Psychosocial determinants of sleep difficulties in adolescence: the role of perceived support from family, peers, and school in an Italian HBSC sample.

The present study explores the concurrent contribution to sleep problems of individual-related, family-related, and school-related factors in adolescence. Gathering from the Italian 2018 Health Behavior in School-Aged Children (HBSC) data collection, we used hierarchical logistic regression on a sample of 3397 adolescents (51% females, Mage = 13.99, SD = 1.62) to explore the contribution to sleep problems of the individual (Model 1: alcohol use, smoking, screen time, physical activity), familial (Model 2: parental communication, parental support), and school-related (Model 3: peer support, schoolmates/students support, teacher support and school pressure) variables. 28.3 percent of adolescents reported having sleep difficulties. Overall, Model 3 significantly improved over Model 2 and Model 1. Data showed that increasing smoking (OR = 1.11; 95% CI: 1.03-1.20) and screen time (OR = 1.05; 95% CI: 1.02-1.08) were associated with sleep difficulties but not alcohol use and physical activity. Also, impaired communication with both parents and increasing parental support (OR = 0.84; 95% CI: 0.78-0.90) were associated with decreased odds of sleep problems. Finally, both increases in school pressure (OR = 1.40; 95% CI: 1.26-1.56) and lack of student support (OR = 1.25; 95% CI: 1.10-1.42) were associated with a higher likelihood of sleep problems, while peer support and teacher support were not.   Conclusion: Our findings highlight the importance of an integrated approach to the study of sleep difficulties in adolescence that includes specific psychosocial contributors such as the quality of parental communication and perceived parental support and considers the quality of the day-to-day relationship with schoolmates and the school level of demands. What is Known: • Adolescents' are at-risk of more significant sleep difficulties, and recent literature highlights the importance of an integrated approach to understanding this phenomenon, including biological, psychosocial, and contextual factors. • The literature lacks findings that consider the concurrent contribution of individual and psychosocial factors to sleep difficulties in adolescence. What is New: • The quality of parental communication and perceived parental support, as expressions of adult figures' emotional and behavioural availability in the adolescent's life, are significant determinants of sleep difficulties. • The quality of day-to-day relationships with schoolmates and the school level of demands contribute to adolescent sleep problems.

The Role of Technology and Social Media Use in Sleep-Onset Difficulties Among Italian Adolescents: Cross-sectional Study.

BACKGROUND: The use of technology and social media among adolescents is an increasingly prevalent phenomenon. However, there is a paucity of evidence on the relationship between frequency of use of electronic devices and social media and sleep-onset difficulties among the Italian population. OBJECTIVE: The aim of this study is to investigate the association between the use of technology and social media, including Facebook and YouTube, and sleep-onset difficulties among adolescents from Lombardy, the most populous region in Italy. METHODS: The relationship between use of technology and social media and sleep-onset difficulties was investigated. Data came from the 2013-2014 wave of the Health Behavior in School-aged Children survey, a school-based cross-sectional study conducted on 3172 adolescents aged 11 to 15 years in Northern Italy. Information was collected on difficulties in falling asleep over the last 6 months. We estimated the odds ratios (ORs) for sleep-onset difficulties and corresponding 95% CIs using logistic regression models after adjustment for major potential confounders. RESULTS: The percentage of adolescents with sleep-onset difficulties was 34.3% (1081/3151) overall, 29.7% (483/1625) in boys and 39.2% (598/1526) in girls. It was 30.3% (356/1176) in 11-year-olds, 36.2% (389/1074) in 13-year-olds, and 37.3% (336/901) in 15-year-olds. Sleep-onset difficulties were more frequent among adolescents with higher use of electronic devices, for general use (OR 1.50 for highest vs lowest tertile of use; 95% CI 1.21-1.85), use for playing games (OR 1.35; 95% CI 1.11-1.64), use of online social networks (OR 1.40 for always vs never or rarely; 95% CI 1.09-1.81), and YouTube (OR 2.00; 95% CI 1.50-2.66). CONCLUSIONS: This study adds novel information about the relationship between sleep-onset difficulties and technology and social media in a representative sample of school-aged children from a geographical location that has not been included in studies of this type previously. Exposure to screen-based devices and online social media is significantly associated with adolescent sleep-onset difficulties. Interventions to create a well-coordinated parent- and school-centered strategy, thereby increasing awareness on the unfavorable effect of evolving technologies on sleep among adolescents, are needed.

