Drug utilization in patients starting haemodialysis with a focus on cardiovascular and antidiabetic medications: an epidemiological study in the Lazio region (Italy), 2016-2020.

BACKGROUND: Entering dialysis is a critical moment in patients' healthcare journey, and little is known about drug therapy around it. A study funded by the Italian Medicines Agency offered the opportunity to leverage data from the Lazio Regional Dialysis and Transplant Registry (RRDTL) and perform an observational study on drug use patterns before and after initiating chronic dialysis. METHODS: Individuals initiating dialysis in 2016-2020 were identified from RRDTL, excluding patients with prior renal transplantation, stopping dialysis early, or dying within 12 months. Use of study drugs, predefined by clinicians, in the two years around the index date was retrieved from the drug claims register and described by semester. For each drug group, proportions of users (min 2 claims in 6 months) by semester, and intensity of treatment in terms of Defined Daily Doses (DDDs) for cardiovascular and antidiabetic agents were compared across semesters, stratifying by sex and age. RESULTS: In our cohort of 3,882 patients we observed a general increase in drug use after initiating dialysis, with the mean number rising from 5.5 to 6.2. Cardiovascular agents accounted for the highest proportions, along with proton pump inhibitors and antithrombotics over all semesters. Dialysis-specific therapies showed the most evident increase, in particular anti-anaemics (iron 4-fold, erythropoietins almost 2-fold), anti-parathyroids (6-fold), and chelating agents (4-fold). Use of cardiovascular and antidiabetic drugs was characterised by significant variations in terms of patterns and intensity, with some differences between sexes and age groups. CONCLUSIONS: Entering dialysis is associated with increased use of specific drugs and goes along with adaptations of chronic therapies.

APOE Christchurch-mimetic therapeutic antibody reduces APOE-mediated toxicity and tau phosphorylation.

INTRODUCTION: We discovered that the APOE3 Christchurch (APOE3Ch) variant may provide resistance to Alzheimer's disease (AD). This resistance may be due to reduced pathological interactions between ApoE3Ch and heparan sulfate proteoglycans (HSPGs). METHODS: We developed and characterized the binding, structure, and preclinical efficacy of novel antibodies targeting human ApoE-HSPG interactions. RESULTS: We found that one of these antibodies, called 7C11, preferentially bound ApoE4, a major risk factor for sporadic AD, and disrupts heparin-ApoE4 interactions. We also determined the crystal structure of a Fab fragment of 7C11 and used computer modeling to predict how it would bind to ApoE. When we tested 7C11 in mouse models, we found that it reduced recombinant ApoE-induced tau pathology in the retina of MAPT*P301S mice and curbed pTau S396 phosphorylation in brains of systemically treated APOE4 knock-in mice. Targeting ApoE-HSPG interactions using 7C11 antibody may be a promising approach to developing new therapies for AD.

Advancements in APOE and dementia research: Highlights from the 2023 AAIC Advancements: APOE conference.

INTRODUCTION: The apolipoprotein E gene (APOE) is an established central player in the pathogenesis of Alzheimer's disease (AD), with distinct apoE isoforms exerting diverse effects. apoE influences not only amyloid-beta and tau pathologies but also lipid and energy metabolism, neuroinflammation, cerebral vascular health, and sex-dependent disease manifestations. Furthermore, ancestral background may significantly impact the link between APOE and AD, underscoring the need for more inclusive research. METHODS: In 2023, the Alzheimer's Association convened multidisciplinary researchers at the "AAIC Advancements: APOE" conference to discuss various topics, including apoE isoforms and their roles in AD pathogenesis, progress in apoE-targeted therapeutic strategies, updates on disease models and interventions that modulate apoE expression and function. RESULTS: This manuscript presents highlights from the conference and provides an overview of opportunities for further research in the field. DISCUSSION: Understanding apoE's multifaceted roles in AD pathogenesis will help develop targeted interventions for AD and advance the field of AD precision medicine. HIGHLIGHTS: APOE is a central player in the pathogenesis of Alzheimer's disease. APOE exerts a numerous effects throughout the brain on amyloid-beta, tau, and other pathways. The AAIC Advancements: APOE conference encouraged discussions and collaborations on understanding the role of APOE.

Changing to Impress: Testing a Mediation Model from Instagram Self-presentation to Cosmetic Surgery.

