Psychosocial risk and protective factors for youth problem behavior are associated with food addiction in the Generation Z.

Objective: Food Addiction (FA) and other well-known risk behavior as substance misuse tend to co-occur and may share similar risk and protective factors. The aim of this study was to assess the association between the diagnosis/severity of FA and psychosocial domains typically related to risk behavior syndrome in a large, nationally representative community sample of Generation Z underage Italian students. Method: The sample consisted of 8,755 students (3,623 from middle schools, 5,132 from high schools). A short version of the Yale Food Addiction Scale 2.0 was administered to evaluate FA. Risk and protective factors related to demographic, personality, behavior, and family variables were examined. Stepwise multivariate logistic and linear regressions were conducted. Results: The prevalence of FA was 30.8%. Female gender, social anxiety and depression symptoms, social withdrawal risk, Internet gaming disorder, social media addiction, current substance use, social challenge engagement and experienced doxing boosted the chance of FA diagnosis, whereas eating fruit and vegetables, playing competitive sports and an average sleep duration of 7-8 h per night reduced these odds. FA severity was significantly and positively associated with trait impulsiveness, social anxiety and depressive symptoms, risk of social withdrawal, recent substance use, social media, and gaming addiction, doxing suffered and risky social challenges participation. Negative associations between the severity of FA and fruit and vegetable diet habits were found. Conclusion: Our findings confirm that FA is widespread among Italian adolescents. The associations between the diagnosis and severity of FA and psychosocial risk factors for health, including, addictive and deviant behaviors related to digital misuse, suggest its belonging to the risk behavior constellation. Health promotion schemes based on a multicomponent strategy of intervention should consider the inclusion of FA and its psychosocial correlates.

Knowledge and practices regarding prostate cancer screening in Spanish men: The importance of personal and clinical characteristics (PROSHADE study).

INTRODUCTION: Patients' decisions on prostate cancer (PCa) opportunistic screening may vary. This study aimed to assess how demographic and health-related characteristics may influence knowledge and decisions regarding PCa screening. METHODS: A cross-sectional survey was conducted among men aged over 40, randomly sampled from the Spanish population, 2022. The survey underwent development and content validation using a modified Delphi method and was administered via telephone. Binomial logistic regression was used to explore the relationship between respondents' characteristics and participants' knowledge and practices concerning PCa and the PSA test. RESULTS: Out of 1,334 men, 1,067 (80%) respondents were interviewed with a mean age of 58.6 years (sd 11.9). Most had secondary or university studies (787, 73.8%) and 61 (5.7%) self-reported their health status as bad or very bad. Most of the respondents (1,018, 95.4%) had knowledge regarding PCa with nearly 70% expressed significant concern about its potential development (720, 70.8%), particularly among those under 64 years (p = 0.001). Out of 847 respondents, 573 (67.7%) reported that they have knowledge regarding the PSA test: 374 (65.4%) reported receiving information from a clinicians, 324 (86.6%) information about the benefits of the test and 189 (49,5%) about its risks, with differences based on educational background. In a multivariable analysis (adjusted for age, educational level and previous prostate problems), respondents with higher levels of education were more likely to have higher knowledge regarding the PSA test (OR 1.75, 95%CI 1.24-2.50, p<0.001). CONCLUSIONS: Although most of the patients reported to have knowledge regarding PCa, half of the interviewed men reported knowledge about PSA test. Differences in knowledge prostate cancer screening and undesirable consequences highlight the need to develop and provide tailored information for patients.

A Novel Decision Tree Model for Predicting the Cancer-Specific Survival of Patients with Bladder Cancer Treated with Radical Cystectomy.