An overview on the emerging area of identification, characterization, and assessment of health apps.

The need to characterize and assess health apps has inspired a significant amount of research in the past years, in search for methods able to provide potential app users with relevant, meaningful knowledge. This article presents an overview of the recent literature in this field and categorizes - by discussing some specific examples - the various methodologies introduced so far for the identification, characterization, and assessment of health apps. Specifically, this article outlines the most significant web-based resources for app identification, relevant frameworks for descriptive characterization of apps' features, and a number of methods for the assessment of quality along its various components (e.g., evidence base, trustworthiness, privacy, or user engagement). The development of methods to characterize the apps' features and to assess their quality is important to define benchmarks and minimum requirements. Similarly, such methods are important to categorize potential risks and challenges in the field so that risks can be minimized, whenever possible, by design. Understanding methods to assess apps is key to raise the standards of quality of health apps on the market, towards the final goal of delivering apps that are built on the pillars of evidence-base, reliability, long-term effectiveness, and user-oriented quality.

Prevalence and Determinants of Tinnitus in the Italian Adult Population.

BACKGROUND: Limited, outdated, and poor quality data are available on the prevalence of tinnitus, particularly in Italy. METHODS: A face-to-face survey was conducted in 2014 on 2,952 individuals, who represented the Italian population aged 18 or more (50.6 million). Any tinnitus was defined as the presence of ringing or buzzing in the ears lasting for at least 5 min in the previous 12 months. RESULTS: Any tinnitus was reported by 6.2% of Italian adults, chronic tinnitus (i.e. for more than 3 months) by 4.8%, and severe tinnitus (i.e. which constitutes a big or very big problem) by 1.2%. The corresponding estimates for the population aged ≥45 years were 8.7, 7.4 and 2.0%, respectively. Multivariable analysis on population aged ≥45 years revealed that old age (odds ratio (OR) = 4.49 for ≥75 vs. 45-54 years) and obesity (OR = 2.14 compared to normal weight) were directly related to any tinnitus, and high monthly family income (OR = 0.50) and moderate alcohol consumption (OR = 0.59 for <7 drinks/week vs. non-drinking) were inversely related. CONCLUSIONS: This is the first study on tinnitus prevalence among the general Italian adult population. It indicates that in Italy tinnitus affects more than 3 million adults and is felt as a major problem by more than 600,000 Italians, mostly aged 45 years or more.

[Social media and health communication: do we need rules?]. / Comunicazione della salute sui social media: abbiamo bisogno di regole?

Social media, online social networks and apps for smartphones and tablets are changing the way to communicate health and health issues to consumers and health professionals. Google, Facebook, Apple, and other companies have launched tools to make easier the doctor-patient communication, to group patients with similar diseases allowing them to share stories, experiences, and opinions, and to remotely track and monitor users health and wellbeing. However several concerns about patients' and consumers' privacy remain. Doctor-patient communication through e-mail and social media also introduces other ethical and privacy issues that were addressed only by few medical societies with appropriate guidelines and policies. In addition, pharmaceutical companies have started to use social media channels to communicate with doctors, patients and consumers. This type of communication has been only partially regulated by the Food and Drug Administration with the recently published guidelines for industries. Similar concerns exist for health and medical applications for smartphones and tablets for which only few agencies (including Food and Drug Administration) are requiring a formal (even if restricted in typology) validation. It's time for Europe and Italy to adopt appropriate guidelines for the use of the new media in health communication.