BACKGROUND: This study examined the relationship between false self-presentation on Instagram and consideration of cosmetic surgery through the mediating role of body image control in photos (BICP), photo manipulation, and body shame. We predicted that false self-presentation on Instagram was indirectly associated with cosmetic surgery intentions through the aforementioned constructs. METHODS: A total of 504 young Italian adults (28.2% males, 18-30 years) completed an online survey. They completed a questionnaire containing the Self-presentation on Instagram Questionnaire, the Body Image Control in Photos Questionnaire-revised, the Photo Manipulation Scale, the Objectified Body Consciousness Scale, and the Acceptance of Cosmetic Surgery Scale. The pattern of associations between the constructs was analyzed via path analysis. RESULTS: The results show that false self-presentation on Instagram was associated with photo manipulation, both directly and indirectly, through BICP. Furthermore, photo manipulation was linked to body shame, but neither of them was associated with cosmetic surgery intentions. Finally, false self-presentation on Instagram was associated with the consideration of cosmetic surgery only through the mediation of BICP. CONCLUSION: Findings indicate that self-presentation styles might affect Instagram photo behaviors and individuals' cosmetic surgery intentions, suggesting that surgeons should fully examine patients' motivations before providing them with services. Furthermore, intervention programs encouraging users to present a more authentic version of themselves online might reduce the risk of self-objectification and reduce the consideration of procedures aimed at modifying one's body for purely aesthetic reasons. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Heterogeneity of smartphone impact on everyday life and its relationship with personality and psychopathology: A latent profile analysis.

BACKGROUND: The relationships between problematic smartphone use and psychological factors have been extensively investigated. However, previous studies generally used variable-centered approaches, which hinder an examination of the heterogeneity of smartphone impact on everyday life. OBJECTIVE: In the present study, we capitalized on latent profile analysis to identify various classes of smartphone owners based on the impact associated with smartphone use (e.g., unregulated usage, preference for smartphone-mediated social relationships) and to compare these classes in terms of established psychological risk factors for problematic smartphone use. METHOD: We surveyed 934 young adults with validated psychometric questionnaires to assess the impact of smartphones, psychopathological symptoms, self-esteem and impulsivity traits. RESULTS: Smartphone users fall into four latent profiles: users with low smartphone impact, users with average smartphone impact, problematic smartphone users, and users favoring online interactions. Individuals distributed in the problematic smartphone user profile were characterized by heightened psychopathological symptoms (stress, anxiety, depression, obsessive-compulsive tendencies) and impulsivity traits. Moreover, users who preferred online interactions exhibited the highest symptoms of social anxiety and the lowest levels of self-esteem. CONCLUSIONS: These findings further demonstrate the multidimensionality and heterogeneity of the impact of smartphone use, calling for tailored prevention and intervention strategies.

Trend and determinants of mortality in incident hemodialysis patients of the Lazio region.

BACKGROUND: . In the last decades some studies observed a moderate progressive decrease in short-term mortality in incident hemodialysis patients. The aim of the study is to analyse the mortality trends in patients starting hemodialysis using the Lazio Regional Dialysis and Transplant Registry. METHODS: . Patients who started chronic hemodialysis between 2008 and 2016 were included. Annual 1-year and 3-year Crude Mortality Rate*100 Person Years (CMR*100PY) overall, by gender and age classes were calculated. Cumulative survival estimates at 1 year and 3 years since the date of starting hemodialysis were presented as Kaplan-Meier curves for the three periods and compared using the log-rank test. The association between periods of incidence in hemodialysis and 1-year and 3-year mortality were investigated by means of unadjusted and adjusted Cox regression models. Potential determinants of both mortality outcomes were also investigated. RESULTS: . Among 6,997 hemodialysis patients (64.5% males, 66.1% over 65 years old) 923 died within 1 year and 2,253 within 3 years form incidence; CMR*100PY were 14.1 (95%CI: 13.2-15.0) and 13.7 (95%CI: 13.2-14.3), respectively; both remained unchanged over the years. Even after stratification by gender and age classes no significant changes emerged. Kaplan-Meier mortality curves did not show any statistically significant differences in survival at 1 year and 3 years from hemodialysis incidence across periods. No statistically significant associations were found between periods and 1-year and 3-year mortality. Factors associated with a greater increase in mortality are: being over 65 years, born in Italy, not being self-sufficient, having systemic versus undetermined nephropathy, having heart disease, peripheral vascular disease, cancer, liver disease, dementia and psychiatric illness, and receiving dialysis by catheter rather than fistula. CONCLUSIONS: . The study shows that the mortality rate in patients with end-stage renal disease starting hemodialysis in the Lazio region was stable over 9 years.

