Anthraquinone laxatives use and colorectal cancer: A systematic review and meta-analysis of observational studies.

This systematic review and meta-analysis were conducted to determine the effects of anthraquinone (AQ) laxatives on colorectal cancer (CRC). We searched PubMed, Embase, Google Scholar, and CENTRAL from inception until March 2021, for randomized controlled trials (RCTs) and observational studies. Through the systematic review, we identified 8 observational studies evaluating AQ laxatives use as a risk factor for CRC development, and 5 studies on CRC risk were included in the meta-analysis using a random-effects model. Through the meta-analysis, we found that a history of AQ laxatives use compared with "other" and "no laxatives" use was associated with CRC development (OR: 1.41; 95% CI: 0.94-2.11), although not at a statistically significant level. The possible association persists even after removal of the outlier studies (OR: 1.51; 95% CI: 0.97-2.34). Selection of cases and controls was judged at low or unclear risk of bias across almost all studies, and the quality of evidence was from moderate to low. In conclusion, it is not possible to associate the use of AQ laxatives with the development of CRC. However, the trend toward an increased risk of CRC provides a strong indication for investigating this issue by performing further high-quality studies.

Effects of lavender on anxiety: A systematic review and meta-analysis.

BACKGROUND: Anxiety is one of the uprising psychiatric disorders of the last decades and lavender administration has been traditionally suggested as a possible treatment. The objective of this review is to assess the efficacy of lavender, in any form and way of administration, on anxiety and anxiety-related conditions. METHODS: The PRISMA guidelines were followed. Retrieved data were qualitatively and quantitatively synthesized. Randomized Controlled Trials (RCTs) and Non-Randomized Studies (NRSs) which investigated the efficacy of lavender, in any form and way of administration, on patients with anxiety, involved in anxiety-inducing settings or undergoing anxiety-inducing activities, compared to any type of control, without language restrictions, were identified through electronic database searches. Medline via PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Google Scholar were systematically searched. All databases were screened up to November 2018. Risk of bias was assessed with the Cochrane risk-of-bias tool and the following domains were considered: randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases. RESULTS: 65 RCTs (7993 participants) and 25 NRSs (1200 participants) were included in the qualitative synthesis and 37 RCTs (3964 participants) were included in the quantitative synthesis. Overall, the qualitative synthesis indicated that 54 RCTs and 17 NRSs reported at least a significant result in favor of lavender use for anxiety. The quantitative synthesis showed that lavender inhalation can significantly reduce anxiety levels measured with any validated scale (Hedges' g = -0.73 [95% CI -1.00 to -0.46], p < 0.00001, 1682 participants), as well as state anxiety (Spielberger's state-trait anxiety inventory (STAI)-State mean difference = -5.99 [95% CI -9.39 to -2.59], p < 0.001, 901 participants) and trait anxiety (STAI-Trait mean difference = -8.14 [95% CI -14.44 to -1.84], p < 0.05, 196 participants). Lavender inhalation did not show a significant effect in reducing systolic blood pressure as a physiological parameter of anxiety. A significant effect in diminishing anxiety levels was also found in favor of the use of oral Silexan® 80 mg/die for at least 6 weeks (Hamilton Anxiety Scale mean difference = -2.90 [95% CI -4.86 to -0.95], p = 0.004, 1173 participants; Zung Self-rating Anxiety Scale mean difference = -2.62 [95% CI -4.84 to -0.39], p < 0.05, 451 participants) or of the administration of massage with lavender oil (Hedges' g = -0.66 [95% CI -0.97 to -0.35], p < 0.0001, 448 participants). DISCUSSION: The most important limitation of this review is the low average quality of available studies on the topic. The majority of included RCTs were characterized by a high overall risk of bias. Another limitation regards the heterogeneity of study designs, especially with regard to non-oral ways of administration. Overall, oral administration of lavender essential oil proves to be effective in the treatment of anxiety, whereas for inhalation there is only an indication of an effect of reasonable size, due to the heterogeneity of available studies. Lavender essential oil administered through massage appears effective, but available studies are not sufficient to determine whether the benefit is due to a specific effect of lavender. Further high-quality RCTs with more homogeneous study designs are needed to confirm these findings. Available information outlines a safe profile for lavender-based interventions, although more attention should be paid to the collection and reporting of safety data in future studies. Considering these findings, since treatments with lavender essential oil generally seem safe, and, in the case of inhalation, also simple and inexpensive, they are a therapeutic option which may be considered in some clinical contexts. OTHER: The present systematic review was not funded and was registered in PROSPERO under the following number: CRD42019130126.