[Social media and medical apps: how they can change health communication, education and care]. / I social media, le apps e la trasformazione della comunicazione, della formazione e dell'assistenza in sanità

Social media and medical apps for smartphones and tablets are changing health communication, education and care. This change involves physicians and other health care professionals which for their education, training and updating have started to follow public pages and profiles opened by medical journals and professional societies on the online social networking sites (such as Facebook, Twitter and Google+), to access scientific content (videos, images, slides) available on user-generated contents sites (such as SlideShare, Pinterest and YouTube) or on health professional online communities such as Sermo, and to use medical and health apps on their smartphones and tablets. As shown by a number of experiences conducted in US by health institutions such as the Centers for Disease Control and Prevention of Atlanta and hospitals such a the Mayo Clinic, these tools are also transforming the way to make health promotion activities and communication, promote healthy habits and lifestyles, and prevent chronic diseases. Finally this change involves patients which are starting to use medical and health apps on their smartphones and tablets to monitor their diseases, and tools such as Patients Like Me (an online patients' community), Facebook and Twitter to share with others the same disease experience, to learn about the disease and treatments, and to find opinions on physicians, hospitals and medical centers. These new communication tools allow users to move to a kind of collaborative education and updating where news and contents (such as public health recommendations, results of the most recent clinical researches or medical guidelines) may be shared and discussed.

[Artificial intelligence in medicine: are we ready?] / Intelligenza artificiale in medicina: siamo pronti?

Artificial intelligence (Ai) tools, in particular those based on machine learning (Ml) and deep learning techniques, have found application in numerous fields of medicine. They are used to create chatbots to provide health information to citizens and patients, to make medical diagnoses, to identify the best treatment to use for a specific patient, to predict a patient's risk of experiencing a specific event, to identify the most promising drug candidate in which to invest in clinical research, and to identify possible cause-effect relationships between pathologies and data collected through the various available sources. The results of published clinical trials measuring the reliability, safety, and efficacy of these tools are often encouraging. However, there are systematic reviews and meta-analyses highlighting the methodological limitations of these studies. Many of these are retrospective and based on previously assembled datasets, while few are prospective ones conducted in real clinical settings and very few are those based on randomized controlled clinical trials. Furthermore, many of these adopt an internal validation of the Ai system to the detriment of an external validation, while the comparison between the performance of the Ml models and that of the experts is only in a few cases conducted using the same dataset. Before being used in the healthcare field, Ai and Ml systems should pass through the scrutiny of rigorous scientific validation, based on methodologically solid studies (prospective, possibly randomized and conducted in real clinical environments) which demonstrate non-inferiority, or superiority, as well as cost-effectiveness, compared to the conventional diagnostic and decision-making pathway. Furthermore, it is necessary to demonstrate the safety and reproducibility in the use of the software and to consider the emerging ethical and legal issues inherent in the professional liability of the doctor in the interaction with the algorithms.

Chronic pancreatitis and pancreatic lithiasis. State of the art.

Chronic pancreatitis and pancreatic lithiasis, isolated or associated, are infrequent diseases in western countries. They are linked to alcohol abuse, cigarette smoking, repeated episodes of acute pancreatitis and hereditary genetic factors. They are characterised by persistent or recurrent epigastric pain, digestive insufficiency, steatorrhoea, weight loss and secondary diabetes. They are easily diagnosed with CT and MRI ultrasound, but are difficult to treat. Medical therapy is symptomatic for diabetes and digestive failure. Invasive treatment is indicated only for pain that cannot be treated otherwise. For lithiasic forms, the therapeutic goal of removing stones can be achieved with shockwave and endoscopy, obtaining fragmentation and extraction of the stones. When this does not happen and these aids have proved ineffective, surgery must be used either as a partial or total resection of the afflicted pancreas, or as a derivation in the intestine of the pancreatic duct dilated and obstructed by Wirsung-jejunal anastomosis. These invasive treatments are effective in 80% of cases, but burdened with complications in 10% and relapses in 5%. KEY WORDS: Chronic Pancreatitis, Chronic Pain, Pancreatic Lithiasis.

