Smoking and alcohol by HPV status in head and neck cancer: a Mendelian randomization study.

HPV-positive and HPV-negative head and neck squamous cell carcinoma (HNSCC) are recognized as distinct entities. There remains uncertainty surrounding the causal effects of smoking and alcohol on the development of these two cancer types. Here we perform multivariable Mendelian randomization (MR) to evaluate the causal effects of smoking and alcohol on the risk of HPV-positive and HPV-negative HNSCC in 3431 cases and 3469 controls. Lifetime smoking exposure, as measured by the Comprehensive Smoking Index (CSI), is associated with increased risk of both HPV-negative HNSCC (OR = 3.03, 95%CI:1.75-5.24, P = 7.00E-05) and HPV-positive HNSCC (OR = 2.73, 95%CI:1.39-5.36, P = 0.003). Drinks Per Week is also linked with increased risk of both HPV-negative HNSCC (OR = 7.72, 95%CI:3.63-16.4, P = 1.00E-07) and HPV-positive HNSCC (OR = 2.66, 95%CI:1.06-6.68, P = 0.038). Smoking and alcohol independently increase the risk of both HPV-positive and HPV-negative HNSCC. These findings have important implications for understanding the modifying risk factors between HNSCC subtypes.

Retinal Microvascular Changes in Association with Endothelial Glycocalyx Damage and Arterial Stiffness in Patients with Diabetes Mellitus Type 2: A Cross-Sectional Study in a Greek Population.

PURPOSE: To evaluate the potential association between endothelial glycocalyx damage, as well as arterial stiffness, and the retinal changes on optical coherence tomography (OCT) and OCT-angiography (OCT-A) in patients with type 2 diabetes mellitus (DM). METHODS: Participants in this cross-sectional study were 65 patients with DM type 2 and 42 age- and gender-matched controls without DM. The demographic and clinical characteristics of the participants were recorded. All patients underwent a thorough ophthalmological examination and multimodal imaging, including fundus photography, OCT, and OCT-A. In addition, evaluation of the endothelial glycocalyx thickness by measuring the perfused boundary region (PBR5-25) of the sublingual microvessel, as well as of the arterial stiffness, by measuring the carotid-femoral pulse wave velocity (PWV), the central aortic pressures and the augmentation index (Aix) was performed. Univariate and multivariate logistic regression analysis was performed for the examination of the potential association between the eye imaging variables and the cardiovascular-related variables. The odds ratios (OR) with the respective 95% confidence intervals (CI) were calculated. A p-value < 0.05 was considered statistically significant. RESULTS: Patients with DM presented significantly higher PBR5-25 compared to controls without DM (p = 0.023). At the univariate analysis, increased PBR5-25 (≥2.19 µm vs. <2.19 µm) was associated with decreased peripapillary VD at the superior quadrant (univariate OR (95% CI) = 0.34 (0.12-0.93), p = 0.037). Multivariate logistic regression analysis showed that increased PWV (≥13.7 m/s vs. <13.7 m/s) was associated with an increased foveal avascular zone (FAZ) area on OCT-A (p = 0.044) and increased FAZ perimeter (p = 0.048). Moreover, increased Aix (≥14.745% vs. <14.745%) was associated with diabetic macular edema (DME) presence (p = 0.050) and increased perifoveal and parafoveal superior and temporal thickness on OCT (p < 0.05 for all associations). CONCLUSIONS: Markers of endothelial damage and arterial stiffness were associated with structural and microvascular retinal alterations in patients with DM, pointing out that OCT-A could be a useful biomarker for detecting potential cardiovascular risk in such patients.

Smartphone Use and Social Media Involvement in Young Adults: Association with Nomophobia, Depression Anxiety Stress Scales (DASS) and Self-Esteem.