Background/Objectives: The aim was to develop a decision tree and a new prognostic tool to predict cancer-specific survival in patients with urothelial bladder cancer treated with radical cystectomy. Methods: A total of 11,834 patients with bladder cancer treated with radical cystectomy between 2004 and 2019 from the SEER database were randomly split into the derivation (n = 7889) and validation cohorts (n = 3945). Survival curves were estimated using conditional decision tree analysis. We used Multiple Imputation by Chained Equations for the treatment of missing values and the pec package to compare the predictive performance. We extracted data from our model following CHARMS and assessed the risk of bias and applicability with PROBAST. Results: A total of 4824 (41%) patients died during the follow-up period due to bladder cancer. A decision tree was made and 12 groups were obtained. Patients with a higher AJCC stage and older age have a worse prognosis. The risk groups were summarized into high, intermediate and low risk. The integrated Brier scores between 0 and 191 months for the bootstrap estimates of the prediction error are the lowest for our conditional survival tree (0.189). The model showed a low risk of bias and low concern about applicability. The results must be externally validated. Conclusions: Decision tree analysis is a useful tool with significant discrimination. With this tool, we were able to stratify patients into 12 subgroups and 3 risk groups with a low risk of bias and low concern about applicability.

Health-Promoting Properties of Processed Red Cabbage (Brassica oleracea var. capitata f. rubra): Effects of Drying Methods on Bio-Compound Retention.

The aim of this work is to describe the effect of convective drying (CD), vacuum drying (VD), infrared drying (IRD), low-temperature vacuum drying (LTVD) and freeze drying (FD) on bio-compound retention of red cabbage and its beneficial health properties. The total phenolics content (TPC), flavonoids (TFC), anthocyanin (TAC) and glucosinolates (TGC) were determined by spectrophotometry. The profiles of phenolic acids, amino acids and fatty acids were determined by HPLC-UV-DAD, LC-DAD and GC-FID, respectively. Antioxidant potential was verified by DPPH and ORAC assays. The antiproliferative activity was measured in the human gastric cell line (AGS). Anti-inflammatory activity was evaluated by phorbol 12-myristate 13-acetate and arachidonic acid models. VD showed high values of TPC = 11.89 ± 0.28 mg GAE/g d.m.; TFC = 11.30 ± 0.9 mg QE/g d.m.; TAC = 0.265 ± 0.01 mg Cya3glu/g d.m.; and TGC = 51.15 ± 3.31 µmol SE/g d.m. Caffeic acid, ferulic acid and sinapic acid were identified. The predominant amino acid and fatty acid were glutamic acid and γ-linolenic acid, respectively. The antioxidant potential was dependent on drying methods for both DPPH and ORAC assays. Dried red cabbage extracts showed clear anti-inflammatory and antiproliferative activity. The dehydration process is an alternative for the retention of bio-compounds and health-promoting properties of red cabbage.

Time perception in stimulant-dependent participants undergoing repetitive transcranial magnetic stimulation.

BACKGROUND: The dopaminergic (DA) system is an important neural system for the modulation of time perception and the timing of motor actions. Dysregulation of the DA system is related to chronic use of stimulant drugs, which lead, among others, to executive dysfunctions. Little is known instead about the potential deficiencies in temporal processing of stimulant-dependent individuals. The present study aimed to investigate temporal processing using a time bisection task with different temporal intervals in chronic cocaine users undergoing repetitive transcranial magnetic stimulation (rTMS). METHOD: Study 1: A time bisection task with short temporal intervals range (480/1920 ms) was administered to 18 cocaine use disorder (CocUD) patients and 20 healthy control before and after the intensive phase of rTMS treatment (5 days apart). Study 2: 22 CocUD participants and 23 control participants completed two temporal tasks (time bisection and time reproduction) with long temporal intervals range (1200/2640 ms) at baseline and immediately after the intensive phase of rTMS treatment. RESULTS: Study 1: A shift in the psychometric function consistent with temporal overestimation in CocUD patients compared to controls was observed. However, no temporal impairment in CocUD patients at test session was found. Study 2: The analysis of temporal variability indices showed a significant difference between groups at baseline but not at Day 5 due to a significant difference between time points only in the CocUD group. CONCLUSIONS: This study report a temporal overestimation in CocUD patients and a temporal variability reduction after an rTMS protocol in CocUD patients.

