Association between malnutrition and anxiety in cancer patients-a retrospective study.

INTRODUCTION: The total number of cancer-related deaths and new cancer cases in 2020 was 19.3 billion and 10.8 billion, respectively. Therefore, prevention, diagnosis, and treatment of neoplastic disease, as well as management of comorbidities, are of paramount importance. In this regards, poor nutritional status and mental disorders are comorbidity conditions frequently observed in cancer patients. The aim of this study was to assess the association between malnutrition and anxiety in hospitalized adult cancer patients. METHODS: This is a retrospective study. Nutrition Risk Screening (NRS) 2002, body mass index (BMI), daily calorie intake, and weight difference between admission and discharge were used to evaluate nutritional status. Anxiety was assessed with the Hospital Anxiety and Depression Scale (HADS-A). Ordered logistic and linear logistic regressions adjusted for sex and age were used to estimate the association between malnutrition and anxiety in cancer patients. RESULTS: A total of 90 patients were included. Higher NRS risk [aß = 0.85; 95% CI (0.28-1.42); p = 0.004], disease stage [aß = 0.77; 95% CI (0.08-1.47); p = 0.029], and cachexia [aß = 2.20; 95% CI (0.75-3.65); p = 0.003] were significantly associated with anxiety symptoms. Moreover, cancer site different than gastrointestinal cancers was associated with a lower risk of anxiety symptoms [aß = - 2.11; 95% CI (- 3.55/ - 0.66); p = 0.005]. CONCLUSION: In the current study, we found a relatively high rate of malnourished patients, indicating the importance of routinely assessing nutritional status and screening cancer patients for mental health issues. This approach could help physicians to treat both in a timely manner, thereby significantly reducing the burden of the disease and improving the quality of life of patients.

Association between Mediterranean diet and dementia and Alzheimer disease: a systematic review with meta-analysis.

BACKGROUND: Dementia affects 5-8% of the population aged over 65 years (~50 million worldwide). Several factors are associated with increased risk, including diet. The Mediterranean diet (MedDiet) has shown potential protective effects against several chronic diseases. AIMS: This systematic review with meta-analysis aim was to assess the association between adherence to the MedDiet and the risk of dementia in the elderly. METHODS: PRISMA-2020 guidelines were followed. PubMed/MEDLINE and Scopus were searched on 17 July 2023. The Newcastle-Ottawa Scale tool was used to assess the risk of bias. The protocol was pre-registered in PROSPERO (registration number: CRD 42023444368). Heterogeneity was assessed using the I2 test. Publication bias was assessed by visual inspection of the funnel plot and by Egger's regression asymmetry test. The final effect size was reported as OR or HR, depending on the study design of the included studies. RESULTS: Out of 682 records, 21 were included in the analysis. The pooled OR was 0.89 (95% CI = 0.84-0.94) based on 65,955 participants (I2 = 69.94). When only cohort studies were included, HR was 0.84 (95% CI = 0.76-0.94) based on 55,205 participants (I2 = 89.70). When only Alzheimer Disease was considered OR was 0.73 (95% CI = 0.62-0.85) based on 38,292 participants (I2 = 63.85). DISCUSSION: Despite the relatively low risk reduction associated with higher adherence to MedDiet among elderly, it should be considered that this population is the most affected. CONCLUSIONS: Adherence to MedDiet could be an effective non-pharmacological measure to reduce the burden of dementia, even among elderly.

Knowledge, attitude and behaviours towards food sustainability in a group of Italian consumers. A cross-sectional study.

Sustainability is crucial for transforming the food system, addressing environmental and nutrition issues and depends on consumer perceptions and values. This cross-sectional study investigates the relationship between sustainability attitudes, knowledge, and eating behaviours. Nearly half reported high level of knowledge regarding food sustainability while 24% expressed high attitude towards food sustainability. Women reported higher levels of knowledge and attitude towards food sustainability. Logistic regression analyses, adjusted for age, sex, and education, revealed that using public transport, biking, or walking was significantly associated with higher odds of having a more positive overall attitude towards food sustainability (OR = 1.77). The overall knowledge score was a strong predictor of a positive overall attitude score (OR = 2.11). Examining individual knowledge-related items, almost all were associated with higher levels of knowledge, except those regarding food and environment interaction. These findings underline a complex scenario where consumers' awareness and knowledge highly influence the applicability of sustainable food choices.