Excessive smartphone use and dependence on social media give rise to multiple issues that negatively affect the overall well-being of individuals. Nomophobia is characterized as a "digital disease" due to the unlimited use of smartphone devices. The aim of this study is to examine smartphone use and social media involvement in association with nomophobia and psychological traits (i.e., depression, anxiety, stress, and self-esteem) of young adults. A cross-sectional investigation was conducted on 1408 Greek undergraduate students aged 18 to 25 years, using an anonymous self-reported questionnaire. Study data were collected through the Nomophobia Questionnaire (NMP-Q), Depression Anxiety Stress Scale (DASS-21), and Rosenberg Self-Esteem Scale (RSES). Participants' social media engagement was summarized through four variables: use of social media applications, number of friends, number of followers, and number of messages exchanged daily on social media. High levels of nomophobia were associated with high engagement in social media and, thereby, with a high number of friends. The same applies to participants with high/normal self-esteem compared to those with low. Regarding stress, anxiety and depression were not associated with digital network use, while elevated stress and anxiety seemed to play a negative role in the number of online followers. In addition, high levels of anxiety were correlated to an increased number of messages exchanged through social media applications.

The Association between the Dietary Antioxidant Index and Weight Status in Primary School Students: An Epidemiological Study.

Obesity is an emerging threat and a current challenge for children and adolescents worldwide. The aim of the present work was to evaluate the relationship between the Dietary Antioxidant Index (DAI) and the weight status of students in early adolescence. A sample of 1580 students aged 10-12 years from 47 primary schools in Greece were enrolled. Anthropometric characteristics were assessed, and calculation of the Body Mass Index (BMI) was used to categorize students into two weight-status groups. Dietary habits and physical activity were evaluated using a self-completed questionnaire, and the DAI was calculated through derived micronutrients' content, along with energy, macro-, and micro-nutrient intake. Crude and adjusted regression analysis showed a significant inverse association of the DAI and body weight status (Odds Ratio (OR): 0.719, 95% Confidence Interval (CI): 0.576; 0.897, and adjusted Odds Ration (aOR): 0.667, 95% CI: 0.489; 0.907). An antioxidant diet seems to play a protective role against increased body weight among students in early adolescence. Thus, dietary patterns rich in antioxidants should be promoted to facilitate healthy habits early in life, and to fight the obesity threat.

The Complexity of Tobacco Smoke-Induced Mutagenesis in Head and Neck Cancer.

Tobacco smoke, alone or combined with alcohol, is the predominant cause of head and neck cancer (HNC). Here, we further explore how tobacco exposure contributes to cancer development by mutational signature analysis of 265 whole-genome sequenced HNC from eight countries. Six tobacco-associated mutational signatures were detected, including some not previously reported. Differences in HNC incidence between countries corresponded with differences in mutation burdens of tobacco-associated signatures, consistent with the dominant role of tobacco in HNC causation. Differences were found in the burden of tobacco-associated signatures between anatomical subsites, suggesting that tissue-specific factors modulate mutagenesis. We identified an association between tobacco smoking and three additional alcohol-related signatures indicating synergism between the two exposures. Tobacco smoking was associated with differences in the mutational spectra and repertoire of driver mutations in cancer genes, and in patterns of copy number change. Together, the results demonstrate the multiple pathways by which tobacco smoke can influence the evolution of cancer cell clones.

Palliative Care in the Community: The Greek Version of the Supportive and Palliative Care Indicators Tool (SPICT™).

INTRODUCTION/OBJECTIVES: Systematic identification of persons with palliative care needs constitutes a major challenge for promoting palliative care in all levels of the health system, including primary care. The aim of this study was to translate, cross-culturally adapt, and content validate Supportive and Palliative Care Indicators Tool (SPICT) for use in the Greek primary care context. Secondary objectives were to probe the use of SPICT-GR in exemplary case vignettes, to discuss the clarity and comprehensibility of its content as well as the appropriateness, acceptability, and feasibility of the tool within the Greek primary care. METHODS: The Greek translation and cross-cultural adaptation of SPICT™ followed World Health Organization recommendations for translation and adaptation of instruments. For this purpose a working group was set up consisting of 2 senior researchers, a primary care professional with postgraduate training in Palliative Medicine and a general practitioner (GP) with special interest in primary palliative care. Three focus groups comprised of health professionals (n = 23) working in primary care settings participated in the pilot testing phase. Participants also completed a questionnaire including rating their perceptions on tool's utility and feasibility as well as on the clarity and relevance of its items. Thematic analysis was used for focus groups discussions on how the tool was perceived and interpreted by health professionals in a Greek healthcare context and descriptive statistics for the quantitative analysis of the questionnaire data. RESULTS: The majority assessed the tool as useful (65%), considered its implementation in primary care as feasible (91%) and rated its items as "relevant" or "very relevant" and "clear" or "very clear." Three themes emerged from focus groups discussions: Guiding clinical practice and facilitating collaboration; promoting comprehensive care and awareness for palliative care; applicability in and suitability for primary care. CONCLUSIONS: SPICT-GR™ was identified as a practical and applicable tool for primary care, a source of guidance for the comprehensive identification of patients' palliative care needs, promoting awareness on palliative care and facilitating a shared language among health care professionals.

