Lifestyles and Quality of Life of People with Mental Illness During the COVID-19 Pandemic.

The COVID-19 pandemic has had a significant impact on the quality of life (QoL), daily lifestyle, and mental health of people suffering from a mental disorder. This study aimed to investigate the effects of the prolongation of the COVID-19 emergency on QoL and lifestyles in a sample of 100 outpatients at the Psychiatry Unit in Palermo University Hospital, Italy. QoL was measured through the 12-item Short Form Survey and the COV19-Impact on Quality of Life. Lifestyle changes during the pandemic were measured through the lifestyle change questionnaire. The majority of participants reported a great impact of COVID-19 on the QoL, and almost half reported worsened lifestyles. Worsened lifestyles were predictive of both poor mental and physical health related QoL. These results suggest that people with mental illness need interventions targeting lifestyles, and the mental health service in Italy should adjust to the ongoing pandemic, developing virtual treatments.

Chemometric Approaches to Analyse the Composition of a Ewe's Colostrum.

Colostrum is a major source of immunity in lambs and, in general, in all newborn ruminants. It allows the transfer of antibodies from the ewe to the lamb, and it becomes the exclusive source of nutrients for a newborn. Among the most significant Pearson correlations, the positive correlation between the Brix refractive index (Brix) and protein (0.90) should be noted. Both parameters (protein percentage and Brix) were then positively correlated with the percentage of fat (0.38 and 0.41), urea (0.81 and 0.67), calcium (0.39 and 0.29), and magnesium (0.58 and 0.59), as well as the yellowness (0.78 and 0.75). Somatic cell count (SCC) and pH, parameters which are indicators of subclinical mastitis, were positively correlated (0.49), and SCC was positively correlated with sodium (0.37) and negatively correlated with potassium (-0.28). Among the macroelements in colostrum-calcium, potassium, magnesium, and sodium-the correlations were largely positive. With respect to the colour parameters, yellowness was negatively correlated with lightness (-0.41) and redness (-0.45). The factor analysis split the total of variance into three latent factors. The first factor was named "Colostrum quality of grazing sheep" because it was positively correlated primarily with SCC, pH, Poly Unsatured Fatty Acids (PUFA), and the sum of the omega-3 Fatty Acids (FAs). The second factor, named "Good quality colostrum", was positively correlated primarily with the refractive index, protein and fat percentages, urea content, phosphorus, Mono Unsatured Fatty Acids (MUFA), and yellowness. The third factor was positively correlated primarily with calcium, potassium, magnesium, and sodium, and it was therefore termed "Mineral component of colostrum". Stepwise discriminant analysis showed that the protein percentage, calcium, and magnesium were able to explain more than 85% of the Brix refractive index, which remains a good parameter for simply evaluating the nutritional quality of sheep colostrum at the level of a farm.

Persistent Organic Pollutants and Fatty Acid Profile in a Typical Cheese from Extensive Farms: First Assessment of Human Exposure by Dietary Intake.

Dairy products represent an important source of beneficial substances for humans. At the same time, they can expose the consumers to environmental contaminants ingested by animals through their diet, influencing their health negatively. This experiment aims to evaluate the risk and benefits related to the consumption of typical stretched cheeses, considering their fatty acid (FA) profile and persistent organic pollutants (POPs) content. Six representative farms, two of them organic, raising Cinisara cattle were selected, considering the typical extensive management systems, based on feeding of natural pasture integrated with concentrate and hay depending on the availability of forage on pastures. A total of 18 cheeses produced in winter, spring and summer with bulk milk of each farm were sampled and analyzed. The chemical composition of cheeses was influenced by farm management, and the FA profile mainly by the season. In particular, cheeses made in spring showed a healthier FA profile with the content of polyunsaturated fatty acids (PUFA), of omega3-PUFA and omega6/omega3 ratio pair to 7.29%, 1.44% and 1.32, respectively, while in winter 5.44%, 0.98% and 2.55, respectively, and in summer 4.77% 0.49% and 3.04, respectively. Due to high levels of feeding integration, cheese made in winter presented unhealthier characteristics compared to the cheeses made in spring and summer, showing high levels of saturated FA (66.2%, 64.2% and 65.5%, respectively), and large contents of polycyclic aromatic hydrocarbons (PAH) (57.07 ng/g fat, 36.25 ng/g fat and 10.22 ng/g fat, respectively) and polychlorinated biphenyls (PCBs) (36.19 ng/g fat, 4.68 ng/g fat and 3.73 ng/g fat, respectively), mainly in those from non-organic farms. Levels of PCBs considered to be hazardous to human health were found in nine samples.