Nutritional quality and level of processing of food items broadcasted on Italian television in advertisements targeted to children.

This study evaluates the nutritional quality and level of processing of food and beverage products advertised on television channels most watched by children, in Italy. Data were collected over 20 non-consecutive days from the five top channels in Italy. A total of 209 food items were analysed using the Nutri-Score and the NOVA classification. Additionally, compliance with nutritional criteria established by the World Health Organisation (WHO) and the EU-PLEDGE was assessed. Results indicate a high proportion of energy-dense and low nutritional quality foods, with 68% falling into less favourable Nutri-Score categories (C, D, and E), and 61% classified as ultra-processed by NOVA classification. When applying WHO and PLEDGE criteria, 71% and 56% of products, respectively, did not meet nutritional standards. This study underscores the low prevalence of nutritionally adequate products in food advertisements targeting children on Italian television, despite differences found based on methodological variations.

The impact of the COVID-19 pandemic on academic performance among developmental age students: a systematic review with meta-analysis.

Objective: The COVID-19 pandemic has disrupted educational systems worldwide, raising concerns about its impact on academic performance, particularly among developmental age students. Methods: A systematic review with meta-analysis aimed to evaluate the association between the COVID-19 pandemic and the academic performance in this population was performed according to PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus and Embase were searched on December 2023 to identify relevant studies. Both fixed and random effect models were performed. The Effect size was reported as Cohen's d with a 95% Confidence Interval. Studies' quality was assessed using the Newcastle-Ottawa scale. The protocol was registered in PROSPERO. Results: A total of 30 studies met the inclusion criteria, but only 13 could be combined in the meta-analysis. Based on a sample size of 4,893,499 students, pooled Cohen's d was -0.07 [(95% CI = -0.10; -0.03); p-value <0.001]. Subgroup analyses by subject suggested that performance in math was affected the most, Cohen's d= -0.14 [(-0.18; -0.10); p-value <0.001]. Conclusion: The findings revealed a significant negative association between the COVID-19 pandemic and academic performance among developmental age students. Interventions to mitigate the adverse effects of the pandemic on educational outcomes in this population are needed.

Social network characteristics and well-being in Italy: insights from the PHRASI Study.

Background: Mental well-being should be prioritized in public health as it represents a valuable resource for individuals and communities, influencing behavior, social cohesion and social inclusion. The support individuals receive from their social networks can have a significant impact on mental well-being. This study used data from the Public Health Residents' Anonymous Survey in Italy, a nationwide cross-sectional survey. The objective was to assess the level of well-being among the Public Health Residents and investigate the association between the social network characteristics and the well-being in this population. Study design: The current cross-sectional study targeted 1,600 public health residents enrolled in various Italian public health specialization schools between June 14 and July 26, 2022. Methods: Participants self-reported both functional and structural characteristics of social network. Well-being was assessed using the WHO-5 well-being index. Linear regression models, adjusted for age and sex, were applied to examine the association between WHO-5 score and social network characteristics. Results: Out of 379 participants, 51.5% reported bad well-being. Those with bad well-being are more likely women, experience lower peer-to-peer and supervisor support, face higher work-to-private life interference, and less frequently have a partner. Greater peer-to-peer support (ß=1.13, 95% CI=0.68; 1.57), and increased supervisor support (ß=1.26, 95% CI=0.86; 1.67), were associated with higher levels of well-being. Conversely, higher work-to-private life interference was associated with lower perceived well-being. Having a partner resulted in a better perceived well-being (ß=1.96, 95% CI=0.94; 2.98). In logistic regression analysis, higher peer-to-peer support (OR=0.68, 95% CI = 0.55;0.85) greater supervisor support (OR=0.60, 95% CI=0.49;0.74) and having a partner (OR=0.51, 95% CI = 0.32;0.82) were associated with reduced odds of bad well-being. Conversely, increased WLI was associated with higher odds of bad well-being (OR=1.47, 95% CI = 1.19;1.82). Conclusions: The characteristics of an individual's social network play a crucial role in her/his well-being and should be considered both in personal and professional contexts when aimed to enhance mental well-being in communities.