Perceptions and educational needs of social and healthcare professionals in the prevention of domestic violence - A focus group study.

OBJECTIVE: To explore and describe social and healthcare professionals' perceptions and educational needs in relation to domestic violence and its prevention. METHODS: A qualitative research was conducted in three European countries. Two multidisciplinary focus group interviews were conducted (in each country) among professionals and higher education teachers in the field of social and health care. Total number of participants were 32 (Finland n=12, Greece n=12, Portugal n=8). The transcribed data were analyzed by thematic analysis. RESULTS: Participants' perceptions of domestic violence and its prevention included: multidimensional phenomenon, consequences, and addressing concern. Domestic violence was seen as a multidimensional phenomenon, which has various consequences for several aspects of life. Professionals have difficulties addressing their concern due to lack of knowledge and tools. Solutions to prevent domestic violence that the participants shared were: education, intervention, and strategies. Education was seen as the key aspect for the prevention of domestic violence. Also, professionals' communication and situation management skills, as well as national and international strategies, were seen as valuable solutions. Educational needs for prevention of domestic violence were expressed based on content, methods, and practices, such as services system and legislation. CONCLUSION: The findings of the current study highlight the social- and healthcare professionals' need for education about domestic violence. It is essential that these professionals receive appropriate training to effectively identify and address domestic violence. The current study provides useful information for the development of relevant training/education for this group of professionals.

Dietary intake of vitamin C and gastric cancer: a pooled analysis within the Stomach cancer Pooling (StoP) Project.

BACKGROUND: Previous studies suggest that dietary vitamin C is inversely associated with gastric cancer (GC), but most of them did not consider intake of fruit and vegetables. Thus, we aimed to evaluate this association within the Stomach cancer Pooling (StoP) Project, a consortium of epidemiological studies on GC. METHODS: Fourteen case-control studies were included in the analysis (5362 cases, 11,497 controls). We estimated odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between dietary intake of vitamin C and GC, adjusted for relevant confounders and for intake of fruit and vegetables. The dose-response relationship was evaluated using mixed-effects logistic models with second-order fractional polynomials. RESULTS: Individuals in the highest quartile of dietary vitamin C intake had reduced odds of GC compared with those in the lowest quartile (OR: 0.64; 95% CI: 0.58, 0.72). Additional adjustment for fruit and vegetables intake led to an OR of 0.85 (95% CI: 0.73, 0.98). A significant inverse association was observed for noncardia GC, as well as for both intestinal and diffuse types of the disease. The results of the dose-response analysis showed decreasing ORs of GC up to 150-200 mg/day of vitamin C (OR: 0.54; 95% CI: 0.41, 0.71), whereas ORs for higher intakes were close to 1.0. CONCLUSIONS: The findings of our pooled study suggest that vitamin C is inversely associated with GC, with a potentially beneficial effect also for intakes above the currently recommended daily intake (90 mg for men and 75 mg for women).

Perceptions and attitudes of people with severe mental disorders towards smoking in Greece.

