Overweight and Obesity in Adult Birth by Cesarean Section: A Systematic Review With Meta-analysis.

CONTEXT: Overweight/obesity is one of the most important health problems. Birth by cesarean section has been shown to influence long-term health outcomes including obesity. OBJECTIVE: The aim of this systematic review-meta-analysis is to update acknowledgment of the increased risk of cesarean section on offspring's overweight/obesity. METHODS: This study follows the PRISMA guidelines. A systematic literature search was conducted on Scopus, PubMed, and Web of Science; we have selected all the articles published until January 2, 2022. For inclusion, studies must have reported either (i) both birth by cesarean section and adult (≥18 years) offspring's body mass index; (ii) cohort or case-control study design; and (iii) a risk estimate. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by the Egger test and the Begg test. Meta-analysis was performed through a random-effects model. RESULTS: Twelve studies with a combined population of 180 065 subjects were included in the meta-analysis. The overall analysis (N = 19) yielded a combined risk estimate for overweight/obesity of 1.19 (95% CI, 1.08-1.30) and the test of heterogeneity resulted into Q = 57.44 ( I2 = 68.67%, P ≤ .001). The risk of offspring obesity is 1.23 (95% CI, 1.09-1.39) and the test of heterogeneity resulted into Q = 39.55 ( I2 = 69.66%, P ≤ .001). Children born by cesarean section have an increased risk of obesity in adulthood.

The Role of Diet in Osteoporotic Fracture Healing: a Systematic Review.

PURPOSE OF REVIEW: Summarize the in vivo evidences on the association between nutrition and osteoporosis fracture healing. RECENT FINDINGS: Osteoporotic fractures constitute a considerable public health burden. The healing capacity of fractures is influenced by local factors related to the fracture and by general factors (e.g., age, sex, osteoporosis, muscular mass, smoking, alcohol, drugs, and diet). The systematic review was conducted according to PRISMA statement. From the literature search on PubMed and Web of Science, from January 2016 to October 2019, twelve studies were selected and resulted highly variable in samples, exposure, methods, outcomes, and outcome assessment. Eleven studies were conducted on laboratory animals. Only one study aimed to investigate the impact of nutritional status on fracture healing in osteoporotic patients. In this review, the role of calcium/vitamin D supplementation remained controversial, while sialoglycoprotein supplementation, phytoestrogen-rich herb extract, flavonoids, and phosphorylated peptides showed a positive effect on osteoporotic fracture healing.

Maternal Folate Intake and Risk of Childhood Brain and Spinal Cord Tumors: A Systematic Review and Meta-Analysis.

BACKGROUND: Many epidemiological studies have investigated the effect of maternal diet and prenatal multivitamin supplementation on pediatric cancer risk. Childhood brain and spinal cord tumors (CBSCT) have been attributed to different possible risk factors. METHODS: We conducted a systematic review and meta-analysis on maternal folate intake before and during pregnancy and the risk of CBSCT. We systematically reviewed publications obtained by searching the Insitute for Scientific Information Web of Knowledge and PubMed literature databases. We extracted the risk estimate of the highest and the lowest reported categories of intake from each study and conducted a meta-analysis using a random-effects model. RESULTS: The results of the pooled analysis of all 10 studies, 1 cohort and 9 case-control studies, indicated that maternal folate intake was inversely associated with CBSCT risk (OR 0.77; 95% CI 0.67-0.88, p < 0.001; I2 = 51.22%, p = 0.001). Separate analyses on the basis of the source of folate (folic acid supplementation, dietary folate) and in relation to the timing of exposure (before pregnancy, during pregnancy) found that folic acid supplementation was associated with an approximately 23% reduction in -CBSCT risk (OR 0.77, 95% CI 0.66-0.90, p = 0.001; I2 = 53.18%, p = 0.001) and consumption during pregnancy was associated with an approximately 20% reduction in CBSCT risk (OR 0.80, 95% CI 0.67-0.97, p = 0.020; I2 = 62.48%, p < 0·001). CONCLUSIONS: Maternal consumption of folic acid is associated with a reduced risk of CBSCT. Further investigations are necessary to increase the reliability of the results and estimate the relationship between dose-response and the best outcome.