"Leo&Giulia standing for public health": an animated series to promote the values of public health among school-aged children. Best practices and field-trial protocol.

Background: The "Leo&Giulia standing for public health" project is an innovative digital health education model targeting primary school children. The project, developed during the COVID-19 pandemic, aims to educate primary school-aged children about public health issues through an animated cartoon series. It highlights the importance of early-life health promotion and the potential role of educational settings in shaping health behaviours. Study design: A 2-year school-based cluster-randomized controlled community trial will be conducted among 8-10-year-old pupils in the province of Pavia, Northern Italy. Methods: The intervention group will receive an educational programme via a new episode of "Leo&Giulia" animated series, focusing on smoking prevention. The study will assess changes in knowledge, attitudes towards smoking, and communication about smoking risks among peers and parents. The trial involves baseline and follow-up assessments through questionnaires targeting both children and parents. Results (expected): We assume that children in the intervention group will demonstrate increased knowledge and awareness of smoking-related health risks and develop negative attitudes towards tobacco use compared to the control group. Enhanced communication about tobacco harms among peers and between children and parents, as well as increased parental involvement in anti-smoking socialization practices, are expected secondary outcomes. Discussion and Conclusions: "Leo&Giulia" integrates health education into the school curriculum, leveraging the appeal of animated content to engage children in public health topics. The project is expected to contribute to the field of health education by demonstrating the effectiveness of digital health interventions in childhood, foreseeing potential long-term impacts on health behaviors and in shaping future public health strategies.

Training needs assessment of European frontline health care workers on vaccinology and vaccine acceptance: a systematic review.

BACKGROUND: The issue of reluctance towards vaccination is becoming more worrisome. Health care workers (HCWs) are the primary point of contact with individuals who make decisions about vaccination. Therefore, it is crucial that HCWs receive sufficient training and periodic updates. The main objective of this systematic review is to evaluate the HCWs' training needs in vaccination and vaccine uptake. METHODS: In February 2022, a search was conducted on MEDLINE, Scopus and Google Scholar databases. The search included papers written in English, Italian, Portuguese, Spanish, French and Romanian, with a publication date ranging from 1 January 2011 to 24 February 2022 and conducted in Europe. To assess the methodological quality of the papers, the Appraisal tool for Cross-Sectional Studies was utilized. RESULTS: The search of scientific literature yielded 640 outcomes on PubMed, 556 on Scopus and 15 on Google Scholar, for a total of 1211 records. After eliminating duplicates, screening titles and abstracts and evaluating the full text of the articles, only 25 of them were found suitable for inclusion. The studies' overall quality ranged from moderate to good. The majority of the research emphasized the need for improved knowledge of vaccine-preventable diseases, vaccine efficacy, immunization schedules and vaccine adverse effects. CONCLUSIONS: It is vital to prioritize educational programmes on vaccinology and vaccine hesitancy for HCWs, with the objective of improving their knowledge, awareness and attitudes. Addressing the diversity of educational backgrounds, roles and training requirements of HCWs involved in vaccination across Europe is a critical issue that must be tackled for future initiatives.

Daily patterns of physical activity, sedentary behavior, and prevalent and incident depression-The Maastricht Study.