Despite its significant decline in the general population, smoking remains endemic and highly prevalent among people with mental disorders. The impact of smoking-attributable morbidity on life expectancy is significant since, in comparison to the general population, people with severe mental disorders have a 15-20-year reduction in life expectancy. A cross-sectional study was conducted among 1015 people with mental disorders through personal interviews. The questionnaire was designed to examine these patients' knowledge, perceptions, and attitudes towards smoking. Individuals were recruited from the mental health residential community services, the outpatient department, and the inpatient facilities of the Psychiatric Hospital of Attica. Statistical analysis was performed using SPSS 26.0. In the sample analyzed, the current-smoking prevalence stood at 68.4% (n=643), while 12.3% reported being former smokers. A staggering 86.3% smoked their first cigarette within 30 minutes of waking up, indicating a high level of dependence. Most of the former smokers (83.6%) reported that their main reason for quitting smoking was to improve their health, and the overwhelming majority (97.4%) had done so using no smoking cessation aid. Although slightly over half of the participants (53.7%) believed that health professionals adequately inform smokers about the harmful health effects of tobacco products, the information provided by health professionals on smoking cessation programs and tobacco harm reduction alternatives was considered sufficient by a mere 11.2%. Multiple logistic regression analysis demonstrated that outpatients tended to have a greater likelihood of being current smokers as compared to inpatients (OR=1.45), while users of mental health residential community services showed a significantly lower likelihood of being current smokers in comparison to inpatients (OR=0.49). Additionally, it was found that women had a lower likelihood of being current smokers compared to men (OR=0.51), while divorced/ widowed participants had a greater likelihood of being current smokers compared to single ones (OR=1.93). Finally, multiple regression analysis indicated that participants with psychotic disorders displayed a 2.39 times greater likelihood of being current smokers compared to those with mood disorders (OR=2.39). Understanding the knowledge, beliefs, and attitudes of people with mental disorders towards tobacco is an essential first step to confronting this neglected epidemic.

Diagnostic accuracy of HPV16 early antigen serology for HPV-driven oropharyngeal cancer is independent of age and sex.

A growing proportion of head and neck cancer (HNC), especially oropharyngeal cancer (OPC), is caused by human papillomavirus (HPV). There are several markers for HPV-driven HNC, one being HPV early antigen serology. We aimed to investigate the diagnostic accuracy of HPV serology and its performance across patient characteristics. Data from the VOYAGER consortium was used, which comprises five studies on HNC from North America and Europe. Diagnostic accuracy, that is, sensitivity, specificity, Cohen's kappa and correctly classified proportions of HPV16 E6 serology, was assessed for OPC and other HNC using p16INK4a immunohistochemistry (p16), HPV in situ hybridization (ISH) and HPV PCR as reference methods. Stratified analyses were performed for variables including age, sex, smoking and alcohol use, to test the robustness of diagnostic accuracy. A risk-factor analysis based on serology was conducted, comparing HPV-driven to non-HPV-driven OPC. Overall, HPV serology had a sensitivity of 86.8% (95% CI 85.1-88.3) and specificity of 91.2% (95% CI 88.6-93.4) for HPV-driven OPC using p16 as a reference method. In stratified analyses, diagnostic accuracy remained consistent across sex and different age groups. Sensitivity was lower for heavy smokers (77.7%), OPC without lymph node involvement (74.4%) and the ARCAGE study (66.7%), while specificity decreased for cases with <10 pack-years (72.1%). The risk-factor model included study, year of diagnosis, age, sex, BMI, alcohol use, pack-years, TNM-T and TNM-N stage. HPV serology is a robust biomarker for HPV-driven OPC, and its diagnostic accuracy is independent of age and sex. Future research is suggested on the influence of smoking on HPV antibody levels.

Reproductive factors, hormonal interventions, and gastric cancer risk in the Stomach cancer Pooling (StoP) Project.

BACKGROUND: Gastric cancer incidence is higher in men, and a protective hormone-related effect in women is postulated. We aimed to investigate and quantify the relationship in the Stomach cancer Pooling (StoP) Project consortium. METHODS: A total of 2,084 cases and 7,102 controls from 11 studies in seven countries were included. Summary odds ratios (ORs) and 95% confidence intervals (CIs) assessing associations of key reproductive factors and menopausal hormone therapy (MHT) with gastric cancer were estimated by pooling study-specific ORs using random-effects meta-analysis. RESULTS: A duration of fertility of ≥ 40 years (vs. < 20), was associated with a 25% lower risk of gastric cancer (OR = 0.75; 95% CI: 0.58-0.96). Compared with never use, ever, 5-9 years and ≥ 10 years use of MHT in postmenopausal women, showed ORs of 0.73 (95% CI: 0.58-0.92), 0.53 (95% CI: 0.34-0.84) and 0.71 (95% CI: 0.50-1.00), respectively. The associations were generally similar for anatomical and histologic subtypes. CONCLUSION: Our results support the hypothesis that reproductive factors and MHT use may lower the risk of gastric cancer in women, regardless of anatomical or histologic subtypes. Given the variation in hormones over the lifespan, studies should address their effects in premenopausal and postmenopausal women. Furthermore, mechanistic studies may inform potential biological processes.