Influence of Citrus Essential Oils on the Microbiological, Physicochemical and Antioxidant Properties of Primosale Cheese.

The aim of this study was to produce a fresh ovine pressed cheese within Pecorino "Primosale" typology with the addition of citrus essential oils (EOs). For this purpose, ewe's pasteurized milk was added with EOs from the peel of lemons, oranges and tangerines. Seven cheese productions were performed at the pilot plant scale level, including one control production (CP) without the addition of EOs and six experimental productions obtained by the addition of two EO concentrations (100 and 200 µL/L) to milk. The acidification process was obtained by means of the starter cultures Lactococcus lactis CAG4 and PON36. All cheeses showed levels of lactic acid bacteria (LAB) around 109 CFU/g, indicating that citrus EOs did not negatively influence the starter evolution. The addition of citrus EOs did not determine significant variations for dry matter, fat and protein percentages but increased the antioxidant capacity of all the experimental cheeses of about 50% in comparison to the control trial. The citrus EOs impacted cheese VOCs, especially for terpene class (limonene, ß-pinene, myrcene, carene, linalool and α-terpineol). The sensory evaluation showed that cheeses enriched with 100 µL/L of citrus EOs were mostly appreciated by the panelists.

Feeding Dairy Ewes with Fresh or Dehydrated Sulla (Sulla coronarium L.) Forage. 1. Effects on Feed Utilization, Milk Production, and Oxidative Status.

Feeding dairy ewes with fresh sulla forage (FSF), a legume species containing condensed tannins (CT), has been shown to increase feed intake, milk yield, and casein and enhances the oxidative status of animals. Dehydration of FSF could be an alternative to hay-making to preserve the nutritional properties. This research aimed to compare the responses of dairy ewes fed with diets based on sulla hay (SH), pelleted dehydrated sulla forage (DSF), or FSF in terms of efficiency of feed utilization, milk production, and the balance between oxidant (reactive oxygen metabolites (ROMs)) and antioxidant (biological antioxidant potential (BAP)) substances at the plasma level. Ten first-lambing (FL) and ten third-lambing (TL) ewes of the Valle del Belice breed at 60 days in milk were allocated into five homogeneous groups fed with different diets in a partial 5 × 2 Latin square design with two phases. The diets differed for the forage basis: SHL = SH ad libitum; DSF2 = 2 kg/day DSF per head plus SH ad libitum; FSF2 = 2 kg/day FSF per head plus SH ad libitum; FSF4 = 4 kg/day FSF per head plus SH ad libitum; FSFL = FSF ad libitum. A commercial concentrate was provided to FL (0.8 kg/day per head) and TL (1.2 kg/day per head) ewes. Dehydration induced slight variations in the content of protein and fiber, showed no loss of vitamin E and polyunsaturated fatty acids, and decreased the level of CT and polyphenols. The DSF2 diet resulted in a higher intake of dry matter, protein, and vitamin E compared to the other diets, whereas, compared to the FSFL diet, its intake was analogous for net energy and was lower in CT and polyphenols. The DSF2 diet was comparable to FSF4 and FSFL diets for milk yield, and to all diets for casein content and the clotting ability of milk. Ewes fed a DSF2 diet exhibited lowest values of ROMs and oxidative stress index (OSI = ROMs/BAP), indicating a better oxidative status, presumably due to the antioxidant protection exerted by the higher vitamin E intake and CT metabolites. These results confirmed the positive effects of FSF on milk production, especially due to CT intake, in improving the efficiency of dietary protein utilization, and showed how favorable effects also occur when FSF is replaced by DSF instead of SH.