Homeless people's recovery in Housing First and Traditional Services: The role of working alliance in Italian housing services.

This study aims to investigate whether a working alliance could represent a potential mechanism that explains the effectiveness of housing services in terms of user recovery, comparing the Housing First (HF) model with Traditional Services (TS). This study included 59 homeless service users in Italy (29 = HF; 30 = TS). Recovery was assessed upon entering the study (T0) and after 10 months (T1). Results indicate that participants inserted in HF services were more likely to report stronger working alliances with social service providers at T0 that, in turn, was directly associated with higher levels of users' recovery at the beginning of the study and indirectly (through recovery at T0) with recovery at T1. Implications of the results are discussed with respect to research and practice on homeless services.

Targeting Runt-Related Transcription Factor 1 Prevents Pulmonary Fibrosis and Reduces Expression of Severe Acute Respiratory Syndrome Coronavirus 2 Host Mediators.

Pulmonary fibrosis (PF) can arise from unknown causes, as in idiopathic PF, or as a consequence of infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Current treatments for PF slow, but do not stop, disease progression. We report that treatment with a runt-related transcription factor 1 (RUNX1) inhibitor (Ro24-7429), previously found to be safe, although ineffective, as a Tat inhibitor in patients with HIV, robustly ameliorates lung fibrosis and inflammation in the bleomycin-induced PF mouse model. RUNX1 inhibition blunted fundamental mechanisms downstream pathologic mediators of fibrosis and inflammation, including transforming growth factor-ß1 and tumor necrosis factor-α, in cultured lung epithelial cells, fibroblasts, and vascular endothelial cells, indicating pleiotropic effects. RUNX1 inhibition also reduced the expression of angiotensin-converting enzyme 2 and FES Upstream Region (FURIN), host proteins critical for SARS-CoV-2 infection, in mice and in vitro. A subset of human lungs with SARS-CoV-2 infection overexpress RUNX1. These data suggest that RUNX1 inhibition via repurposing of Ro24-7429 may be beneficial for PF and to battle SARS-CoV-2, by reducing expression of viral mediators and by preventing respiratory complications.

The Italian COVID-19 Anxiety Syndrome Scale: Investigation of the COVID-19 anxiety syndrome and its association with psychological symptoms in an Italian population.

INTRODUCTION: The COVID-19 Anxiety Syndrome Scale (C-19ASS) is a quick and reliable scale assessing dysfunctional coping strategies activated in response to COVID-19 fear and threat. The present study aimed to provide a preliminary validation of the Italian version of the C-19ASS and investigated whether the C-19ASS would mediate the relationship between the Big Five personality traits and psychological outcomes. METHOD: In Study 1, a community sample of 271 participants completed the Italian version of the C-19ASS and results were subjected to a Principal Component Analysis. In study 2, a community sample of 484 participants completed the Italian version of the C-19ASS and a series of measures assessing COVID-19 anxiety, COVID-19 fear, functional impairment, personality traits, depression, generalized anxiety and health anxiety. Internal consistency, concurrent and incremental validity were assessed. Path analyses were run. RESULTS: Factor analysis identified a two-factor solution (i.e., C-19ASS Perseveration and C-19ASS Avoidance) and confirmatory factor analysis suggested a two-factor model best fits the data. The Italian version of the C-19ASS showed good internal consistency. There was also evidence of convergent validity and incremental validity. Path analyses showed that C-19ASS Perseveration mediates the relationship between emotional stability and psychological symptoms (depression, generalized anxiety and health anxiety). CONCLUSION: The Italian version of the C-19ASS appears to be a reliable and valid measure of the COVID-19 anxiety syndrome. The COVID-19 anxiety syndrome could be a suitable therapeutic target to reduce psychological symptoms typically linked to pandemic events, such as depression generalized anxiety and health anxiety.

How Communication Technology Fosters Individual and Social Wellbeing During the Covid-19 Pandemic: Preliminary Support For a Digital Interaction Model.