Assessment of Bio-Compounds Content, Antioxidant Activity, and Neuroprotective Effect of Red Cabbage (Brassica oleracea var. Capitata rubra) Processed by Convective Drying at Different Temperatures.

Parkinson's disease (PD) is the second most common neurodegenerative disorder, and no efficient therapy able to cure or slow down PD is available. In this study, dehydrated red cabbage was evaluated as a novel source of bio-compounds with neuroprotective capacity. Convective drying was carried out at different temperatures. Total phenolics (TPC), flavonoids (TFC), anthocyanins (TAC), and glucosinolates (TGC) were determined using spectrophotometry, amino acid profile by LC-DAD and fatty acid profile by GC-FID. Phenolic characterization was determined by liquid chromatography-high-resolution mass spectrometry. Cytotoxicity and neuroprotection assays were evaluated in SH-SY5Y human cells, observing the effect on preformed fibrils of α-synuclein. Drying kinetic confirmed a shorter processing time with temperature increase. A high concentration of bio-compounds was observed, especially at 90 °C, with TPC = 1544.04 ± 11.4 mg GAE/100 g, TFC = 690.87 ± 4.0 mg QE/100 g and TGC = 5244.9 ± 260.2 µmol SngE/100 g. TAC degraded with temperature. Glutamic acid and arginine were predominant. Fatty acid profiles were relatively stable and were found to be mostly C18:3n3. The neochlorogenic acid was predominant. The extracts had no cytotoxicity and showed a neuroprotective effect at 24 h testing, which can extend in some cases to 48 h. The present findings underpin the use of red cabbage as a functional food ingredient.

Reply to Jue, J.S.; Alameddine, M. Role of PSA Density and MRI in PSA Interpretation. Comment on "Lumbreras et al. Variables Associated with False-Positive PSA Results: A Cohort Study with Real-World Data. Cancers 2023, 15, 261".

We thank you and your co-authors for the comment [...].

Comprehensive Evaluation of the Bioactive Composition and Neuroprotective and Antimicrobial Properties of Vacuum-Dried Broccoli (Brassica oleracea var. italica) Powder and Its Antioxidants.

In this study, vacuum drying (VD) was employed as an approach to protect the bioactive components of and produce dried broccoli powders with a high biological activity. To achieve these goals, the effects of temperature (at the five levels of 50, 60, 70, 80 and 90 °C) and constant vacuum pressure (10 kPa) were evaluated. The results show that, with the increasing temperature, the drying time decreased. Based on the statistical tests, the Brunauer-Emmett-Teller (BET) model was found to fit well to sorption isotherms, whereas the Midilli and Kucuk model fit well to the drying kinetics. VD has a significant impact on several proximate composition values. As compared with the fresh sample, VD significantly reduced the total phenol, flavonoid and glucosinolate contents. However, it was shown that VD at higher temperatures (80 and 90 °C) contributed to a better antioxidant potential of broccoli powder. In contrast, 50 °C led to a better antimicrobial and neuroprotective effects, presumably due to the formation of isothiocyanate (ITC). Overall, this study demonstrates that VD is a promising technique for the development of extracts from broccoli powders that could be used as natural preservatives or as a neuroprotective agent.

Neolithic expansion and the 17q21.31 inversion in Iberia: an evolutionary approach to H2 haplotype distribution in the Near East and Europe.