Feeding Dairy Ewes with Fresh or Dehydrated Sulla (Sulla coronarium L.) Forage. 2. Effects on Cheese Enrichment in Bioactive Molecules.

Sulla is a tanniferous legume species largely used as fresh or preserved forage in the ruminants' diets. Due to its content in polyphenols with antioxidant activity, especially condensed tannins (CT), fresh sulla forage (FSF), when eaten by ruminants, is able to enrich animal products with antioxidant molecules and polyunsaturated fatty acids (PUFA) that are beneficial for consumers' health. Dehydration represents a valid alternative to haymaking to preserve these properties also in periods when FSF is unavailable. In this research, the effects of ewes' diets based on sulla hay (SH), pelleted dehydrated sulla forage (DSF) or FSF were evaluated on cheese physico-chemical traits, including fatty acid (FA) profile, vitamins A and E, polyphenols, antioxidant capacity and oxidative stability. The individual daily milk from 10 first lambing (FL) and 10 third lambing (TL) Valle del Belìce ewes at about 60 days in milk, divided homogeneously into 5 groups fed different diets in a partial 5 × 2 Latin square design with 2 phases, and the bulk milk of farming ewes fed only on natural pasture, were used in 2 sessions of micro cheese-making to manufacture cheeses, sampled at 48 h of ripening. The experimental diets were: SHL = SH ad libitum; DSF2 = 2 kg/day DSF per head plus SH ad libitum; FSF2 = 2 kg/day FSF per head plus SH ad libitum; FSF4 = 4 kg/day FSF per head plus SH ad libitum; FSFL = FSF ad libitum. Concentrate was supplied at the amount of 0.8 or 1.2 kg/day per head for FL and TL, respectively. Cheese health properties greatly improved with FSFL diet, based on the exclusive use of fresh forage, that induced the increase in the content of molecules with antioxidant activity, as vitamin A, vitamin E and polyphenols, enhancing the oxidative stability, and the level of PUFA as rumenic acid (C18:2 c9t11) and α-linolenic acid (ALA, C18:3n-3). Cheeses from the DSF2 group showed levels of vitamin A, vitamin E and PUFA higher than SHL cheeses and comparable to those of FSF4 cheeses, whereas their ALA content was not different from that of FSFL cheeses. Evaluating those molecules affected by the level of fresh forage in the diet for their ability to trace the animals' feeding regime, ALA and its ratio with linoleic acid (LA, C18:2n-6) (LA/ALA) exhibited an effective role as biomarker in discriminating cheese from animals fed fresh forage-based diets. The results showed how dehydrated sulla pellets, as an alternative to hay in periods of limited availability of fresh forage, can preserve the nutritional and health properties of dairy products with regards to their antioxidant capacity and FA profile.

Alcohol binge drinking in adolescence and psychological profile: Can the preclinical model crack the chicken-or-egg question?