Preclinical and Clinical Evidence Supporting Use of Cannabidiol in Psychiatry.

BACKGROUND: Cannabidiol (CBD) is a major chemical compound present in Cannabis sativa. CBD is a nonpsychotomimetic substance, and it is considered one of the most promising candidates for the treatment of psychiatric disorders. OBJECTIVE: The aim of this review is to illustrate the state of art about scientific research and the evidence of effectiveness of CBD in psychiatric patients. METHODS: This review collects the main scientific findings on the potential role of CBD in the psychiatric field, and results of clinical trials carried out on psychiatric patients are commented. A research was conducted in the PUBMED, SCOPUS, and ScienceDirect databases using combinations of the words cannabidiol, psychiatry, and neuropsychiatric. RESULTS: Preclinical and clinical studies on potential role of CBD in psychiatry were collected and further discussed. We found four clinical studies describing the effects of CBD in psychiatric patients: two studies about schizophrenic patients and the other two studies carried out on CBD effects in patients affected by generalized social anxiety disorder (SAD). CONCLUSION: Results from these studies are promising and suggest that CBD may have a role in the development of new therapeutic strategies in mental diseases, and they justify an in-depth commitment in this field. However, clinical evidence we show for CBD in psychiatric patients is instead still poor and limited to schizophrenia and anxiety, and it needs to be implemented with further studies carried out on psychiatric patients.

[A new model of integrated care: Ospedale di Continuità]. / La continuità di cura: un nuovo modello.

The "Continuity of Care Hospital", which is now realized in the Santa Verdiana Hospital, Castelfiorentino (Italy), is aimed at solving the existing gap between hospitalists and primary care physicians. This new model of care could represent an effective tool for solving the emerging medical and teaching needs of a population characterized by advanced age and comorbidities.

Atrial fibrillation after cardiac surgery: incidence, risk factors, and economic burden.

OBJECTIVE: To evaluate the incidence of postoperative atrial fibrillation (POAF), the predisposing factors, the results of treatment before discharge, and the impact on duration and costs of hospitalization. DESIGN: A prospective observational study. METHODS: Patients who underwent cardiac surgery from January 1, 2007 to December 31, 2007. INTERVENTIONS: Electrocardiography was continuously monitored after surgery. Patients with symptomatic new-onset atrial fibrillation or lasting >15 minutes were treated with amiodarone and with DC shock in prolonged cases. RESULTS: POAF occurred in 29.7%, with the higher incidence between the 1st and 4th postoperative day. Age (p < 0.001), atrial size >40 mm (p < 0.001), previous episodes of AF (p < 0.001), female sex (p = 0.010), and combined valve and bypass surgery (p = 0.012) were multivariate predictors of POAF at logistic regression. Sinus rhythm was restored by early treatment in 205 of 215 patients. This was associated with a low incidence of cerebrovascular events (<0.5%) and with a limited increase of average length of hospitalization (24 hours) in patients with POAF. CONCLUSIONS: The overall incidence of POAF in the authors' center is close to 30%; 95.3% of patients were discharged in sinus rhythm. The increase in length and costs of hospitalization (on average, 1.0 day with a burden of about €1,800/patient) were significantly lower than in previous investigations.

Effects of short-term consumption of bread obtained by an old Italian grain variety on lipid, inflammatory, and hemorheological variables: an intervention study.

The aim of this study was to evaluate the influence of short-term dietary intake of bread obtained by a selected variety of old grain grown in Tuscany, Italy on some parameters related to the atherosclerotic process. Twenty healthy subjects (median age, 39.5 years) followed for 10 weeks a diet containing bread (150 g/day) made from the test grain (test period) and for the same period a diet containing commercially available bread of the same quantity (control period). Lipid, inflammatory, and hemorheological profiles before and after dietary intervention were evaluated. The test period showed a significant (P < .05) improvement of total cholesterol (pre-intervention, 211.2 +/- 10.8 mg/dL; post-intervention, 196.5 +/- 9.8 mg/dL) and low-density lipoprotein-cholesterol levels (pre-intervention, 137.5 +/- 8.1 mg/dL; post-intervention, 119.5 +/- 7.5 mg/dL), whereas no significant changes during the control period were observed. With regard to inflammatory and hemorheological parameters, the test period showed a significant decrease in some of the parameters investigated (interleukin-8 [pre-intervention vs. post-intervention, 67.4 +/- 10.7 vs. 43.9 +/- 4.1 pg/mL], whole blood viscosity at high [4.36 +/- 0.03 vs. 4.32 +/- 0.03 mPa x s, respectively] and low [26.1 +/- 0.4 vs. 24.8 +/- 0.5 mPa x s, respectively] shear rates, and erythrocyte filtration [8.4 +/- 0.7% vs. 9.1 +/- 0.6%, respectively]) relative to the control period, which showed no significant changes. Short-term dietary intake of whole grain bread obtained from an old grain variety seems to impose a favorable status with regard to lower circulating levels of markers of atherosclerosis.