Nomophobia and Its Association with Depression, Anxiety and Stress (DASS Scale), among Young Adults in Greece.

Smartphones with their numerous applications have become essential daily equipment, prompting scientific research to deal with the impact of their use on psychosocial health. Under this spectrum, the aim of the present cross-sectional study was to examine the association between nomophobia and the negative emotional states of depression, anxiety, and stress, in relation to self-esteem and sociodemographic data, among the young adult population. The study sample consisted of 1408 young adults aged 18-25 years, participating on a voluntary basis with an online anonymous questionnaire. Data were collected through the "Nomophobia Questionnaire (NMP-Q)", "Depression Anxiety Stress Scales-short form (DASS-21)", and Rosenberg Self-Esteem Scale (RSES). The questionnaire also included socio-demographic characteristics and smartphone use variables. Data analysis showed that women were identified with severe depression and stress to a greater extent than men (63.3% vs. 55.1% for depression and 18.1% vs. 13.8% for stress scale). With respect to nomophobia, participants with severe levels of nomophobia also exhibited severe levels of negative emotional states in all DASS components, i.e., 40.6% in depression, 73.7% in anxiety, and 32.7% in stress (all p values < 0.001). Participants with severe levels of depression and anxiety were very often checking their phone and used it in all daily activities. Moreover, correlation analysis revealed that self-esteem had a moderating effect on the relationship between nomophobia and DASS, a fact that modifies the association between the involved variables: stronger relationships appeared between nomophobia and DASS components in individuals with normal/high self-esteem than in individuals with low self-esteem.

Digital Health and Health Promotion: A Scoping Review of Systematic Reviews.

INTRODUCTION AND METHODOLOGY: Health Promotion is moving into a new technological era, that of Digital Health Promotion (DHP). The aim was to collect systematic reviews of digital health promotion interventions. RESULTS AND DISCUSSION: 147 articles met the criteria and were included in the present study. A diverse range of digital health promotion topics was identified, with certain topics garnering significant attention. While this scoping review provides valuable insights into the field of digital health promotion interventions, a more detailed analysis of their alignment with health prevention stages will serve as a critical next step.

Protein Intake, Source and Effect on Children's Weight Status: An Epidemiological Study in Greece.

The development of overweight and obesity during late childhood and early adolescence is one of the most critical issues in public health. Additionally, over the past few years, the consumption of protein has tended to increase in both children and adults. The present study aimed to evaluate whether the protein type, either plant- or animal-sourced, as well as the quantity consumed, could potentially have a relationship with excess body weight in children. A total of 47 primary schools were selected, and 1728 students, aged 10-12 years, were enrolled for the purposes of this study, leading to our final sample of 712. Physical measurements, such as weight and height, were measured, and children were separated into two weight status categories according to their Body Mass Index, which was obtained through the International Obesity Task Force criteria. Students' diets were assessed through a questionnaire, and total, plant- and animal-derived protein intakes were calculated. Unadjusted analysis showed a statistically significant association between body weight and plant protein. After adjustment for overall energy intake, sex, age, and exercise, there was a statistically significant negative association between plant protein and excess body weight in children (OR: 0.964, 95% CI: 0.936; 0.992), but a lack of association for animal-sourced protein (OR: 1.002, 95% CI: 0.991; 1.013). Dietary plant-derived protein seems to have a positive effect on weight status in children, independently of total energy intake and physical activity; nevertheless, additional research is required in order to elucidate the underlying mechanisms.

Prevalence and Factors Related to Nomophobia: Arising Issues among Young Adults.