During adolescence, internal and external factors contribute to engaging with alcohol binge drinking (ABD), putting at risk the neurodevelopment of brain regions crucial for emotional control and stress coping. This research assessed the prevalence of ABD in late adolescent students of Southern Italy and characterized their psychological profile and drinking motives. Translational effects of alcohol binge drinking in the animal model were also studied. Seven hundred and fifty-nine high school students of both sexes (aged 18-20) were recruited. Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), Drinking Motives Questionnaire-Revised Short Form, Millon Clinical Multiaxial Inventory-Third Ed., State-Trait Anxiety Inventory, Connor-Davidson Resilience Scale, and Basic Self-Esteem Scale identified alcohol habits, drinking motives, and psychopathological profile. Eighty-five percentage of the students drank alcohol and 28% of them engaged in ABD; AUDIT-C correlated with enhancement, coping, and conformity motives. ABD was related to a greater likelihood of presenting clinical syndromes and personality disorders, as well as low resilience and self-esteem. Thereafter, in the pre-clinical model, adolescent male rats were exposed to alcohol (3.5 g/kg) in an intermittent binge-like paradigm and tested during prolonged abstinence. Rats were evaluated for anxiety-like behavior, motivated behaviors, resilience, and stress response following a psychosocial challenge. Binge-like alcohol-exposed adolescent rats displayed high integrated z-score for social- and novelty-induced anxiety, altered motivation-driven output, decreased resilience, and a blunted HPA axis response to psychosocial stress, with respect to respective controls. Our data confirm that ABD is the chosen pattern of drinking in a significant percentage of high school students in Southern Italy, and highlights AUDIT-C score as a relevant parameter able to predict the occurrence of affective disturbances. The evidence from the preclinical model shows that ABD produces detrimental consequences in the adolescent rat brain, resulting in negative affect, emotional dysregulation, and aberrant stress response, pointing to decreasing excessive alcohol drinking as a primary goal for the global act for brain health.

Changes in Touch Avoidance, Stress, and Anxiety During the COVID-19 Pandemic in Italy.

In the present study we analyzed how attitudes toward touch have changed during the COVID-19 pandemic in an Italian sample, through two different studies: in the first we contacted participants of the Italian validation study of the Touch Avoidance Questionnaire, asking them to take part in a follow-up study (N = 31, 64.5% women, age 42.58 ± 15.15); in the second we recruited a new sample of 717 people (73.92% women, age 34.25 ± 13.11), comparing it to the full validation sample of the Touch Avoidance Questionnaire (N = 335, 64.48% women, age = 35.82 ± 14.32) to further investigate the relationship between the pandemic, stress responses, fear of contagion, anxiety, and attitudes toward touch. Overall, we found higher post-pandemic scores for touch avoidance toward strangers and family members and lower scores in touch avoidance toward friends of either gender, along with a slight increase in anxiety and stress. Touch avoidance was also positively related to anxiety and/or stress levels except for touch avoidance toward same-sex friends, for which the relationship with anxiety was negative. Surprisingly, we found that young people were the most anxious, despite older people being more at-risk of dying from COVID-19. Women were slightly more stressed out. COVID-19-related fears were significant predictors of touch avoidance toward partners, friends and strangers, but not of touch avoidance toward family. The results suggest that touch avoidance increased during the pandemic (except toward same-sex friends), together with anxiety and stress levels, but the change was relatively small.

Effects of Grazing Season on Physico-Chemical Characteristics and Fatty Acids of Nutritional Interest of Caciocavallo Palermitano Cheese.

The aim of this work was to evaluate, in the different production seasons of the year, the physico-chemical quality of an artisanal cheese traditionally obtained from autochthonous grazing cows, with particular reference to fatty acids (FA) of nutritional interest that play an important role in the risk or prevention of some human pathologies. For this purpose, cheeses were sampled in 11 farms, repeating the samplings in 3 different periods of the year (summer, autumn-winter, and spring) when the productive conditions of the pastures varied. The cheeses produced in the spring period, when cows ingest a greater amount of grazed forage, resulted in a more adequate composition of the main FA, which are recognized as having a health effect, such as α-linolenic, trans-vaccenic, rumenic, docosapentaenoic (DPA) and docosahexaenoic (DHA) acids. Branched-chain FA were found in greater quantities in spring cheeses, as well as in summer ones. The FA composition of cheeses produced in the different seasons was reflected in some nutritional indexes that also resulted as more suitable in cheeses obtained in the spring period. The positive effects induced on the FA profile of cheeses are presumably linked to the diet of autochthonous cows, which is mainly based on forage from natural pastures. Therefore, the results obtained confirm the benefits of grazing, which is able to guarantee the production of healthier cheeses for consumers.

Efficacy of a Functional Therapy Program for Depression and C-Reactive Protein: A Pilot Study.