Large retroperitoneal sarcoma invading the inferior vena cava successfully resected. Technical notes of two cases.

Retroperitoneal sarcomas are rare neoplasms . They frequently reach a very large size and invade adjacent organs before they are detected. Involvent of the inferior vena cava is uncommon. Distant metastases are a late feature. The mainstay of treatment is compartmental resection and contiguous organ resection. We report two cases of right-sided massive primary retroperitoneal leiomyosarcoma in pauci symptomatic women. In both cases treatment consisted of radical surgery. En bloc resection of the tumor and surrounding tissues and organs as well as part of the right wall of the subrenal IVC. To close the wall defect direct suture repair was used resulting in a reduced caliber but no hemodynamic sequelae or endoluminal thrombi. All the resection margins, including the inferior vena cava wall, were negative. The postoperative course was unremarkable and caval blood flow was optimal. The current gold standard treatment for retroperitoneal sarcoma is en bloc multivisceral resectionresection. KEY WORDS: Peritoneal sarcoma, Surgery, Vena cava.

Should I give kids money? The role of pocket money on at-risk behaviors in Italian adolescents.

BACKGROUND: Discussion on the impact of pocket money on positive behaviors is still debated. OBJECTIVE: To investigate the effect of diverse money allowance schemes on risky behaviors (smoking, alcohol, binge drinking, drug use, gambling) during adolescence. METHOD: 989 students aged 15 from Lombardy (Italy) reported information on money availability in the 2018 wave of the Health Behaviour in School-aged Children study. To analyze the relationship between money availability and risky behaviors we computed odds ratios and 95% confidence intervals through unconditional multiple logistic regression models. RESULTS: Spending more than 10€ weekly was associated with higher likelihood to smoke, binge drink or gamble. Receiving pocket money (rather than receiving money upon request) was related to higher likelihood to engage in risky behaviors. CONCLUSIONS: Pocket money may have a negative impact on adolescents, particularly with a substantial amount of money. More research is needed to understand why providing money only if needed may serve as a protective factor against risky behaviors.

[Psychological interventions on the Internet and digital therapeutics in the field of mental health: are we ready?] / Interventi psicologici su Internet e terapie digitali nell'ambito della salute mentale: siamo pronti?

In the last years, Information and Communication Technology has increasingly offered solutions in the field of psychology and mental health. Internet-based psychological interventions, apps, solutions based on social media have been suggested as tools to be used with the usual psychotherapy interventions, or in some cases, in substitution to them. Many of these are based on cognitive behavioral therapy (which by its nature is easily transferable into digital format) and fall into the category of digital therapeutics. On the other hand, tele-psychiatry, an area in strong expansion (also justified by the need to continue providing care to patients in this period of covid-19 which has prevented, or severely limited, face-to-face meetings), seems to improve the access to specialized mental health care, reduce delays in care, reduce stigma and promote greater patient attention. There is evidence that comes from randomized clinical trials, systematic reviews and meta-analysis and that demonstrates the efficacy of these tools in managing and preventing episodes of depression, anxiety and addictions. For other mental health disorders further confirmation is needed. In this context, it is therefore necessary to make greater use of randomized clinical trials with an adequate number of patients recruited, with a sufficient observation period and with easily measurable endpoints.

[Social media and health: it's time to refine the methodology for interpreting studies and evaluating information.] / Social media e salute: affinare la metodologia per interpretare e valutare le informazioni.

The pandemic we are experiencing has accelerated the availability of health content on the Internet, multiplying the points at which such content is generated and shared. As a result, we have witnessed the growing of the "infodemic" phenomenon. To combat it, over the years a series of documents and guides have been produced to provide tools allowing users to evaluate health-related content on the Net. With the advent of social media platforms, these tools have been adapted to posts and videos, focusing on reliability and completeness of the contents, conflicts of interest, accessibility, and usability of social media platforms. Access to studies using data from social media platforms can also lend themselves to misinterpretation. A methodology similar to that used to evaluate systematic reviews to be applied to studies of social media platforms could help citizens, patients and doctors to understand if researchers have focused on the right questions, have provided the right answers, have used the most appropriate social media platforms and analytics tools. Taking a cue from the methodology today used to generate reliable content and to interpret the results of systematic reviews could be the right way to address these new research areas with greater scientific rigor.