[Employment status and perceived health in Italy: data from the European Union Statistics on Income and Living Conditions (EU-SILC) longitudinal study]. / Condizione occupazionale e salute percepita in Italia: evidenze da dati longitudinali EU-SILC.

The aim of this study was to investigate the relationship between employment status (permanent employment, fixed-term employment, unemployment, other) and perceived health status in a sample of the Italian population. Data was obtained from the European Union Statistics on Income and Living Condition (EU-SILC) study during the period 2009 - 2012. The sample consists of 4,848 individuals, each with a complete record of observations during four years for a total of 19,392 observations. The causal relationship between perceived/self-reported health status and employment status was tested using a global logit model (STATA). Our results confirm a significant association between employment status and perceived health, as well as between perceived health status and economic status. Unemployment that was dependent on an actual lack of work opportunities and not from individual disability was found to be the most significant determinant of perceived health status; a higher educational level produces a better perceived health status.

Garlic consumption and colorectal cancer risk in man: a systematic review and meta-analysis.

OBJECTIVE: Colorectal cancer shows large incidence variations worldwide that have been attributed to different dietary factors. We conducted a meta-analysis on the relationship between garlic consumption and colorectal cancer risk. DESIGN: We systematically reviewed publications obtained by searching ISI Web of Knowledge, MEDLINE and EMBASE literature databases. We extracted the risk estimate of the highest and the lowest reported categories of intake from each study and conducted meta-analysis using a random-effects model. RESULTS: The pooled analysis of all fourteen studies, seven cohort and seven case-control, indicated that garlic consumption was not associated with colorectal cancer risk (OR=0·93; 95 % CI 0·82, 1·06, P=0·281; I 2=83·6 %, P≤0·001). Separate analyses on the basis of cancer sites and sex also revealed no statistically significant effects on cancer risk. However, when separately analysed on the basis of study type, we found that garlic was associated with an approximately 37 % reduction in colorectal cancer risk in the case-control studies (combined risk estimate=0·63, 95 % CI 0·48, 0·82, P=0·001; I 2=75·6 %, P≤0·001). CONCLUSIONS: Our results suggest that consumption of garlic is not associated with a reduced colorectal cancer risk. Further investigations are necessary to clarify the discrepancy between results obtained from different types of epidemiological studies.

Maternal and Perinatal Health in Umbria region in 2012.

BACKGROUND: Pregnancy and childbirth still involve risk for pregnant women and their babies and health in the perinatal period remains an important public health priority. This study addresses the question of perinatal health in Umbria region. METHODS: Data were obtained from the administrative source of the regional Standard Certificate of Live Births in Umbria in 2012. We used population data, which merges data from each mother and her baby for a total of 7964 records. To describe perinatal health we considered pathological pregnancy, fetal growth defect, birth weight, gestational age, Apgar scores at 5 minutes and stillbirth such as indicators of Maternal and Neonatal Health in according with population characteristics and risk factors (maternal age, parity, mothers' educational level and mothers' country of birth). RESULTS: In Umbria, in 2012 we have: - 29 stillbirths corresponding to a rate of stillbirths of 3.52 ‰ (stillbirths per 1000 births) - a perinatal mortality rate ( stillbirths and deaths in the first week of life) of 4.9 per 1000 live births and stillbirths - an Infant mortality rate (within the first year of life) of 2.5 per 1000 live births The 1.4 % of infants underwent neonatal resuscitation. This percentage detects an indicative Apgar score of important neonatal suffering (0-3) in the 1% of neonates. The frequency of infants with birth weight less than 2500 grams (LBW) was 6.4 %, with higher values ​​in females (7.3%) than males (2.7%). The frequency of infants with birth weight less than 1500 grams is 0.8%. The preterm birth (<37 weeks of gestation) rate is 6.3% of the total: 5.6% are pregnancies among the 32 and 36 weeks of gestation and 0.7% are pregnancies under the 32nd week of gestation. The pathological pregnancies are 7.9% and the Fetal Growth Restriction (FGR) is 2.7%. The health perinatal indicators considered were different in different population subgroups. The most representative population was Italian women (76.8%), with maternal age between 25-34 years (56.4%), primiparous (61.9%) and mothers with medium education levels (48.1%). CONCLUSIONS: Results highlight the existence of differences in perinatal health. Worse maternal condition and neonatal status were observed especially for less advantaged social classes (i.e., foreign or poorly educated). Such inequalities should be examined in all areas of public policy and public services, to ensure equal opportunity for all.