The chromosomal region 17q21.31 harbors a 900 kb inversion polymorphism named after the microtubule-associated protein tau (MAPT) gene. Since no recombination occurs, two haplotypes are recognized: a directly oriented variant (H1) and an inverted variant (H2). The H2 haplotype features a distribution pattern with high frequencies in the Near East and Europe, medium levels in South Asia and North Africa, and low levels elsewhere. Studies of this genomic region are relevant owing to its likely association with numerous neurodegenerative diseases. However, the causes underlying the geographic distribution of the haplotype frequencies remain a bone of contention among researchers. With this work, we have intended to outline a plausible hypothesis on the origin of the high European H2 frequencies. To that end, we have analyzed an extensive population database (including three new Iberian populations) to explore potential clinal variations of H2 frequencies. We found a sigmoidal frequency cline with an upward trend from South Asia to Europe. The maximum value was detected in the Basques from Gipuzkoa province (0.494) with the curve's inflection point in the Near East. From our results, we suggest that the most likely scenario for high H2 frequencies in Europe would be a founding event in the Near East during the late Paleolithic or early Neolithic. Subsequently, such H2 overrepresentation would have reached Europe with the arrival of the first Neolithic farmers. The current frequencies and geographic distribution of the 17q21.31 inversion suggest that the founding events mainly affected the H2D subhaplotype.

Drying Kinetic Modeling and Assessment of Mineral Content, Antimicrobial Activity, and Potential α-Glucosidase Activity Inhibition of a Green Seaweed (Ulva spp.) Subjected to Different Drying Methods.

The green algal genus Ulva grows widely on all continents and is used for several applications such as functional foods, cosmeceuticals, nutraceuticals, and pharmaceuticals due to its nutritional characteristics. However, to increase its shelf-life and retain its bioactive components, it is necessary to apply some conservation technology, such as drying. The aim of this work is to describe the drying kinetic behavior of the green seaweed Ulva spp. by applying three dehydration methods: convective drying (CD), vacuum drying (VD), and solar drying (SD) by mathematical modeling and determining the retention of mineral content by atomic absorption spectroscopy and the antimicrobial potential against four strains such as Staphylococcus aureus, Escherichia coli, Saccharomyces cerevisiae, and Penicillium sp. by measurement of inhibition zones and α-glucosidase activity inhibition, as reported by IC50 determination. A freeze-dried sample was used as the control. The equilibrium moisture values calculated using the Guggenheim-Anderson-de Boer model were 0.0108, 0.0108, and 0.0290 g water/g d.m., for CD, VD and SD, respectively. The Midilli and Kucuk model showed robustness to fit all the experimental data of drying kinetic modeling. Ulva spp. is an important source of potassium with a ratio of Na/K < 0.29. Inhibition halos were observed in all samples against S. cerevisiae and Penicillium sp. with higher values than fluconazole action. An inhibitory effect on α-glucosidase activity was observed in all samples, mainly in the freeze-dried sample. Finally, dried Ulva spp. is a rich source of macro- and microminerals with antimicrobial activity and is a potential α-glucosidase inhibitor. Thus, it can be considered as a potential functional ingredient for food manufacturing.

Dietary fibre in processed murta (Ugni molinae Turcz) berries: bioactive components and antioxidant capacity.

In this study the dietary fibre (DF) of fresh and processed murta berries was characterised with respect to bioactive and antioxidant properties. DF content was determined by three different methods (AOAC, dialysis membrane and indigestible fraction methods) comparing their effectiveness. The antioxidant activity of phenolic compounds (PC) in purée, fruit leather and isolated DF of murta berries was evaluated by DPPH and ORAC assays. Total phenolics and flavonoids linked to DF were determined by colorimetric tests, while PC profiles in the respective murta products were identified by HPLC. DF concentration was > 50 g/100 g dm, fluctuating between 52.03 ± 1.32 and 57.18 ± 0.61 g/100 g dm, exhibiting simultaneously high antioxidant activity, with ORAC values of 38,190 ± 661 and 26,425 ± 1399 µmol Trolox equivalent/100 g dm in the isolated DF of fresh murta berries and processed murta fruit leather respectively, which enabled a classification as antioxidant dietary fibre. Total phenolics and flavonoids linked to DF retained a high concentration in the fruit leather, implying a favourable effect of processing. Gallic acid and pyrogallol were found associated to DF, at a level of 34.03 ± 1.17 and 631.07 ± 22.10 mg/100 g dm in the fresh berries respectively, which conferred to murta berries a functional property not yet reported. Supplementary Information: The online version contains supplementary material available at 10.1007/s13197-022-05416-1.