The aim of the present study was to test an explanatory model for individual and social wellbeing which incorporates the advantages of using digital technologies during the COVID-19 pandemic. The study was carried out in Italy, one of the countries that has been most severely affected by the pandemic worldwide. The study was designed to include variables that might be specifically pertinent to the uniqueness of the restrictions imposed by the pandemic. Adults living in Italy (n = 1412) completed an online survey during the lockdown period in March 2020. Results showed two distinct digital interaction processes highlighted by the facilitating use of online emotions ("e-motions") and online social support ("e-support"). In short, e-motions were positively related to posttraumatic growth, which in turn was positively associated with positive mental health and higher engagement in prosocial behaviors. Moreover, individuals who perceived themselves as having greater e-support were characterized by higher levels of positive mental health, which it turn was positively associated with prosocial behaviors. Collectively, these two digital interaction processes suggest that digital technologies appear to be critical resources in helping individuals cope with difficulties raised by the COVID-19 pandemic.

Friendship quality in adolescence: the role of social media features, online social support and e-motions.

The last decade has seen a growing interest in understanding what role social media play in adolescent experiences, including friendship relationships. However, little is known about the associations of specific characteristics of social media and individual factors with friendship quality. This study was designed in line with the tenets of the so-called Transformation Framework (Nesi et al., 2018) with the aim of testing whether and how social media features, online social support, and online expressions of emotions play a role in adolescents' friendship quality. Participants were 744 Italian adolescents (64.5% females) with an average age of 15.9 years (SD = 1.31). First, a path analysis was conducted to test the hypothesized model on the whole sample of adolescents. Finally, two multi-group analyses (MGA) were conducted to analyze differences across gender groups (female vs. male) and group of social media users (problematic vs. non-problematic). Path analysis yielded a complex pattern of associations, in which different perceived social media features were significantly associated with different dimensions of friendship quality, both directly and indirectly via perceived online social support and the tendency to express e-motions on social media. Moreover, MGAs confirmed significant differences among both genders and social media users. The findings provide support for the importance of considering social media as a social context with its own characteristics for the study of adolescents' peer experiences, by taking into consideration that the hypothesized role of social media in supporting friendship relations during adolescence may depend on individual factors. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03564-3.

Mortality differences between migrants and Italians residing in Rome before, during, and in the aftermath of the great recession. A longitudinal cohort study from 2001 to 2015.

BACKGROUND: In Europe, one of the most consistent findings is that of migrant mortality advantage in high-income countries. Furthermore, the literature shows that economic shocks, which bring worse health outcomes, can severely affect the most disadvantaged individuals. We analyse differences and changes in all-cause mortality between Italians and migrants residing in Rome before, during, and in the aftermath of the Great Recession (2001-2015) by birth-cohort. METHODS: The analysis is a longitudinal open cohort study. Mortality data come from the Register of the Causes of Death (58,637 deaths) and the population denominator (n = 2,454,410) comes from the Municipal Register of Rome. By comparing three time-periods (2001-2005, 2006-2010, and 2011-2015), we analyse all-cause mortality of Rome residents born, respectively, in the intervals 1937-1976, 1942-1981, 1947-1986 (aged 25-64 years at entry into observation). Computing birth-cohort-specific death rates and applying parametric survival models with age as the time-scale, we compare mortality differences between migrants and Italians by gender, area of origin, and time-period. RESULTS: Overall, we find a lower risk of dying for migrants than Italians regardless of gender (Women: HR = 0.61, 95% CI 0.56-0.66; Men: HR = 0.49, 95% CI 0.45-0.53), and a lower death risk over time for the total population. Nevertheless, such a pattern changes according to gender and migrants' area of origin. CONCLUSION: Given the relevance of international migrations in Europe, studying migrants' health has proved increasingly important. The deterioration in migrant health and the gradual weakening of migrants' mortality advantage is likely to become a public health issue with important consequences for the healthcare system of all European countries.

Avoidable hospitalisation for diabetes mellitus among immigrants and natives: Results from the Italian Network for Longitudinal Metropolitan Studies.