The care of pregnant women and their babies: empirical data from Umbria region.

BACKGROUND: The promotion of the concept of evidence-based health care in the field of maternity care began in the 1980s; the indicators in this field were devised to enable us to know key components of care for mothers and babies and to relate them to health outcomes. METHODS: The study is based on data from the Standard Certificate of Live Birth (SCLB) forms of the Umbria region (Italy) during 2012, which merges data from each mother and her baby for a total of 7964 records. We followed the healthcare indicators recommended by World Health Organization for monitoring and evaluating maternal and child health services. We considered number of prenatal medical visits and timing of first antenatal visit such as indicators of Antenal care, and mode of delivery and place of birth by volume of deliveries such as indicators of Intrapartum care in healthcare maternal and child services. Odds ratios were calculated to indicate the likelihood of some individual and social variables across appropriate access to prenatal care. RESULTS: It is present an association between social disadvantage (mothers' educational level and mothers' country of birth) and inappropriate access to prenatal care, low number of prenatal medical visits (below 4) and late timing of first visit (after more than 12 gestational weeks). In Umbria there are 11 place of birth, 9 of I level and 2 of II level. Overall, 29.3% births occurred in 6 maternity units with fewer than 500 births in 2012 (in Italy is 7.3%). The average rate of cesarean section observed in the NTSV sample (Nulliparous, Terminal, Single, Vertex), was 28.2%. This value was higher than expected, especially in this class with an indication for the physiological birth. The World Health Organization recommends that the caesarean section rate should not be higher than 10% to 15%. Moreover there is a wide variability between birth centers (7.2% -41.4%). CONCLUSIONS: The use of mother and child prenatal care services was associated with individual characteristics of the mothers from less advantage social classes (i.e., unemployed or poorly educated); cesarean section was higher than expected, especially in the NTSV sample; we foresee an important role for application of indicators that proactively help health-care professionals to deliver the right care at the right time.

Employment status and perceived health condition: longitudinal data from Italy.

BACKGROUND: The considerable increase of non-standard labor contracts, unemployment and inactivity rates raises the question of whether job insecurity and the lack of job opportunities affect physical and mental well-being differently from being employed with an open-ended contract. In this paper we offer evidence on the relationship between self-reported health and the employment status in Italy using the Survey on Household Income and Wealth (SHIW); another aim is to investigate whether these potential inequalities have changed with the recent economic downturn (time period 2006-2010). METHODS: We estimate an ordered logit model with self-reported health status (SRHS) as response variable based on a fixed-effects approach which has certain advantages with respect to the random-effects formulation: the fixed-effects nature of the model also allows us to solve the problems of incidental parameters and non-random selection of individuals into different labor market categories. RESULTS: We find that temporary workers, first-job seekers and unemployed individuals are worse off than permanent employees, especially males, young workers, and those living in the center and south of Italy. CONCLUSION: Health inequalities between permanent workers and job seekers widen over time for male and young workers, and arise in the north of the country as well.

Socio-demographic determinants and access to prenatal care in Italy.