Effects of a 1-year dietary intervention with n-3 polyunsaturated fatty acid-enriched olive oil on non-alcoholic fatty liver disease patients: a preliminary study.

BACKGROUND AND AIMS: Non-alcoholic fatty liver disease (NAFLD) is a worldwide diffuse condition due to alimentary, environment and genetic factors. The aim of our preliminary study was to evaluate the effectiveness of long-term consumption of food enriched with n-3 polyunsaturated fatty acids (PUFA) in patients with NAFLD. METHODS: Eleven patients were enrolled; six (four males, two females) were planned for oral administration of 6.5 ml olive oil enriched with n-3 PUFA for 12 months, while five (four males, one female) were used as controls. RESULTS: Consumption of olive oil enriched with n-3 PUFA demonstrated a significant improvement of liver echo-texture and of the Doppler Perfusion Index after 12 months (after: 0.19 ± 0.02 vs. pre: 0.15 ± 0.03; P < 0.05), whereas no significant changes were seen at the end of follow-up in controls. Moreover, patients who consumed the olive oil enriched with n-3 PUFA showed a significant amelioration of liver enzymes, and of triglycerides (post: 132.8 ± 63.7 vs. pre: 164.5 ± 85.5 mg/dl; P = 0.04) in a general linear model adjusted for age and gender. Interestingly, patients reported to have a significant increase of adiponectin levels (post: 1,487.9 ± 96.7 vs. pre: 1,143 ± 24.8 µg/ml; P = 0.04). CONCLUSION: The results of this preliminary study showed that long-term consumption of olive oil enriched with n-3 PUFA in patients with NAFLD is able to decrease circulating liver enzymes and triglycerides, with a significant improvement of adiponectin levels.

[Dealing with error in cardiology]. / L'errore in cardiologia.

A commonly used definition describes an error as a harmful or potentially harmful occurrence for the patient. Although over the last years the evolution of medicine has been characterized by remarkable technological advances, the percentage of errors in clinical practice has not changed since the '40s. In this setting, the aim of our review is to assess how errors develop in real life in modern cardiology and how they can be identified early, corrected, and possibly prevented. In our opinion, the more a healthcare system (i.e., a cardiology ward or a hospital) is capable of facing its error, the safer it is. In our daily practice, errors can be distinguished in "clinical errors" (mainly related to knowledge) and "system errors" (mainly referring to healthcare organization; i.e., the integrated cardiac network). Bearing in mind the high frequency and consequences, cardiologists should consider errors as among the main determinants of quality of care, which the whole team has to deal with. Time and resources should be spent to identify the best approaches to cope with errors, tailored for each cardiology team. Ultimately, the care of a patient with heart disease should be viewed holistically and not as the afinalistic sum of procedures, no matter how technically developed.

Psychological predictors of the antihypertensive effects of music-guided slow breathing.