OBJECTIVE: Affecting more than 264 million people, depression is a systemic and multifactorial disorder that represents one of the leading causes of illness and disability worldwide. Several studies showed an inflammatory response in depressed patients, including the involvement of both chronic low-grade inflammatory response and activation of cell-mediated immunity. The present study aimed to verify the efficacy of a structured functional therapy program for patients with depressed mood, and to determine whether this program can significantly reduce levels of C-reactive protein. METHOD: 28 outpatients with depressed mood received 20 individual sessions of Functional therapy. Data about socio-demographic variables, depression, self-esteem, and quality of life were collected; moreover, blood specimens were collected before and after treatment, and CRP measurement was performed by immunoenzymatic method. All measures were administered at baseline, at the end of treatment (i.e., 3 months after baseline), and at follow-up (i.e., 6 months after baseline). RESULTS: A repeated measures ANOVA showed a significant difference after treatment on depression levels, levels of self-esteem, and all dimensions of quality of life, such as physical, psychological, social relationships, and environment. Furthermore, a statistically significant difference on levels of CRP was found. Moreover, at follow-up, improvements were maintained. CONCLUSIONS: The study revealed initial evidence of the efficacy of a functional therapy program on treating depression and its psychological and inflammation-related markers.

Fatty Acids as Biomarkers of the Production Season of Caciocavallo Palermitano Cheese.

This experiment aims to evaluate the potential of fatty acids (FA) of Caciocavallo Palermitano cheese as biomarkers of production season and pasture-based diet. A total of 48 cheeses were made in the four seasons with milk from two farms that raised cows of Cinisara breed. The animals were fed on pasture with supplementation of wheat bran and wheat straw in the barn, and in summer also with Opuntia ficus-indica cladodes. The chemical composition and FA profile of cheese were influenced by the season and not by the farm. In particular, cheeses produced in spring were characterized by higher protein and lower fat, and showed higher contents in trans-vaccenic acid, α-linolenic acid, rumenic acid, n-3 polyunsaturated FA (PUFA), and total PUFA. In winter, the lower availability of grazing forage, requiring a higher level of feeding integration, was responsible for an increase of saturated FA (SFA). The multivariate analysis distinguished clearly the cheeses made in winter and spring, while those produced in autumn and summer showed some overlapping points. Further investigations should be carried out to evaluate the effects of type and level of feeding integration on the presence of FA more suitable to be used as biomarkers of period and diet.

Fatty Acid Composition of Salami Made by Meat from Different Commercial Categories of Indigenous Dairy Cattle.

In autochthonous dairy cattle farms, the production of salami could represent an alternative commercial opportunity. Therefore, a study was carried out to investigate the fatty acid (FA) composition of salami made using the meat from grazing (GB) or housed (HB) young bulls and grazing adult cows (AC) of Cinisara breed. The products were manufactured by adding 20% of pork lard. Animal category influenced the FA composition, although the addition of lard mitigated the differences found in fresh meat. The salami from GB showed higher polyunsaturated FA content (p ≤ 0.01) and, in particular, a higher level of linoleic acid (p ≤ 0.05), than from other animal categories. Salami made from AC meat showed lower polyunsaturated/saturated FA ratio (p ≤ 0.05), but a better n-6/n-3 ratio compared to HB (p ≤ 0.05), due to the lower content of linoleic acid. Multivariate analysis showed an important influence of animal category on FA composition due to age, feeding system and meat fat content of animals, despite the addition of lard.

The Use of Winery by-Products to Enhance the Functional Aspects of the Fresh Ovine "Primosale" Cheese.