BACKGROUND: Many governments have made commitments to examine inequalities in healthcare access based on studies assessing the association between several socio-demographic factors and late initiation or fewer prenatal examinations. This study addressed the question of whether socio-demographic determinants were significant in explaining differences in prenatal care in one administrative region of Italy, Umbria. METHODS: Data were obtained from the administrative source of the regional Standard Certificate of Live Births between 2005 and 2010, and were merged with Census data to include a socio-economic deprivation index. Standard and multilevel logistic regression models were used to analyze the magnitude of various individual-level maternal characteristics and socio-demographic indicators, such as nationality, employment status, education with respect to late access to the first examination, and low number of medical visits. RESULTS: The study involved approximately 37,000 women. The heterogeneous effects of socio-demographic variables were documented on the prenatal care indicators analyzed. A multivariate model showed that women born outside Italy had a higher probability of making their first visit later than the 12th week of pregnancy and low numbers of prenatal medical visits; the estimated odds ratio for the analyzed indicators range from 2.25 to 3.05. Inadequate prenatal healthcare use was also observed in younger and pluriparous women and those with low education; in addition, having a job improved the use of services, possibly through transmission of information of negative consequences due to delayed or few prenatal visits. Interestingly, this study found a substantial reduction in the number of pregnant women who do not use prenatal healthcare services properly. CONCLUSIONS: The aim of this research is to provide more accurate knowledge about the inadequate use of prenatal healthcare in Italy. Results highlight the existence of differences in healthcare use during pregnancy, especially for women from less advantaged social classes (i.e., unemployed or poorly educated). Such inequalities should be examined in all areas of public policy and public services, to ensure equal opportunity for their use.

[Knowledge about sexual health in Italian adolescents girls and women: the need for intergenerational communication]. / Conoscenze sulla salute sessuale di un gruppo di ragazze adolescenti e donne adulte in Italia: il bisogno di comunicazione tra generazioni.

The aim of this study, performed between September to November 2010, was to provide insight into Italian girls' and women's knowledge of sexual health and sexuality, in particular regarding the physiology of human reproduction, contraception, sexuality, cervical cancer screening and abortion. The data used were obtained through face-to-face interviews with two groups of women, performed by a trained interviewer using a structured multiple-choice questionnaire. The first group was composed of young women aged 17 to 20 years, randomly selected from five high-school institutes in the inner-city area of Perugia (Italy), while the second group was made up of women aged 30 to 43 years, recruited amongst women undergoing postpartum checks at a regional hospital. The number of correct answers for each group of questions and the total number of correct answers in the questionnaire were calculated. A Poisson regression model was used to identify the main determinants of answering correctly. Adult women gave a higher rate of correct answers for each topic, except for those related to abortion, contraception, and HPV. Characteristics of adult women associated with a better knowledge about sexuality were: discussing about sexuality with friends or partner, being Italy-born and having an open and relaxed attitude toward sex. For younger women, better knowledge was associated with being Italy-born, having attended affectivity education courses and having an open and relaxed attitude towards sex. Results suggest that no sex education or information source by itself is effective but what is needed is a combination of various information sources, both formal and informal, including parent-adolescent communication.

Benzene Exposure and Lung Cancer Risk: A Systematic Review and Meta-Analysis of Human Studies.

Lung cancer is a leading cause of death with nearly 1.8 million deaths estimated worldwide in 2020. Although benzene is classified as a human carcinogen (Group 1) on the basis of its association with acute myeloid/non-lymphocytic leukaemia, there is still limited evidence that it may influence lung cancer risk. This study examined the potential link between benzene exposure and risk of lung cancer using a systematic review of epidemiological studies and meta-analysis. We searched through PubMed, Web of Science and Scopus databases up to 10 February 2023 to identify all articles on the association between benzene exposure and lung cancer (incidence or prevalence) and/or mortality. We extracted the risk estimates of the highest and the lowest reported categories of benzene exposure and conducted a meta-analysis using a random-effects model. Heterogeneity and publication bias were analysed using an I2 test and funnel plots asymmetry, respectively. Twenty-one studies were included in the final analysis, with a total of 10,750 lung cancer cases and 2899 lung cancer deaths. Overall, risk estimates of lung cancer prevalence and mortality in association with benzene exposure were 1.20 (n = 14; 95% CI 1.05-1.37) and 1.15 (n = 13; 95% CI 1.02-1.30), respectively. In all cases, heterogeneity was quite large, while no significant publication bias was observed. When only studies that adjusted for smoking habit were selected, the risk for lung cancer increased by up to 34% (n = 9; 95% CI 1.10-1.64). Our data, which show a strong association between benzene exposure and lung cancer risk, may have important public health implications. However, further studies are needed to identify the lung cancer risk associated with benzene exposure considering different smoking conditions.