Efficacy, tolerance and predictors of response to the treatment with hyperbaric oxygen therapy for patients with hemorrhagic radiation cystitis.

OBJECTIVES: The aim was to study the efficacy and tolerance in patients with haemorrhagic radiation-induced cystitis (HRC) treated with hyperbaric oxygen therapy (HOT) and analyze which factors were related to the response to the treatment. MATERIAL AND METHODS: We performed a retrospective cohort study of patients treated with HOT for HRC symptoms in a provincial referral centre from 2010 to 2020. We evaluated clinical response to treatment, number of hospitalizations due to HRC and subjective response using the PGI-I questionnaire. RESULTS: We treated 52 patients, with a median of 30 sessions, during 6 months and 40 months (6-68 months) of follow-up. 69.2%of patients responded completely and 21,2% partially. The 53.2% of patients improved before the first 10 sessions. Reduction of hospitalizations/per year due to haematuria from 2.8 to 1.1 (p=0,001). The 73,5% of patients stated that they were "very much better" or "much better" after treatment. During the follow-up, 15.4% of patients had recurrence of HRC. 9.6% of the patients required salvage cystectomy. The patients with a highest RTOG-EORTC scale had more risk to still with symptoms (OR 3.01 (IC95 1.48 - 6.16). All patients were able to complete the proposed treatment plan with good tolerance to HOT. CONCLUSIONS: These results show the clinical benefit of HOT in the treatment of HRC, with a reduction of the number of hospitalizations and a subjective improvement.

PROSHADE Protocol: Designing and Evaluating a Decision Aid for Promoting Shared Decision Making in Opportunistic Screening for Prostate Cancer: A Mix-Method Study.

Background: Opportunistic prostate-specific antigen (PSA) screening may reduce prostate cancer mortality risk but is associated with false positive results, biopsy complications and overdiagnosis. Although different organisations have emphasised the importance of shared decision making (SDM) to assist men in deciding whether to undergo prostate cancer screening, recent evaluations show that the available decision aids fail to facilitate SDM, mainly because they do not consider the patients' perspective in their design. We aim to systematically develop and test a patient decision aid to promote SDM in prostate cancer screening, following the Knowledge to Action framework. Methods: (1) Feasibility study: a quantitative survey evaluating the population and clinician (urologists and general practitioners) knowledge of the benefits and risks derived from PSA determination and the awareness of the available recommendations. Focus groups to explore the challenges patients and clinicians face when discussing prostate cancer screening, the relevance of a decision aid and how best to integrate it into practice. (2) Patient decision aid development: Based on this data, an evidence-based multicomponent SDM patient decision aid will be developed. (3) User-testing: an assessment of the prototype of the initial patient decision aid through a user-testing design based on mix-methods (questionnaire and semi-structured review). The decision aid will be refined through several iterative cycles of feedback and redesign. (4) Validation: an evaluation of the patient decision aid through a cluster-randomised controlled trial. Discussion: The designed patient decision aid will provide balanced information on screening benefits and risks and should help patients to consider their personal preferences and to take a more active role in decision making. Conclusions: The well-designed patient decision aid (PDA) will provide balanced information on screening benefits and risks and help patients consider their personal preferences.

Mortality prediction models after radical cystectomy for bladder tumour: A systematic review and critical appraisal.

INTRODUCTION: To identify risk-predictive models for bladder-specific cancer mortality in patients undergoing radical cystectomy and assess their clinical utility and risk of bias. METHODS: Systematic review (CRD42021224626:PROSPERO) in Medline and EMBASE (from their creation until 31/10/2021) was screened to include articles focused on the development and internal validation of a predictive model of specific cancer mortality in patients undergoing radical cystectomy. CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) and Prediction model Risk Of Bias ASsessment Tool (PROBAST) were applied. RESULTS: Nineteen observational studies were included. The main predictors were sociodemographic variables, such as age (18 studies, 94.7%) and sex (17, 89.5% studies), tumour characteristics (TNM stage (18 studies, 94.7%), histological subtype/grade (15 studies, 78.9%), lymphovascular invasion (10 studies, 52.6%) and treatment with chemotherapy (13 studies, 68.4%). C-index values were presented in 14 studies. The overall risk of bias assessed using PROBAST led to 100% of studies being classified as high risk (the analysis domain was rated to be at high risk of bias in all the studies), and 52.6% showed low applicability. Only 5 studies (26.3%) included an external validation and 2 (10.5%) included a prospective study design. CONCLUSIONS: Using clinical predictors to assess the risk of bladder-specific cancer mortality is a feasibility alternative. However, the studies showed a high risk of bias and their applicability is uncertain. Studies should improve the conducting and reporting, and subsequent external validation studies should be developed.