Fresh ovine "primosale" cheese was processed with the addition of grape pomace powder (GPP). Cheese making was performed using pasteurized ewes' milk and four selected Lactococcus lactis strains (Mise36, Mise94, Mise169 and Mise190) inoculated individually. For each strain the control cheese (CCP) was not added with GPP, while the experimental cheese (ECP) was enriched with 1% (w/w) GPP. GPP did not influence the starter development that reached levels of 109 CFU/g in all final cheeses. The comparison of the bacterial isolates by randomly amplified polymorphic DNA (RAPD)-PCR showed the dominance of the added strains over indigenous milk bacteria resistant to pasteurization. GPP addition reduced fat content and determined an increase of protein and of secondary lipid oxidation. Sensory tests indicated that cheeses CCP94 and ECP94, produced with the strain Mise94, reached the best appreciation scores. Following in vitro simulated human digestion, bioaccessible fraction of ECP94 showed antioxidant capacity, evaluated as radical scavenging activity and inhibition of membrane lipid oxidation, significantly higher than that from CCP94, with promising increase in functional properties. Thus, the main hypothesis was accepted since the functional aspects of the final cheeses improved, confirming that GPP is relevant for sustainable nutrition by using winemaking by-products.

Views of Schizophrenia Among Future Healthcare Professionals: Differences in Relation to Diagnostic Labelling, Causal Explanations, and Type of Academic Degree Program.

OBJECTIVE: Stereotyped beliefs about schizophrenia are well-established in the society and relatively common among healthcare professionals and students. The aim of this study was to investigate the opinions about the causes, treatment, and outcome of schizophrenia among healthcare students. METHOD: Undergraduate nursing and psychology students completed selected items of the Opinion on Mental Illness Questionnaire after reading a clinical vignette of undiagnosed schizophrenia. RESULTS: Students who labelled the description as schizophrenia were more pessimistic regarding full recovery from the disorder. Those who acknowledged greater relevance to biogenetic risk factors were more convinced of the efficacy of medications. Respondents' opinions on the efficacy of psychological interventions were more positive among psychology students than among nursing students. CONCLUSIONS: The study confirmed the associations of schizophrenia labelling with prognostic pessimism and beliefs about the efficacy of pharmacological treatment among future healthcare professionals. Students' opinions were less influenced by differences between academic degree programs. Information about current recovery rate and comprehensive care for schizophrenia may support future healthcare professionals in the relationship and the clinical management of PWS.

Development of "Quadrello di Ovino", a Novel Fresh Ewe's Cheese.

This work was performed to produce a new soft ewe's milk cheese, namely "Quadrello di ovino" (QdO) cheese, to enlarge ewe's dairy product portfolio of South Italy, barely limited to Pecorino cheese typology. Cheese making was performed applying the technology for "Crescenza" cheese typology with some modifications. In particular, pasteurized ewes' milk was inoculated with two commercial starter formulations (SF1 and SF2) of Streptococcus thermophilus to obtain two different productions (QdO-P1 and QdO-P2, respectively). Plate counts demonstrated the ability of both starter formulations to drive the fermentation process, since S. thermophilus counts reached 109 CFU/g in both productions. Generally, the two starter formulations did not affect the chemical composition of QdO cheeses that contained, on average, 64.08% dry matter of which approximately 54.99% were fats and 36.39% proteins. Among chemical parameters, significant differences were registered for secondary lipid oxidation state (significantly lower for QdO-P2), fatty acids and volatile organic compounds (VOCs). However, the differences registered among cheese VOCs from were not perceived by the panelists who recognized both cheese productions highly similar, although QdO-P2 cheeses were mostly appreciated by the judges. This study allowed to produce a novel fresh ovine cheese with specific chemical and sensorial characteristics well appreciated by consumers.

Efficacy of a fasting-mimicking diet in functional therapy for depression: A randomised controlled pilot trial.

OBJECTIVE: This randomized controlled trial examined the efficacy of adding a fasting-mimicking diet to a structured psychotherapy protocol for treating depression. DESIGN: Of 20 patients with depression, 10 were randomly assigned to psychotherapy and dieting (i.e., experimental group) and the other 10 to psychotherapy only (i.e., control group). Patients in both groups received 20 individual sessions of functional therapy along with nutrition consultation. Patients in the control group were instructed to maintain their usual daily diets. RESULTS: Both treatments were effective in reducing depression as well as increasing self-esteem and quality of life. The experimental group showed improved self-esteem and psychological quality of life as well as a reduction in their mean body mass index, in comparison to the control group. CONCLUSIONS: The study revealed initial evidence of the efficacy of combining psychotherapy with a fasting-mimicking diet to treat depression and its correlates.