Consumption of Tap Water and Sociodemographic-Associated Characteristics: A Nationwide Cross-Sectional Study.

Safe water is a global public health concern amid increasing scarcity and pollution. Bottled water production and consumption contribute to these problems. This study examines tap water consumption in Italy, assessing associated sociodemographic factors and related health outcomes such as obesity and self-perceived health status. Data from the Italian National Statistics Institute's "Aspects of daily life" survey (N = 45,597) were analyzed. Covariates included education, age, gender, economic status, region, concerns about waste and climate change, consumption of carbonated drinks excluding water, alcohol consumption, consumption of vegetables, consumption of snacks, body mass index, and self-perceived health status. Bivariate analyses and mixed-effect logistic regression models explored the associations. People who drink tap water made up 19,674, with a higher prevalence in people aged 45 to 59 old, people with a graduate/post-graduate degree diploma, with optimal economic resources, people concerned about waste production and climate change, and those coming from the north-east regions of Italy. Underweight people showed a higher prevalence of TW consumption as well as those who less than occasionally drank carbonated drinks, drank alcohol, consumed vegetables more than once a day and snacks less than once a week, dairy products more than once a day, sweet less than once a week, cured meat less than once a week, and chicken meat less than once a week, those with no consumption of sheep meat, consumption of beef meat less than once a week and consumption of pork meat less than once a week, and those with a satisfactory level of perceived health status. Regressions showed that all other age classes are less likely to drink tap water than people younger than 20 years old. The category with "inadequate" economic resources is more likely to consume tap water. Low educational classes show a low likelihood of consuming tap water as well as islands. A concern about waste production and climate change is associated with an increased likelihood of consuming tap water. Tap water consumption was negatively associated with obesity but not with a satisfactory self-perceived health status. Insights from this study can inform public health strategies.

Malnutrition-Related Health Outcomes in Older Adults with Hip Fractures: A Systematic Review and Meta-Analysis.

Hip fracture is a common condition in older adults, leading to disability and mortality. Several studies have demonstrated the association between nutritional status and the risk of a negative health outcome after fractures. In this systematic review, we evaluated the association between malnutrition and mortality, changes in mobility/living arrangements, and postoperative complications, such as delirium, in older patients with hip fractures. A literature search on the PubMed, Web of Science, and Scopus databases, up to September 2023, was conducted to identify all studies involving older subjects that reported an association between MNA/GNRI/PNI/CONUT and health outcome after hip fracture. Meta-analysis was performed by a random-effects model using risk values (RR, OR, and HR) extracted from the 14 eligible selected studies. Malnutrition significantly increased the risk of any analyzed adverse outcome by 70% at 1 month, and up to 250% at 1 year. Malnutrition significantly increased delirium risk by 275% (OR = 2.75; 95% CI 1.80-4.18; p ≤ 0.05), mortality risk by 342% (OR = 3.42; 95% CI 2.14-5.48; p ≤ 0.05), mortality hazard risk by 351% (HR = 3.51; 95% CI 1.63-7.55; p ≤ 0.05) at 1 month, and transfer-to-more-supported-living-arrangements risk by 218% (OR = 2.18; 95% CI 1.58-3.01; p ≤ 0.05), and declined mobility risk by 41% (OR = 1.41; 95% CI 1.14-1.75; p ≤ 0.05), mortality risk by 368% (OR = 3.68; 95% CI 3.00-4.52; p ≤ 0.05), and mortality hazard risk by 234% (HR = 2.34; 95% CI 1.91-2.87; p ≤ 0.05) at 1 year. Malnutrition of older patients increases the risk of death and worsens mobility and independence after hip fractures. The results of the present study highlight the importance of nutritional status evaluation of older subjects with hip fractures in order to prevent potential adverse outcomes (Registration No: CRD42023468751).

The role of a mindful movement-based program (Movimento Biologico) in health promotion: results of a pre-post intervention study.