BACKGROUND AND AIMS: Italy has experienced a relevant increase in migration inflow over the last 20 years. Although the Italian Health Service is widely accessible, immigrants can face many barriers that limit their use of health services. Diabetes mellitus (DM) has a different prevalence across ethnic groups, but studies focusing on DM care among immigrants in Europe are scarce. This study aimed to compare the rates of avoidable hospitalisation (AH) between native and immigrant adults in Italy. METHODS AND RESULTS: A multi-centre open cohort study including all 18- to 64-year-old residents in Turin, Venice, Reggio-Emilia, Modena, Bologna and Rome between 01/01/2001 and 31/12/2013-14 was conducted. Italian citizens were compared with immigrants from high migratory pressure countries who were further divided by their area of origin. We calculated age-, sex- and calendar year-adjusted rate ratios (RRs) and 95% confidence intervals (95% CIs) of AH for DM by citizenship using negative binomial regression models. The RRs were summarized using a random effects meta-analysis. The results showed higher AH rates among immigrant males (RR: 1.63, 95% CI: 1.16-2.23), whereas no significant difference was found for females (RR: 1.14, 95% CI: 0.65-1.99). Immigrants from Asia and Africa showed a higher risk than Italians, whereas those from Central-Eastern Europe and Central-Southern America did not show any increased risk. CONCLUSION: Adult male immigrants were at higher risk of experiencing AH for DM than Italians, with differences by area of origin, suggesting that they may experience lower access to and lower quality of primary care for DM. These services should be improved to reduce disparities.

Prevalence of chronic kidney disease in the Lazio region, Italy: a classification algorithm based on health information systems.

BACKGROUND: Estimating CKD prevalence is difficult. Information on CKD prevalence is rather scanty in Italy and available figures come from surveys in selected geographical areas. Administrative data have been already demonstrated to be an effective tool in estimating the epidemiological burden of diseases, however there is limited experience in literature as far as CKD is concerned. METHODS: The aim of this study is to develop an algorithm based on regional Health Administrative Databases to identify individuals with CKD and provide estimates of disease prevalence in Lazio Region (Italy); about 5.500.000 inhabitants in 2017. A population-level analysis based on a record-linkage strategy using data from Health Administrative Databases has been applied in Lazio Region. CKD cases were identified between January 1, 2012 and December 31, 2017 using Outpatient Specialist Service Information System, Hospital Discharge Registry, Ticket Exemption Registry and Drug Dispensing Registry. Age-specific and standardized prevalence rates were calculated by gender. CKD cases were classified as higher and lower severity. RESULTS: The algorithm identified 99,457 individuals with CKD (mean age 71 years, 55.8% males). The exclusive contributions of each regional source used were: 35,047 (35.2%) from Outpatient Specialist Service Information System, 27,778 (27.9%) from Hospital Discharge Registry, 4143 (4.2%) from Ticket Exemption Registry and 463 (0.5%) from Drug Dispensing Registry; 5.1% of cases were found in all databases. The standardized prevalence rate at December 31, 2017 was 1.76, 2.06% for males and 1.50% for females. The prevalence increased with age, rising from 0.33% (age 0-18) up to 14.18% (age 85+) among males and from 0.25% up to 8.18% among females. The proportion of CKD individuals with lower severity disease was 78.7% in both genders. CONCLUSIONS: The proposed algorithm represents a novel tool to monitor the burden of CKD disease, that can be used by the regional government to guide the development and implementation of evidence-based pathways of care for CKD patients. The high prevalence of people with CKD of lower severity should be carefully considered in order to promote diagnosis and optimal management at early stages.

Disparities in emergency department use between Italians and migrants residing in Rome, Italy: the Rome Dynamic Longitudinal Study from 2005 to 2015.

BACKGROUND: The Emergency Department (ED) can be considered an indicator of accessibility and quality and can be influenced in period of economic downturns. In the last fifteen years, the number of migrants in Italy has doubled (from 2.4 million in 2005 to 5.2 in 2019, 4.1 and 8.7% of the total population, respectively). However, evidence about migrants' healthcare use is poor, and no studies focused on the ED utilisation rate during the Great Recession are available. This study aims to analyse trends in all-cause and cause-specific ED utilisation among migrants and Italians residing in Rome, Italy, before and after 2008. METHODS: Longitudinal study based on data from the Municipal Register of Rome linked to the Emergency Department Register from 2005 to 2015. We analysed 2,184,467 individuals, aged 25-64 in each year. We applied a Hurdle model to estimate the propensity to use the ED and to model how often individuals accessed the ED. RESULTS: Migrants were less likely to be ED users than Italians, except for Africans (RR = 1.46, 95%CI 1.40-1.52) and Latin Americans (RR = 1.04, 95%CI 1.00-1.08) who had higher all-cause utilisation rates than non-migrants. Compared to the pre-2008 period, in the post-2008 we found an increase in the likelihood of being an ED user (OR = 1.34, 95%CI 1.34-1.35), and a decrease in ED utilisation rates (RR = 0.96, 95%CI 0.96-0.97) for the whole population, with differences among migrant subgroups, regardless of cause. CONCLUSIONS: This study shows differences in the ED utilisation between migrants and Italians, and within the migrant population, during the Great Recession. The findings may reflect differentials in the health status, and barriers to access primary and secondary care among migrants. In this regard, health policies and cuts in health spending measures may have played a key role, and interventions to tackle health and access disparities should include policy measures addressing the underlying factors, adopting a Health in All Policies perspective. Further researches focusing on specific groups of migrants, and on the causes and diagnoses related to the ED utilisation, may help to explain the differences observed.