Genito Pelvic Pain/Penetration Disorder (GPPPD) in Spanish Women-Clinical Approach in Primary Health Care: Review and Meta-Analysis.

Sexuality is a component of great relevance in humans. Sexual disorders are a major public health problem representing a high prevalence in the general population. DSM-5 genito-pelvic pain/penetration disorder (GPPPD) includes dyspareunia and vaginismus (DSM-IV-TR). To assess the importance of research on these disorders in Spain, we evaluated the Spanish scientific publications of primary and community care. The objective was to quantify the magnitude of the publications of GPPPD in Spanish women in primary and community care. For this, we used the method of conducting a systematic review and meta-analysis of studies evaluating GPPPD. As main results, of the 551 items found, we selected 11 studies that met the inclusion criteria. In primary care in Spain, one in nine women has these disorders; the percentage of women with GPPPD in this study (raw data) was 11.23% (95% CI: 0-29%) (vaginismus 5%; penetration pain 8.33%; dyspareunia 16.45%). These percentages can differ of those from other countries, and they are at the top of the data of the European countries (9-11.9%). There is much variability in the studies found in the world with respect to the prevalence of these health problems.

Mortality Trends Related to Bladder Cancer in Spain, 1999-2018.

Bladder cancer (BC) is an important cause of premature mortality (PM, <75 years). Spain has one of the highest BC mortality rates in Europe. The objective of this study was to analyse BC mortality trends between 1999 and 2018 in Spain. The study was based on data from the National Institute of Statistics (Instituto Nacional de Estadística-INE). Age-adjusted mortality rates (AAMRs) were calculated by sex and age group. A trend analysis was performed using Joinpoint regression models and years of potential life lost (YPLL). Mortality in men resulting from BC decreased in all age groups studied. This was not observed in women, for whom mortality only decreased in the ≥75 age group. Deaths due to BC occurred prematurely in 38.6% of men and in 23.8% of women, which indicated a greater impact on YPLL in men compared to women. Over the last 20 years, there has been a significant decrease in BC mortality rate, except in women under 75 years of age. Despite this temporal trend of decreasing mortality, BC continues to have a significant impact on YPLL, mainly in men. Given this context, it is important to direct more resources towards prevention and early diagnosis strategies to correct this situation.

Variables Associated with False-Positive PSA Results: A Cohort Study with Real-World Data.

(1) Background: There are no real-world data evaluating the incidence of false-positive results. We analyzed the clinical and analytical factors associated with the presence of false-positive results in PSA determinations in practice. (2) Methods: A prospective cohort study of patients with a PSA test was performed in clinical practice. We followed the patients by reviewing their medical records for 2 years or until the diagnosis of PCa was reached, whichever came first. (3) Results: False-positive PSA rate was 46.8% (95% CI 44.2-49.2%) and false-negative PSA rate was 2.8% (95% CI 2-3.5%). Patients aged 61-70 years and those over 70 years were more likely to have a false-positive result than those under 45 years (aOR 2.83, 95% CI 1.06-7.55, p = 0.038, and aOR 4.62, 95% CI 1.75-12.22, p = 0.002, respectively). Patients with urinary tract infection were more likely to have a false-positive result (aOR 8.42, 95% CI 2.42-29.34, p = 0.001). Patients with diabetes mellitus were less likely to have a false-positive result (aOR 0.63, 95% CI 0.41-0.98, p = 0.038); (4) Conclusions: This study has generated relevant information that could be very useful for shared decision making in clinical practice.