This study aims to compare the accelerometer-measured daily patterns of PA and sedentary behavior among participants with and without prevalent/incident depressive symptoms. We used data from 5582 individuals in The Maastricht Study (59.9 ± 8.6 years, 50.3% women). Daily patterns of sedentary time, light-intensity physical activity (LiPA), moderate-to-vigorous physical activity (MVPA), and sit-to-stand transitions were objectively measured at baseline with the activPAL3 activity monitor. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire, both at baseline and annually (median follow-up: 5.1 years). General linear models were used to compare patterns of physical activity and sedentary behavior between those with and without prevalent/incident depressive symptoms. Participants with prevalent depressive symptoms had significantly more sedentary time (18.6 min/day) and lower LiPA (26.8 min/day) and MVPA (4.8 min/day) than participants without depressive symptoms. Considering the daily patterns, participants with prevalent depressive symptoms had significantly more sedentary time early in the afternoon (12:00-18:00), early evening (18:00-21:00), and during the night (00:00-03:00), less time in LiPA in all periods between 09:00-21.00 and less MVPA in the morning (09:00:12:00), early afternoon (12:00-15:00), and evening (18:00-21:00), than those without. Similar differences in activity and sedentary behavior patterns between those and without incident depressive symptoms were observed albeit the differences were smaller. Overall, we did not find specific time slots particularly associated with both prevalent and incident depressive symptoms. These findings may indicate that less sedentary time and more intense PA can be important targets for the prevention of depression irrespective of the timing of the day.

Transition to retirement impact on health and lifestyle habits: analysis from a nationwide Italian cohort.

BACKGROUND: Retirement is a life-course transition likely to affect, through different mechanisms, behavioural risk factors' patterns and, ultimately, health outcomes. We assessed the impact of transitioning to retirement on lifestyle habits and perceived health status in a nationwide cohort of Italian adults. METHODS: We analysed data from a large cohort of Italian adults aged 55-70, derived from linking six waves of the Participation, Labour, Unemployment Survey (PLUS), a national survey representative of the Italian workforce population, conducted between 2010 and 2018. We estimated relative-risk ratios (RRR) of transition to retirement and their corresponding 95% confidence intervals (CIs) for selected behavioural risk factors and health outcomes using multivariable logistic regression models. We used propensity score matching (PSM) to account for potential confounders. RESULTS: We included 5169 subjects in the study population, of which 1653 retired between 2010 and 2018 (exposed, 32%). Transition to retirement was associated with a 36% increased probability of practising sports (RRR 1.36, 95% CI 1.12-1.64). No statistically significant changes were reported for smoking habit (current smoker RRR: 1.18, 95% CI 0.94-1.46) and BMI (overweight/obese RRR: 0.96, 95% CI 0.81-1.15). Overall, retiring was associated with improved self-rated health status (RRR 1.26, 95% CI 1.02-1.58). CONCLUSION: Individual data-linkage of multiple waves of the PLUS can offer great insight to inform healthy ageing policies in Italy and Europe. Transition to retirement has an independent effect on perceived health status, physical activity and selected behavioural risk factors. It should be identified as a target moment for preventive interventions, with particular reference to primary prevention so as to promote health and wellbeing in older ages.

What can internet users' behaviours reveal about the mental health impacts of the COVID-19 pandemic? A systematic review.

OBJECTIVES: At the end of 2019, an acute infectious pneumonia (coronavirus disease 2019 [COVID-19]) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, and subsequently spread around the world starting a pandemic. Globally, to date, there have been >118 million confirmed cases, including >2 million deaths. In this context, it has been shown that the psychological impact of the pandemic is important and that it can be associated with an increase in internet searches related to fear, anxiety, depression, as well as protective behaviours, health knowledge and even maladaptive behaviours. STUDY DESIGN: This is a systematic review. METHODS: This review aims to collect, analyse and synthesise available evidence on novel data streams for surveillance purposes and/or their potential for capturing the public reaction to epidemic outbreaks, particularly focusing on mental health effects and emotions. RESULTS: At the end of the screening process, 19 articles were included in this systematic review. Our results show that the COVID-19 pandemic had a great impact on internet searches for mental health of entire populations, which manifests itself in a significant increase of depressed, anxious and stressed internet users' emotions. CONCLUSIONS: Novel data streams can support public health experts and policymakers in establishing priorities and setting up long-term strategies to mitigate symptoms and tackle mental health disorders.

Insight the data: Wikipedia's researches and real cases of arboviruses in Italy.