BACKGROUND: The possibility that daily sessions of music-guided slow breathing may reduce 24-h ambulatory blood pressure (ABP), and predictors of efficacy were explored in a randomized, placebo-controlled trial with parallel design. METHODS: Age-matched and sex-matched hypertensive patients were randomized to music-guided slow breathing exercises (4-6 breaths/min; 1: 2 ratio of inspiration: expiration duration) (Intervention; n = 29) or to control groups who were thought to relax while either listening to slow music (Control-M; n = 26) or reading a book (Control-R; n = 31). At baseline and at follow-up visits (1 week and 1, 3 and 6 months), ABP monitoring was performed. RESULTS: At mixed model analysis, intervention was associated with a significant reduction of 24-h (P = 0.001) and night-time (0100-0600 h) (P < 0.0001) systolic ABP. The average reduction of systolic 24-h ABP at 6 months was 4.6 mmHg [confidence limits at 95% 1.93-7.35] and 4.1 mmHg (95% confidence limits 1.59-6.67) vs. Control-M and Control-R groups, respectively, (P < 0.001 for both). Antihypertensive treatment was selected as negative predictor of BP reduction at multivariate stepwise analysis. When antihypertensive treatment was inserted as covariate in a generalized linear model, psychological subscales assessed at baseline by the Mental Health Inventory questionnaire were found to affect systolic blood pressure reduction at 6-month follow-up (general positive affect P < 0.001; emotional ties, P < 0.001; loss of behavioral control, P = 0.035). In particular, a level of general positive affect higher than the 75th percentiles was found to be significantly associated with low treatment efficacy (odds ratio 0.09; 95% confidence limits 0.01-0.93). CONCLUSION: Daily sessions of voluntary music-guided slow breathing significantly reduce 24-h systolic ABP, and psychological predictors of efficacy can be identified.

[Past, present and future of green tea: from pleasant beverage to drug in pills?]. / Storia ed attualità del tè verde: da bevanda voluttuaria a farmaco in compresse?

During the 17th century, new drinks entered the European market: wine and beer, which were largely widespread among the different European countries, were joined by coffee and tea; their consumption at was first limited to the higher classes, but they soon became popular at all levels of society. Even if their therapeutic effects were strongly stressed from different points of view, at first they encountered a certain resistance. Tea, in particular, represented a sort of compromise between a pleasant habit, bound to economic and social reasons, and a therapeutic scope. Green tea is unfermented tea. In Japan the most frequently used method of production is steaming, that deactivates the oxidase in tea leaves, determining the retention of a brilliant green colour. Its use has been proposed in a number of clinical conditions and pathologies, even if its putative therapeutic properties must be further assessed in rigorously designed and conducted clinical trials. Aim of this paper is to call needed attention to the potential role of green tea extracts in prevention and in therapy in relation to the scientific methodology of clinical research.

Academic education in complementary medicine: a tuscan methodological perspective.

The implementation of complementary medicine (CM) involves a large number of persons in Italy, and in the nineties, the percentage of Italian citizens adopting the most frequent and relevant practices of CM almost doubled. Appropriate academic education in CM is an important and fascinating challenge for current didactic systems in the Italian University. Already in 2004, the Joint Italian Conference of the Deans of the Faculties of Medicine and of the Presidents of Medical Degree Courses released an official statement regarding the relationship between CM and health area degree courses. The main teaching objectives embedded in the institutional framework proposed by the Joint Italian Conference are now finding specific implementation modalities in the University of Florence. For many years, the Florence Medical School has had strong and fruitful contacts with institutional bodies in Tuscany and, together with these institutions, has established a continuous dialogue with the world of CM. This exchange has given rise to various teaching activities within the academic setting. With specific reference to the undergraduate curriculum in Medicine and Surgery, a methodological course regarding CM has been designed and conducted, with selective attention being given to the CM practices having an enhanced rate of supportive scientific evidence, such as herbal medicine and acupuncture. With regard to the postgraduate curriculum, a Master degree in Acupuncture and Traditional Chinese Medicine and a Master in Clinical Phytotherapy are already active in the University of Florence and are having a remarkable success among the attending health professionals. This high degree of satisfaction well documents the importance, need and feasibility of structured academic education in CM and, in particular, of a methodological didactics such as those currently implemented in the Florence Medical School.

Coffee consumption and risk of coronary heart disease: a meta-analysis.

BACKGROUND AND AIMS: During the past three decades the relationship between habitual coffee drinking and coronary heart disease (CHD) has been assessed in numerous studies, with conflicting results. The aim of this study was to systematically examine the data published on the association between habitual coffee consumption and risk of CHD. METHODS AND RESULTS: Thirteen case-control and 10 cohort studies were included. Case-control studies incorporated 9487 cases of CHD and 27,747 controls, and cohort studies included a total of 403,631 participants that were followed for between 3 and 44 years. The summary of odds ratios (OR) for the case-control studies showed statistically significant associations between coffee consumption and CHD for the highest intake group (>4 cups/day), OR 1.83 (95% CI 1.49-2.24; P<0.0001), and for the second highest category (3-4 cups/day), OR 1.33 (95% CI 1.04-1.71; P<0.0001), while no significant association emerged for low daily coffee intake (< or =2 cups/day), OR 1.03 (95% CI 0.87-1.21; P=0.45). The analysis of long-term follow-up cohort studies did not show any association between the consumption of coffee and CHD, with a relative risk (RR) of 1.16 (95% CI 0.95-1.41; P=0.14) for the highest category, and 1.05 (95% CI 0.90-1.22; P=0.57) and 1.04 (95% CI 0.90-1.19; P=0.60) for the second and third highest categories, respectively. These results did not differ substantially when controlling for region of origin, fatal and non-fatal events, year of publication, and number of years of follow-up. CONCLUSIONS: Despite a significant association between high consumption of coffee and CHD reported among case-control studies, no significant association between daily coffee consumption and CHD emerged from long-term follow-up prospective cohort studies.