Sexuality, Quality of Life, Anxiety, Depression, and Anger in Patients with Anal Fissure. A Case-Control Study.

Anal fissures (AFs) are lesions located in the lower anal canal. They can be primary (chronic or acute) or secondary to a basic disease. There is high comorbidity of depression and anxiety in patients with chronic AF, with poorer quality of life (QoL) and sexual function. This is a case-control study carried out in the San Juan Hospital (Alicante, Spain). Sixty-seven participants were included in the study, including 35 cases and 32 controls: 36 males and 31 females. This study aims to investigate the association of presenting AFs with sexuality, quality of life, anxiety, depression, and anger. The instruments used were the Spanish validated versions of the validated original selected questionnaires. These instruments were used to assess health-related quality of life, anxiety, anger, depression, and sexual function. Results show higher values in cases than in controls with statistical significance in anxiety state and trait; anxiety and depression; bodily pain, general health, and vitality; and 10 of the 12 anger factors. Higher values in controls than in cases with statistical significance in sexuality and many of the QoL factors were found. Addressing these issues in AF surgical patients would be beneficial for their clinical assessment and intervention.

Do the Prostate-Specific Antigen (PSA) Tests That Are Ordered in Clinical Practice Adhere to the Pertinent Guidelines?

Scientific societies have provided guidelines to reduce PSA-specific harms. We studied the potential non-compliance of PSA testing with current guidelines in general practice. A cross-sectional study of a random sample of 1291 patients with a PSA test was performed between January and April 2018 in primary health care. Patients with a previous prostate cancer diagnosis or those who were being followed-up for previous high PSA values were excluded. Two independent researchers classified whether each test was potentially non-compliant with recommendations. We estimated frequencies of potentially non-compliant PSA determinations and calculated prevalence ratios (PR) to assess their relationship with possible explanatory variables. A total of 66% (95% CI: 62-69%) of PSA requests in asymptomatic patients were potentially non-compliant with the current guideline. This was associated with having a previous diagnosis of neoplasm (PR adjusted by age and life expectancy: 1.18; 95% CI: 1.02-1.37) as well as being a current consumer of tobacco, alcohol, or other drugs (PR: 0.80; 95% CI: 0.67-0.97). Real world data shows that patients are still frequently exposed to overdiagnosis risk with a PSA potentially non-compliant with recommendations. Patients diagnosed with another neoplasm or non-consumers of toxic substances were more exposed, probably due to increased contact with doctors or health-seeking behaviour.

The role of repetitive transcranial magnetic stimulation (rTMS) in the treatment of behavioral addictions: Two case reports and review of the literature.

BACKGROUND: Several behaviors, besides consumption of psychoactive substances, produce short-term reward that may lead to persistent aberrant behavior despite adverse consequences. Growing evidence suggests that these behaviors warrant consideration as nonsubstance or "behavioral" addictions, such as pathological gambling, internet gaming disorder and internet addiction. CASE PRESENTATION: Here, we report two cases of behavioral addictions (BA), compulsive sexual behavior disorder for online porn use and internet gaming disorder. A 57-years-old male referred a loss of control over his online pornography use, started 15 years before, while a 21-years-old male university student reported an excessive online gaming activity undermining his academic productivity and social life. Both patients underwent a high-frequency repetitive transcranial magnetic stimulation (rTMS) protocol over the left dorsolateral prefrontal cortex (l-DLPFC) in a multidisciplinary therapeutic setting. A decrease of addictive symptoms and an improvement of executive control were observed in both cases. DISCUSSION: Starting from these clinical observations, we provide a systematic review of the literature suggesting that BAs share similar neurobiological mechanisms to those underlying substance use disorders (SUD). Moreover, we discuss whether neurocircuit-based interventions, such as rTMS, might represent a potential effective treatment for BAs.