Nomophobia is characterized as apprehension of being apart from smartphone, which causes the user to seek proximity with the device. The purpose of this study was to explore the prevalence and factors associated to nomophobia among young adults in Athens, the capital city of Greece. A cross-sectional study was performed on a sample of 1408 young adults aged 18-25 years. The questionnaire was anonymous, including the socio-demographic characteristics of the participants, the smartphone uses, and the nomophobia questions. Statistical analyses were done by simple univariable techniques or modeling the data through generalized linear models. Almost all participants (99.9%) exhibited any level of nomophobia, with the moderate level prevailing (57.0%). Women and non-working participants were more likely to exhibit severe nomophobia (adj PR = 1.57) and any level of nomophobia was 30% higher among the participants whose father had no academic degree (p = 0.029). In addition, 59% of those with severe nomophobia had very frequent phone checking (p < 0.001) while 45.8% with any level of nomophobia reported a negative influence on their academic performance. Attention should be paid to early prevention through the development of integrated health promotion programs.

"DOMINO - Stop Domestic Violence". An Educational Mobile Application.

Domestic violence affects people of all socioeconomic backgrounds and education levels and can happen to anyone. It is a public health issue that needs to be addressed with health and social care professionals playing an essential role in prevention and early intervention. These professionals need to be prepared through proper education. A European funded project developed "DOMINO - Stop domestic violence" educational mobile application which was piloted among 99 social and/or health care students and professionals. Most of the participants (n= 59, 59.6%) indicated that the DOMINO mobile application was easy to install and over half of them (n=61, 61.6%) would recommend the app. They found it easy to use, and quick access to useful materials and tools. Participants found case studies and the checklist good and useful tools for them. The DOMINO educational mobile application is available open access, in English, Finnish, Greek, Latvian, Portuguese and Swedish, for any stakeholder worldwide who is interested to learn more about domestic violence prevention and intervention.

Technologies in Home-Based Digital Rehabilitation: Scoping Review.

BACKGROUND: Due to growing pressure on the health care system, a shift in rehabilitation to home settings is essential. However, efficient support for home-based rehabilitation is lacking. The COVID-19 pandemic has further exacerbated these challenges and has affected individuals and health care professionals during rehabilitation. Digital rehabilitation (DR) could support home-based rehabilitation. To develop and implement DR solutions that meet clients' needs and ease the growing pressure on the health care system, it is necessary to provide an overview of existing, relevant, and future solutions shaping the constantly evolving market of technologies for home-based DR. OBJECTIVE: In this scoping review, we aimed to identify digital technologies for home-based DR, predict new or emerging DR trends, and report on the influences of the COVID-19 pandemic on DR. METHODS: The scoping review followed the framework of Arksey and O'Malley, with improvements made by Levac et al. A literature search was performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. The search spanned January 2015 to January 2022. A bibliometric analysis was performed to provide an overview of the included references, and a co-occurrence analysis identified the technologies for home-based DR. A full-text analysis of all included reviews filtered the trends for home-based DR. A gray literature search supplemented the results of the review analysis and revealed the influences of the COVID-19 pandemic on the development of DR. RESULTS: A total of 2437 records were included in the bibliometric analysis and 95 in the full-text analysis, and 40 records were included as a result of the gray literature search. Sensors, robotic devices, gamification, virtual and augmented reality, and digital and mobile apps are already used in home-based DR; however, artificial intelligence and machine learning, exoskeletons, and digital and mobile apps represent new and emerging trends. Advantages and disadvantages were displayed for all technologies. The COVID-19 pandemic has led to an increased use of digital technologies as remote approaches but has not led to the development of new technologies. CONCLUSIONS: Multiple tools are available and implemented for home-based DR; however, some technologies face limitations in the application of home-based rehabilitation. However, artificial intelligence and machine learning could be instrumental in redesigning rehabilitation and addressing future challenges of the health care system, and the rehabilitation sector in particular. The results show the need for feasible and effective approaches to implement DR that meet clients' needs and adhere to framework conditions, regardless of exceptional situations such as the COVID-19 pandemic.

Yoghurt Intake and Gastric Cancer: A Pooled Analysis of 16 Studies of the StoP Consortium.