OBJECTIVES: The primary aim of this study was to evaluate the temporal correlation between Wikitrends and conventional surveillance data generated for Chikungunya, Dengue, Zika, and West Nile Virus infection reported by bulletin of Italian National Institute of Health (Istituto Superiore di Sanità in italian, ISS). STUDY DESIGN: A cross-sectional study design was used. METHODS: The reported cases of Dengue and Chikungunya were selected from July 2015 to December 2019. For West Nile Virus, the bulletins are issued in the period June-November (6 months) of the years 2015-2019, and for Zika virus, the data reported in the ISS bulletin start from January 2016. From Wikipedia Trends, we extracted the number of monthly views by users from the July 2015 to December 2019 of the pages Chikungunya, Dengue, Zika virus, and West Nile Virus. RESULTS: A correlation was observed between the bulletin of ISS and Wikipedia Wikitrends, the correlation was strong for Chikungunya and West Nile Virus (r = 0.9605; r = 0.9556, respectively), and highly statistically significant with P-values <0.001. The correlation was moderate for Dengue and Zika virus (r = 0.6053; r = 0.5888, respectively), but highly statistically significant with P-values <0.001. CONCLUSIONS: Classical surveillance system should be integrated with the tools of digital epidemiology that have potential role in public health for the dynamic information and provide near real-time indicators of the spread of infectious disease.

Attitude of students of health professions towards a health care workers' mandatory vaccination: a multi-center cross-sectional survey.

SUMMARY: Introduction. Seasonal influenza epidemics represent a cost that affects companies in terms of sick leave and lost productivity, therefore vaccination can improve occupational health. The vaccination of Healthcare Workers (HCW) has a dual function because in addition to protecting the workers, it also protects the most fragile patients. The students of medical and nursing degree courses, as well as other health professions, attend the workplace daily and are similar to workers in Legislative Decree 81/08. The purpose of this research is to assess the prevalence of students who are in favor of the introduction of a mandatory vaccination for healthcare workers, and to investigate what factors predispose them to be favorable. Methods. We performed a multi-center cross-sectional study using a validated questionnaire in a sample of students from different university courses from October 10th, 2017 to September 30th, 2018. For qualitative variables, absolute and relative frequencies, and for categorical variables Pearson's Chi-square test (χ2) were calculated. A multivariable logistic regression model was used. Results. A total of 3131 questionnaires were completed by 2132 women and 999 men. The prevalence of students who are favorable to the introduction of a mandatory flu vaccination is 87.3% and that this data is linked to the female gender (aOR 1.52 CI 95% 1.12-2.06), being a medical student compared to nursing (aOR 2.14 CI 95% 1.45-3.17), coming from central Italy (aOR 3.08 CI 95% 2.11-4.51) and northern Italy (aOR 3.09 CI 95% 2.12-4.49) compared to Southern Italy and the Islands, wanting to get vaccinated for the next season (aOR 6.37 CI 95% 3.73-10.88), declaring to have a good/excellent level of knowledge on vaccine-preventable diseases (aOR 1.44 CI 95% 1.04-1.99), planning a recommendation based on ministerial indications (aOR 2.12 CI 95% 1.28-2.30) and having received requests for clarification on vaccinations (aOR 2.02 CI 95% 1.44-2.85). Discussion. The sample of university students showed to be largely in agreement with the introduction of mandatory vaccination for HCW, which is important for the prevention of influenza virus in the workplace. To increase adherence of healthcare workers to vaccination campaigns against seasonal influenza in the workplace, it is necessary that operative strategies are implemented with educational messages.

Violence on doctors. An observational study in Northern Italy.

BACKGROUND: Violence in the workplace is now universally recognized as a significant global public health issue and is one of the most serious issues affecting the healthcare sector. OBJECTIVES: To assess the prevalence of workplace violence. METHODS: We performed a multicenter cross-sectional study using an anonymous questionnaire submitted to doctors from Northern Italy. The survey investigates socio-demographic information, the number of years of work in the health sector and the physical and verbal aggressions that occurred in the workplace in the last 12 months. RESULTS: The sample consists of 4545 healthcare workers, of whom 2603 (57.27%) are females. The mean age of the sample is 49.79 years (SD ± 12.63). The risk of being victim of physical aggression at work in the last 12 months is significantly associated with the following independent variables: male gender (aOR 2.09, 95% CI 1.51-2.88), work in the public sector (aOR 2.57, 95% CI 1.72-3.85), being victim of verbal aggression at work in the last 12 months (aOR 22.52, 95% CI 10.97-46.20), work in the operational units of the Medical area (aOR 2.36, 95% CI 1.33-4.21) and the Territorial area (aOR 1.97, 95% CI 1.04-3.74). DISCUSSION: The prevalence of violent behaviour is difficult to assess, because violent incidents are underreported or unreported. The results of the study suggest that increased awareness is necessary to develop effective control strategies at individual, hospital and national levels.