[Applications of digital medicine to care pathways: taxonomy, methods, impact on patients, barriers to overcome.] / Applicazioni della digital medicine ai PDTA: tassonomia, metodologia, impatto sul paziente e barriere da superare.

Digital health represents an important step in the management of chronic diseases also in light of the reform of proximity care that is intended to be implemented as part of the Recovery Plan (PNRR). For this purpose, the inclusion of digital health tools in the care pathways is strategic. A specific Working Group of the MaCroScopio Project defined a taxonomic, methodological and cultural framework within which the development of digital health can be promoted. This would ensure that the introduction of this type of technological innovation addresses not only the need for a more efficient health system but also the real patients' healthcare requirements. At the same time it fosters the reduction of healthcare access inequalities, instead of their exacerbation.

Prevalence and Correlates of Overweight, Obesity and Physical Activity in Italian Children and Adolescents from Lombardy, Italy.

Investigating pediatric overweight and physical activity correlates is essential to design effective preventive programs. We used regional data (Lombardy, northern Italy) from the 2019 survey "OKKio alla Salute" (3093 children aged 8-9 years with measured anthropometric data), and from the 2018 wave of the "Health Behaviour in School-aged Children" survey (2916 adolescents aged 11-15 years with self-reported anthropometric data). In both the surveys, a cluster sampling methodology was used. Unconditional multiple logistic regression models were applied to estimate the odds ratios (OR) and corresponding 95% confidence intervals (CI) of overweight, obesity and poor physical activity. The prevalence of overweight (including obesity) was 22.4% for children aged 8-9 years and 14.4% for adolescents aged 11-15 years. A higher prevalence of overweight was observed among males, children with greater birth weight and those with obese parents. Scant physical activity was higher among females and older adolescents. There was a direct relationship between obesity and increased psychological distress (OR = 2.44; 95% CI: 1.12-5.27) or being victims of bullying (OR = 2.25; 95% CI: 1.17-4.34). Increasing physical activity significantly decreased the frequency of mental health outcomes. Prevention campaigns should be promoted to safeguard childhood physical and psychological wellbeing.

[The concrete contribution of digital health to improving individual and population adherence.] / Il contributo della digital health al miglioramento dell'aderenza individuale e di popolazione.

From traditional alert systems based on applications or text messages to MEMS (Medication Event Monitoring System), up to technologically advanced systems such as the so-called "smart pills", and those printed with 3D technology containing sensors capable of regulating the gradual release of the active substance based on the patient's health, the article offers a brief review of the experiences of applying digital health to improve adherence to drug treatment.

A Proposal For COVID-19 Applications Enabling Extensive Epidemiological Studies.

During the next phase of COVID-19 outbreak, mobile applications could be the most used and proposed technical solution for monitoring and tracking, by acquiring data from subgroups of the population. A possible problem could be data fragmentation, which could lead to three harmful effects: i) data could not cover the minimum percentage of the people for monitoring efficacy, ii) it could be heavily biased due to different data collection policies, and iii) the app could not monitor subjects moving across different zones or countries. A common approach could solve these problems, defining requirements for the selection of observed data and technical specifications for the complete interoperability between different solutions. This work aims to integrate the international framework of requirements in order to mitigate the known issues and to suggest a method for clinical data collection that ensures to researchers and public health institution significant and reliable data. First, we propose to identify which data is relevant for COVID-19 monitoring through literature and guidelines review. Then we analysed how the currently available guidelines for COVID-19 monitoring applications drafted by European Union and World Health Organization face the issues listed before. Eventually we proposed the first draft of integration of current guidelines.

[Social media for continuing education in nephrology. Myth or reality?]