Introduction: Mindful movement is a comprehensive approach that integrates various bodily, emotional and cognitive aspects into physical activity, promoting overall well-being. This study assessed the impact of a mindful movement program, known as Movimento Biologico (MB), on participants psychological well-being (PWB), positive mental health (PMH), sense of coherence (SOC), and interoceptive awareness. Methods: MB program was conducted for students attending the bachelor's degree in Kinesiology and Sport Sciences of University of Perugia over 8 weeks (from October 16 to November 27, 2022). Participants were requested to fill in four questionnaires before and after the MB program: (1) 18-item PWB scale; (2) 9-item PMH scale; (3) 13-item SOC scale; (4) 32-item scale for Multidimensional Assessment of Interoceptive Awareness (MAIA). Wilcoxon signed-rank tests were used to assess changes, with significance set at p < 0.05. Results: Thirty-eight students (mean age 21.2, 60.5% male) participated. Several MAIA subscales, including noticing (p = 0.003), attention management (p = 0.002), emotional awareness (p = 0.007), self-regulation (p < 0.001), body listening (p = 0.001), and trusting (p = 0.001), showed significant improvements. PMH increased significantly (p = 0.015), and there was a significant enhancement in the autonomy subscale of PWB (p = 0.036). SOC and overall PWB also improved, though not significantly. Conclusion: The MB program significantly improved participants' positive mental health and interoceptive awareness. This likely resulted from better recognition and management of positive physiological sensations, a stronger link between physical sensations and emotions, enhanced confidence in one's body, and increased autonomy.

Hysterectomy and thyroid cancer risk: A systematic review and meta-analysis.

Background: Incidence rates of thyroid cancer have increased. Recent studies findings suggest that women who underwent a hysterectomy have an elevated relative risk of thyroid cancer. The aim of our meta-analysis is to summarize the evidence about the association between hysterectomy and thyroid cancer risk. Methods: PubMed, Web of Science, and Scopus database were searched for studies published up to 5 September 2023. The PRISMA statement was followed. Heterogeneity was explored with Q statistic and the I2 statistic. Publication bias was assessed with Begg's and Egger's tests. Results: Sixteen studies met the criteria. The pooled analysis showed a significantly 64% increment of thyroid cancer risk in association with any hysterectomy (OR 1.64, 95% CI 1.48-1.81; I2 = 28.68%, p = 0.156). Hysterectomy without oophorectomy was a stronger predictor of risk than hysterectomy with oophorectomy. The pooled analysis of data regarding hysterectomy without oophorectomy showed a statistically significant increment of thyroid cancer risk by 59%. Hysterectomy with oophorectomy was associated with an increase of thyroid cancer risk of 39% (OR 1.39, 95% CI 1.16-1.67; I2 = 42.10%, p = 0.049). Significant publication bias was not detected. Conclusions: Our findings help with decision making around these surgeries.

COVID-19 Vaccination Actual Uptake and Potential Inequalities Due to Socio-Demographic Characteristics: A Population-Based Study in the Umbria Region, Italy.

Socio-demographic factors are responsible for health inequalities also in vaccination. The aim of this study was to evaluate their role at the population level through a population-based study performed on the whole population entitled to receive COVID-19 vaccines in the Umbria Region, Italy, and registered to the Regional Healthcare Service as of 28 February 2021. Socio-demographic characteristics and vaccination status in terms of uptake of at least one dose of any available vaccine, completion of the primary vaccination cycle and uptake of the booster doses as of 28 February 2022 were collected from the Umbria regional database. The percentage of eligible population who did not initiate the COVID-19 vaccination, complete the full vaccination cycle and get the booster dose was 11.8%, 1.2% and 21.5%, respectively. A younger age, being a non-Italian citizen, and not holding an exemption for chronic disease/disability and a GP/FP were associated with all the endpoints. Females, as compared to males, were more likely to not initiate the vaccination but less likely to not receive the booster dose. On the contrary, the findings did not show a significant association between the deprivation index and the vaccine uptake. The findings, beyond confirming current knowledge at the population level, provide new inputs for better tailoring vaccination campaigns.