[Opinions, attitudes and knowledge of Italian health science university students on mandatory vaccinations: a cross-sectional study]. / Opinioni, attitudini e conoscenze degli studenti di area sanitaria in merito all'obbligatorietà vaccinale. Studio trasversale.

BACKGROUND: The role of vaccination in reducing the incidence, morbidity and mortality of vaccine preventable diseases is well-known; however, vaccination uptake for some vaccine-preventable diseases remains low among Italian healthcare workers. The aim of this study was to evaluate knowledge attitudes and practice regarding mandatory vaccinations among Italian health science university students. METHODS: A multi-center study was conducted in 14 Italian universities. A standardized, previously validated and anonymous questionnaire consisting of 21 questions was administered to health science students. The students were informed on the questionnaire during a Hygiene and Preventive Medicine lesson of their degree course, so they were asked to fill it out. A multivariable logistic regression model was used, the results are expressed as adjusted Odds Ratio (aOR). RESULTS: A total of 3131 students completed the questionnaire, of whom 90% were found to be in agreement with the introduction of a mandatory vaccination law for children and 87% with the potential introduction of mandatory vaccination for health care workers. Having an insufficient/sufficient/fair level of knowledge related to vaccine preventable diseases and vaccinations, compared with having a good/excellent level of knowledge, was associated with being less supportive towards the mandatory childhood vaccination law (OR 0,64; IC 95% 0.44-0.93). CONCLUSIONS: We found that having good/excellent knowledge regarding vaccine preventable diseases and their related vaccinations is associated in a statistically significant manner to the propensity towards supporting mandatory vaccinations. This is probably due to a greater awareness of the importance of immunization and its value.

Is dietary fibre truly protective against colon cancer? A systematic review and meta-analysis.

Colorectal cancer is the third most common cancer worldwide. Growing evidence shows that about 47% of cases of colorectal cancer can be prevented by a healthy lifestyle. We performed a systematic review and meta-analysis aimed to evaluate the association between dietary fibre intake and the risk of colon cancer. We performed a structured computer search on PubMed, including epidemiological studies reporting results of dietary fibre intake and risk of colon cancer in women or men. We compared subjects exposed to the highest versus the lowest consumption. The search strategy identified 376 papers. After screening, 25 datasets were included in our meta-analysis. Results suggest a protective role of dietary fibre intake on colon cancer risk ES = 0.74 (95% CI = 0.67-0.82), p value = .000, but, moderate statistical heterogeneity (χ2 = 42.73, p value = .011) was found. Due to the high mortality of colorectal cancer, it is important to identify effective preventive measures, especially those of a healthy lifestyle, such as a healthy diet.

Leveraging Google Trends, Twitter, and Wikipedia to Investigate the Impact of a Celebrity's Death From Rheumatoid Arthritis.

BACKGROUND: Technological advancements, such as patient-centered smartphone applications, have enabled to support self-management of the disease. Further, the accessibility to health information through the Internet has grown tremendously. This article aimed to investigate how big data can be useful to assess the impact of a celebrity's rheumatic disease on the public opinion. METHODS: Variable tools and statistical/computational approaches have been used, including massive data mining of Google Trends, Wikipedia, Twitter, and big data analytics. These tools were mined using an in-house script, which facilitated the process of data collection, parsing, handling, processing, and normalization. RESULTS: From Google Trends, the temporal correlation between "Anna Marchesini" and rheumatoid arthritis (RA) queries resulted 0.66 before Anna Marchesini's death and 0.90 after Anna Marchesini's death. The geospatial correlation between "Anna Marchesini" and RA queries resulted 0.45 before Anna Marchesini's death and 0.52 after Anna Marchesini's death. From Wikitrends, after Anna Marchesini's death, the number of accesses to Wikipedia page for RA has increased 5770%. From Twitter, 1979 tweets have been retrieved. Numbers of likes, retweets, and hashtags have increased throughout time. CONCLUSIONS: Novel data streams and big data analytics are effective to assess the impact of a disease in a famous person on the laypeople.