Potentially avoidable hospitalization for asthma in children and adolescents by migrant status: results from the Italian Network for Longitudinal Metropolitan Studies.

BACKGROUND: Global migration toward Europe is increasing. Providing health assistance to migrants is challenging because numerous barriers limit their accessibility to health services. Migrants may be at a greater risk of developing asthma and receiving lower quality healthcare assistance than non-migrants. We aim to investigate whether immigrants as children and adolescents have higher rates of potentially avoidable hospitalization (PAH) for asthma compared to Italians. METHODS: We performed a retrospective longitudinal study using six cohorts of 2-17-year-old residents in North and Central Italy from 01/01/2001 to 31/12/2014 (N = 1,256,826). We linked asthma hospital discharges to individuals using anonymized keys. We estimated cohort-specific age and calendar-year-adjusted asthma PAH rate ratios (HRRs) and 95% confidence intervals (95%CIs) among immigrants compared to Italians. We applied a two-stage random effect model to estimate asthma PAH meta-analytic rate ratios (MHRRs). We analyzed data by gender and geographical area of origin countries. RESULTS: Three thousand three hundred four and 471 discharges for asthma PAH occurred among Italians and immigrants, respectively. Compared to Italians, the asthma PAH cohort-specific rate was higher for immigrant males in Bologna (HRR:2.42; 95%CI:1.53-3.81) and Roma (1.22; 1.02-1.45), and for females in Torino (1.56; 1.10-2.20) and Roma (1.82; 1.50-2.20). Asthma PAH MHRRs were higher only among immigrant females (MHRRs:1.48; 95%CI:1.18-1.87). MHRRs by area of origin were 63 to 113% higher among immigrants, except for Central-Eastern Europeans (0.80; 0.65-0.98). CONCLUSION: The asthma PAH meta-analytic rate was higher among female children and adolescent immigrants compared to Italians, with heterogeneity among cohorts showing higher cohort-specific PAH also among males, with some differences by origin country. Access to primary care for children and adolescent immigrants should be improved and immigrants should be considered at risk of severe asthma outcomes and consequently targeted by clinicians.

Testing the Italian version of the Cyberchondria Severity Scale and a metacognitive model of cyberchondria.

Cyberchondria refers to the tendency to excessively and compulsively search for online medical information despite the distress experienced, with consequent impairment of daily-life activities. The current two studies sought to explore (i) the factor structure of the Italian version of the Cyberchondria Severity Scale (CSS) and (ii) a metacognitive model of cyberchondria. Participants were Italian community adults who reported using the Internet to search for health-related information (Study 1: N = 374, Study 2: N = 717). Results from Study 1 supported the Italian version of the CSS exhibiting a five-factor structure, with the resulting scales demonstrating good internal consistency, 5-week test-retest reliability, and generally strong correlations with indices of health anxiety. In Study 2, results of a path analysis showed that the negative metacognitive belief domain ("thoughts are uncontrollable") shared the strongest direct association with each of the five dimensions of cyberchondria, followed by beliefs about rituals. Consistently, the strongest indirect associations were found between "thoughts are uncontrollable" and all the five cyberchondria dimensions via beliefs about rituals. These results provide support for an Italian version of the CSS and the metacognitive conceptualization of cyberchondria.

[Increased offer of renal transplantation and better outcomes in the Lazio Region, Italy 2008-2017]. / Aumento dell'offerta di trapianto di rene e miglioramento degli esiti nella regione Lazio, anni 2008-2017.