Low adherence of a clinically healthy Italian population to nutritional recommendations for primary prevention of chronic diseases.

BACKGROUND AND AIM: Several data demonstrated that dietary habits significantly affect the health state of the population. During recent years all the major scientific associations have provided nutritional recommendations for primary prevention of chronic diseases but few data are available about prevalence of adherence to these recommendations in an otherwise healthy population. The aims of this study were to evaluate dietary habits, and to assess the adherence of the general population to the recommendations for correct nutritional behaviour. METHODS AND RESULTS: Dietary habits, anthropometric and biochemical parameters were evaluated in a population of 932 (367 M; 565 F) clinically healthy subjects living in Florence, enrolled in an epidemiologic study conducted between 2002 and 2004. By comparing the dietary pattern with the nutritional guidelines, the study population reported a hyperproteic and hyperlipidic nutritional pattern, with a considerably low contribution from polyunsaturated fats (PUFA). A low fibre intake is shown in both genders. In addition, food consumption pattern showed an increased consumption of some foods such as meat, both fresh and processed, and a low intake of some "healthy" foods like fruit and vegetables. CONCLUSIONS: We found several nutritional flaws in the dietary habits of a clinically healthy Italian population. In particular, we reported a high intake of animal protein and total fats with a very low contribution from PUFA.

[The historical evolution of obstetrician formation]. / Evoluzione storica della formazione dell'ostetrica.

The evaluation of the historical development of obstetrician formation presents features of great modernity. At the end of the XVIII century in Florence the first School of Obstetrics for midwives was established. In the School two relevant complementary formative approaches were privileged: ex cathedra didactics and clinical training. The basic tools for these educational methodologies were constituted by handbook production and by wax anatomical models, the latter a field for the meeting and confrontation of surgeons and craftsmen. The historical-social scenario in which this original evolution took place was Tuscany society in the period of Enlightenment, that promoted the formation of professional figures capable of managing natural childbirth in an autonomous way, while nevertheless placing them under a previously lacking health policy control. In this cultural environment particularly impressive was the influence of J.P. Frank (Austria and Lombardy), but also present were other forces, deriving from other European countries, that aimed at including the formation of obstetricians in a scientific programme, thus excluding an unguarded non-structured training.

[Does coffee consumption represent a coronary risk factor?]. / Caffè e rischio coronarico: dalla storia alla attualità.

Aim of this paper is to critically review the evidence available regarding the relationship between coffee consumption and coronary risk. Large prospective studies do not support the hypothesis that moderate (< 5 cups of coffee a day) caffeine consumption significantly increases the risk of coronary heart disease. Data on higher coffee consumption are scanty and do not allow the acquisition of established conclusions, even if they suggest a statistically significant trend in coronary risk with increasing dose.

Physiological asymmetry of trunk ranging and pelvis motility: an anatomo-functional study in 80 healthy subjects.

A key feature in physiotherapeutic treatment of patients with motion disturbances is the appropriate ranging of the trunk and pelvis motility. Eighty subjects randomly selected and free from known pathology of the muscular-skeletal and/or of the neurological system classed into four groups according to the age and the sex have been assessed, by using a new, simple and easy administrable tool. Our results demonstrate that the new measurement tool showed a very low intra- and inter-observer variability, that healthy subjects showed a more adduced and elevated right scapula if compared to the contralateral one and, as regard as the pelvic motion, a broader joint excursion in passive motion compared with active motion in the overall group, a broader joint excursion in young subjects compared with elderly ones, and a broader joint excursion in female subjects compared with males subjects. In conclusion our study allowed to identify a range of physiological asymmetry and pelvis motility. Such a range of physiological asymmetry might be useful as a reference for the physiotherapists.