About 60% of the world population has access to the Internet in 2021, making it the main tool in fostering communication between people. Lately, digital information and communication have especially taken place on platforms known as Social Media (SoMe) or Social Networks. In the last decade the usefulness of these tools in carrying information aimed at updating professionals in Medicine and Nephrology has become evident. There are several examples of SoMe utilization in Nephrology, as demonstrated by the existing accounts or Pages operated by the main international nephrological Scientific Societies, or the most renowned specialized medical journals. Twitter, Facebook and YouTube are the most versatile SoMe for these objectives; however, other platforms such as Tik Tok, Linkedin, Instagram, and WhatsApp may serve the same purpose. This digital revolution in disseminating information has proved very useful during the recent COVID-19 pandemic, even though some inappropriate uses have emerged, such as the diffusion of fake news, which has favored the emergence of "adverse effects" or a surge of antiscientific positions. In this review, we examine how physicians and nephrologists can take advantage of digital information for their continuing education. We quote the main resources in the international scenario and illustrate some specific national examples, such as the Journal Club of the Nephrology post-graduate program of the University of Milan and the Facebook group "Medical and Nephrology Community".

[Information technology and digital health to support health in the time of CoViD-19.] / Information technology e digital health a supporto della salute ai tempi della CoViD-19.

The CoViD-19 pandemic has provided the opportunity for the health care's digital revolution with the unprecedented accelerated expansion of telehealth, telemedicine and other digital health tools. Several tools have been developed and launched at national and international level to face the emergency, including tools to perform online triage, symptoms checking, video visits and remote monitoring, and to conduct local and national epidemiological surveillance studies. Artificial intelligence-based tools have also been developed to diagnose cases of CoViD-19 or to identify patients at risk. Most of these technologies have been endorsed by medical societies such as the American Medical Association and the American Academy of Family Physicians which launched specific guidelines about their use. The growth in telemedicine services and in digital health technologies could not have occurred without important telehealth regulatory changes that have occurred in some countries aimed at promoting their use to face the CoViD-19 emergency, such as the deregulation of the use of video conferencing and video chat systems to carry out video visits, and the payment parity between telehealth and in clinic care. In order to decide whether to continue using these tools even after the pandemic is over, it could be useful to perform validation and efficacy studies of these tools to study their implications on the doctor-patient relationship, to understand if the new features can be integrated with the other technological tools already in use, and if they can improve clinical practice and quality of care.

Adenocarcinoma of the esophagogastric junction: the role of abdominal-transhiatal resection.

The surgical strategy for adenocarcinoma of the esophagogastric junction is still controversial. The aim of this study was to evaluate surgical results of the abdominal-transhiatal approach for 100 consecutively operated type II and III cardia adenocarcinoma, to clarify clinicopathological differences between these tumors, and to define prognostic factors. A prospectively maintained database identified 100 consecutively operated patients with Siewert type II and III cardia adenocarcinoma. Survival was analyzed by the Kaplan-Meier method. Differences between subgroups and prognostic factors were evaluated by the log rank test and Cox regression. Concerning clinicopathological characteristics, only the incidence of T1-2 stage was significantly higher in Siewert II type (P = .006). A complete (R0) resection was obtained in 74 patients (74%). Overall postoperative mortality and morbidity rates were 6% and 28%, respectively. Overall actuarial 5-year survival rate in resected patients was 27.4% (median 27 months), with 20.6% for type II and 34 for type III cancers (P = .07). Considering R0 resections, overall actuarial 5-year survival rate was 33.9% (median 33 months), with 26.7% for type II and 40.5 for type III cancer (P = .06). Pathologic T and N stage and R status were independent prognostic factors by multivariate analysis, and Siewert type showed a trend toward significance. The abdominal-transhiatal approach is a safe surgical approach, allowing complete tumor resection and adequate lymphadenectomy in these patients. True carcinoma of the cardia may be a distinct clinical entity with a more aggressive natural history than subcardial gastric carcinoma.