OBJECTIVES: 1. to describe temporal trend (2008-2017) in kidney transplant (KT) provision in the Lazio Region; 2. to measure KT outcomes by comparing three different time periods; 3. to estimate the prevalence of individuals with functioning kidney transplant. DESIGN: cross sectional (objective 1); cohort study (objectives 2 and 3). SETTING AND PARTICIPANTS: the study population included people residing in Lazio Region who received a kidney transplant between 2008 and 2017. Participants were selected through the integration of data from different sources: the Hospital Information System, the Regional Register of Dialysis and Transplantation, and the Regional Waiting List for Kidney Transplantation. MAIN OUTCOME MEASURES: standardised KT incidence rates x100,000 by year and age-specific rates were calculated separately for men and women. Mortality and failure of KT were considered as outcomes at one year; for both outcomes, the cumulative incidence x100 and raw and adjusted (by gender and age) incidence rates x100,000 person-day were calculated using a Poisson model. Raw and standardised prevalence rates x100,000 of people residing in Lazio Region with functioning KT at 31.12.2016 were calculated. RESULTS: in the study period, 1,646 KTs were performed. The KT rate increased significantly overtime, ranging between 2.9 in 2008 and 3.6 in 2017. Rates were higher for men compared to women. For men aged 65+ incidence KT rate increased significantly: 3.5 in 2008 and 7.1 in 2017. Among women, there was an increasing trend in the age groups 0-18 and 35-49 years. The one-year mortality rate decreased from 11.9 in 2008-2010 to 4.2 in 2014-2016. The failure rate was stable: 21.4 in 2008-2010 and 19.2 in 2014-2016. The number of individuals with functioning kidney transplant was 1,148. The standardised prevalence rate was 25.8 in men and 14.6 in women. CONCLUSIONS: increased offer of renal transplantation and better outcomes were observed in Lazio region. The proposed methodology is useful for the construction of indicators to monitor over time both KT provision and outcomes.

[Mortality inequalities in Rome: the role of individual education and neighbourhood real estate market]. / Differenziali di mortalità a Roma: il ruolo dell'istruzione e dei prezzi immobiliari del quartiere di residenza.

OBJECTIVES: to investigate the association between real estate prices, education, and mortality. DESIGN: cohort study. SETTING AND PARTICIPANTS: residents in Rome at the 2011 Italian Census, not living in institutions, and living in the address reported in the Census survey. People aged 18-99 years were followed from 2011 to 2016 using anonymous record linkage procedures with administrative databases. The Census includes several individual information, such as gender, age, education, residential neighbourhood. Data and cause of death were collected from mortality register. Real estate prices (euros/m2) were available for each neighbourhood. MAIN OUTCOME MEASURES: adjusted Cox regression models (hazard ratios - HRs and 95%CIs) were used to estimate the association among individual education, real estate price in the neighbourhood, and mortality. RESULTS: the subjects selected were 2,051,376 (54% women, 22.5% with high education level). During the follow-up, 127,352 subjects died. Taking into account gender, age, marital status, and real estate prices, education level was strongly associated with all-cause mortality; compared to highly educated the higher mortality, risk was 35% (95%CI 32%-37%) for low education level and 16% (95%CI 14%-19%) for medium education level. Taking into account the same factors and education level, each increase of 1,000 euros in price/m2 was inversely associated with mortality (HR 0.96, 95%CI 0.96-0.97). CONCLUSIONS: there is an independent association between the two indicators and mortality in Rome. A simple indicator such as real estate prices can be used to tackle inequalities.

The Role of Metacognitions and Thinking Styles in the Negative Outcomes of Adolescents' Peer Victimization.

Psychological mechanisms that may explain the link between peer victimization and its adverse outcomes are still understudied. The current study aimed to apply the Self-Regulatory Executive Function (S-REF) model of psychopathology (Wells & Matthews, 1994, 1996) to help explain this link in a sample of adolescents. A total of 1,169 Italian adolescents (47.7% females; Mage = 15.79, SD = 1.07) completed self-report measures of peer victimization, metacognitions, thinking styles (worry and rumination), and adjustment indices (somatic symptoms, anxiety, depression). The hypothesized model based on the S-REF model was tested through path analysis. Results confirmed that peer victimization was positively associated with both positive and negative metacognitions that, in turn, were linked to worry and rumination, which were associated with higher psychological and somatic problems. The strongest indirect links were found between peer victimization and anxiety via negative metacognitions and worry, and between victimization and depression via negative metacognitions and rumination. Overall, the results support to the application of the S-REF model to peer victimization experiences during adolescence. The clinical implications of these findings are discussed.