BACKGROUND: Yoghurt can modify gastrointestinal disease risk, possibly acting on gut microbiota. Our study aimed at exploring the under-investigated association between yoghurt and gastric cancer (GC). METHODS: We pooled data from 16 studies from the Stomach Cancer Pooling (StoP) Project. Total yoghurt intake was derived from food frequency questionnaires. We calculated study-specific odds ratios (ORs) of GC and the corresponding 95% confidence intervals (CIs) for increasing categories of yoghurt consumption using univariate and multivariable unconditional logistic regression models. A two-stage analysis, with a meta-analysis of the pooled adjusted data, was conducted. RESULTS: The analysis included 6278 GC cases and 14,181 controls, including 1179 cardia and 3463 non-cardia, 1191 diffuse and 1717 intestinal cases. The overall meta-analysis revealed no association between increasing portions of yoghurt intake (continuous) and GC (OR = 0.98, 95% CI = 0.94-1.02). When restricting to cohort studies, a borderline inverse relationship was found (OR = 0.93, 95% CI = 0.88-0.99). The adjusted and unadjusted OR were 0.92 (95% CI = 0.85-0.99) and 0.78 (95% CI = 0.73-0.84) for any vs. no yoghurt consumption and GC risk. The OR for 1 category of increase in yoghurt intake was 0.96 (95% CI = 0.91-1.02) for cardia, 1.03 (95% CI = 1.00-1.07) for non-cardia, 1.12 (95% CI = 1.07-1.19) for diffuse and 1.02 (95% CI = 0.97-1.06) for intestinal GC. No effect was seen within hospital-based and population-based studies, nor in men or women. CONCLUSIONS: We found no association between yoghurt and GC in the main adjusted models, despite sensitivity analyses suggesting a protective effect. Additional studies should further address this association.

Mushroom consumption and risk of gastric cancer: a pooled analysis within the stomach cancer pooling project and a combined meta-analysis with other observational studies.

Edible mushrooms have high concentrations of vitamins and minerals. They are considered 'functional foods' for their disease-prevention properties. Mushroom consumption may reduce the risk of gastric cancer, the fifth most common cancer worldwide. We investigated the association between mushroom consumption and gastric cancer risk in a pooled analysis within the Stomach Cancer Pooling (StoP) Project and in a meta-analysis that also included previously published studies. A total of 3900 gastric cancer cases and 7792 controls from 11 studies were included in the StoP analysis. Mushroom consumption was measured using food frequency questionnaires. Higher mushroom consumption was associated with a lower risk of gastric cancer [relative risk (RR) for the highest vs. lowest consumption categories, 0.82; 95% confidence interval (CI), 0.71-0.95]. The corresponding RRs were 0.59 (95% CI, 0.26-1.33) in a meta-analysis of four previously published studies and 0.77 for all studies combined (95% CI, 0.63-0.95; n = 15 studies). In geographic subgroup analysis, the pooled risk in Western Pacific countries was (RR, 0.59; 95% CI, 0.40-0.87; n = 6). The stronger effect in Asian countries may reflect high level of antioxidants in mushroom species consumed in Asia.

Clustering of Activity-Related Behaviors in Relation to Self-Reported Causes of Stress among Pre-Adolescents: Results from a National Epidemiological Study.

An epidemiological study was conducted among 1728 10-12-year-old students (55.1% girls) and their parents during 2014-2016 in Greece. This study aimed to identify the dominant clusters of physical activity/sedentariness among preadolescents and investigate their association with self-reported sources of stress. Children's physical activity levels and sources of stress were evaluated using validated questionnaires that assessed daily hours of activities, both on weekdays and on weekends, including physical activity, screen-based sedentary time, and non-screen-based sedentary time. The k-means algorithm of cluster analysis was applied. Three clusters of children's physical activity/sedentariness were revealed. Cluster 1 was characterized as "Inactive-Non sedentary", cluster 2 as "Active -Non-screen sedentary", and cluster 3 as "Inactive-Sedentary". Parental needs/expectations were associated with physical activity patterns (p = 0.009), i.e., children assigned to the third and second clusters had 36% and 51% lower odds to be stressed due to parental requirements [(OR for cluster 3 = 0.64, 95% CI = 0.41-0.99), (OR for cluster 2 = 0.49, 95% CI = 0.32-0.76)], compared with their first-cluster counterparts. Considering the need to promote physical activity in early life stages, the identification of these complex activity-related patterns along with their significant interaction with parental expectations as a cause of stress could enhance the effectiveness of targeted behavior change interventions among those parent-child dyads most in need.