[Design and validation of a questionnaire for assessing Public Health residents' opinions and knowledge regarding the new mandatory vaccination law in Italy (DL 73/2017)]. / Costruzione e validazione di un questionario rivolto a Medici in formazione specialistica in Igiene e Medicina Preventiva, riguardante opinioni e conoscenze relative al DL 73/2017.

BACKGROUND: Vaccines are an important tool to prevent communicable diseases. Despite their importance, vaccines seem to be victims of their own success and declining levels of vaccination uptake have been recorded in Europe and Italy. For this reason, Italy introduced a new mandatory vaccination law on July 31, 2017. We aimed to validate a questionnaire to assess the opinions and knowledge of Public Health residents about this issue. METHODS: A team of public health residents developed a questionnaire and validated it by administering it to a panel of 10 Public Health residents, members of the Vaccines and Vaccine Hesitancy Working Group of the Public Health residents Assembly of the Italian Society of Hygiene and Preventive Medicine. Cronbach's Alpha and Cohen's Kappa tests were used to analyse results. RESULTS: The final version of the questionnaire consisted in 23 items. The validation process showed a high level of internal consistency (alpha=0,82). The tests showed a relevant level of agreement (k= 0,75 ± 0,07). Finally, the feasibility test pointed out that 80% of respondents declared the questions were clear and easy to understand. CONCLUSION: The designed questionnaire is a valid and useful tool.

In vitro Biological Effects of Sulforaphane (SFN), Epigallocatechin-3-gallate (EGCG), and Curcumin on Breast Cancer Cells: A Systematic Review of the Literature.

Much of the recent research in neoplasia has been focusing on the epigenetics of cancer cells, particularly as regards the search for potential molecular biomarkers that could be used for early diagnosis, effective treatment, and prognosis of several types of cancer. Carcinogenesis often starts with mutations in oncogenes and tumor suppressor genes, and it leads to anomalies in cellular processes as vital as cell cycle regulation and apoptosis. Because malignant changes arise as a result of genetic as well as epigenetic mechanisms, one possible means of intervention involves reprogramming gene expression, so as to-at least in part-revert the molecular alterations. DNA methylation and demethylation, acetylation and deacetylation of histones, and microRNAs are a few examples of the epigenetic mechanisms responsible for tumor development and progression. Many biologically active compounds present in food-including sulforaphane, curcumin, and epigallocatechin-have been found to modulate those processes. We here systematically review information on the effects of such bioactive dietary compounds on human breast cancer cell lines, and explore the mechanisms underlying those effects with a view to their potential therapeutic application.

Cardiovascular diseases and hard drinking waters: implications from a systematic review with meta-analysis of case-control studies.

This systematic review with meta-analysis, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, aims at evaluating the potential correlation between magnesium and calcium concentration in drinking waters and the risk of cardiovascular diseases (CVD), which impose a considerable burden in high-income countries. Included studies were of the case-control studies type. From an initial list of 643 potentially eligible articles, seven studies were finally retained in the quantitative analysis. Since each one of them assessed different ion concentrations, subjects exposed to the highest concentration versus those exposed to the lowest concentration were compared. By including an overall figure of 44,000 subjects, the result suggests a protective effect of the ions on CVD prevention, with an effect-size (ES) of 0.82 (95% confidence interval CI = [0.70-0.95], p-value = 0.008) for calcium, and ES = 0.75 (95% CI = [0.66-0.86], p-value = 0.000) for magnesium. Hard water consumption seems to be protective against CVD. However, the high heterogeneity (I2 = 75.24, p-value = 0.001 for calcium; I2 = 72.96, p-value = 0.0024 for magnesium) and the existence of publication bias limits the robustness and generalizability of these findings. Further high-quality studies are needed to reproduce and confirm these results.