis B virus infection. AIMS: We carried out a meta-analysis of observational studies to summarize the existing evidence and assess quantitatively the association between occult hepatitis B virus infection and chronic liver disease. METHODS: We searched the available literature on this issue published up to May 2012 using PubMed and EMBASE. All articles that provided enough information to estimate the chronic liver disease risk associated with occult hepatitis B virus infection were selected. Fourteen studies were retrieved. RESULTS: A total of 1503 subjects with (cases) and 2052 without chronic liver disease (controls) were included. The summary odds ratio for chronic liver disease from all studies was 8.9 (95% confidence interval: 4.1-19.5). The meta-analysis restricted to 7 studies with more precise effect estimate (wt%>8%) provided a lower odds ratio estimate (odds ratio=3.9; 95% confidence interval: 1.7-9.0). CONCLUSIONS: These findings suggest a relevant association between occult hepatitis B virus infection and chronic liver disease, confirming the hypothesis that hepatitis B virus may play a pathogenic role even in the "occult" status.