Increased functional connectivity in gambling disorder correlates with behavioural and emotional dysregulation: Evidence of a role for the cerebellum.

Gambling disorder (GD) is a psychiatric disease that has been recently classified as a behavioural addiction. So far, a very few studies have investigated the alteration of functional connectivity in GD patients, thus the concrete interplay between relevant function-dependent circuitries in such disease has not been comprehensively assessed. The aim of this research was to investigate resting-state functional connectivity in GD patients, searching for a correlation with GD symptoms severity. GD patients were assessed for gambling behaviour, impulsivity, cognitive distortions, anxiety and depression, in comparison with healthy controls (HC). Afterwards, they were assessed for resting-state functional magnetic resonance imaging; functional connectivity was assessed through a data-driven approach, by using independent component analysis. The correlation between gambling severity and the strength of specific resting-state networks was also investigated. Our results show that GD patients displayed higher emotional and behavioural impairment than HC, together with an increased resting state functional connectivity in the network including anterior cingulate cortex, the caudate nucleus and nucleus accumbens, and within the cerebellum, in comparison with the control group. Moreover, a significant correlation between behavioural parameters and the strength of the resting-state cerebellar network was found. Overall, the functional alterations in brain connectivity involving the cerebellum observed in this study underpin the emotional and behavioural impairment recorded in GD patients. This evidence suggests the employment of novel neuromodulatory therapeutic approaches involving specific and salient targets such as the cerebellum in addictive disorders.

Effects of adding solid and molten chocolate on the physicochemical, antioxidant, microbiological, and sensory properties of ewe's milk cheese.

A novel dairy product, namely "chocolate cheese", was produced with two typical Sicilian food products: Pecorino cheese, processed from ewe's milk, and Modica chocolate. The cheese, manufactured with 0%, 5%, 10%, and 15% (w/w) solid or molten chocolate, was evaluated after 0, 2, 4, and 6 weeks of vacuum storage for its nutritional and health properties. The addition of chocolate reduced the pH, protein, fat, and ash; the addition of 5% or 10% molten chocolate reduced hardness (N/mm2 ). The addition of either solid or molten chocolate resulted in a slight increase (P < 0.1038) in the total polyphenol content, a higher oleic acid content, and less oxidative stability. The microbiological profile showed that the total mesophilic count and the number of mesophilic coccus lactic acid bacteria (LAB) were approximately equal (about 108 CFU/g) in all cheese. The survival of the microorganisms was affected by both the chocolate added and the storage time. Chocolate cheese stored for 6 weeks had less Enterobacteriaceae than control cheese, whereas yeasts were detected at higher cell densities in the former cheese. Filamentous fungi were undetectable in some cheese. Differences were also observed in the number of mesophilic rod LAB, which increased progressively over time in all cheese, and in Enterobacteriaceae, yeasts, and filamentous fungi, which decreased during storage. Descriptive and hedonic sensory tests and principal component analysis showed that fresh cheese and cheese stored for 2 weeks, including 5% molten chocolate, were the most preferred by evaluators. Based on these results, chocolate cheese has the potential to be appreciated in the market for its nutritional, health, and sensory properties. PRACTICAL APPLICATION: Chocolate cheese, made by combining two typical Sicilian foods, Pecorino cheese and Modica chocolate, is proposed as a novel dairy product. The highest sensory acceptance was obtained with the addition of 5% molten chocolate and storage for 2 weeks. Given its improved antioxidant properties, healthier fat, and sensory properties, chocolate cheese has the potential to be appreciated in the market, especially by young consumers.

A Cross-Sectional Survey on Burnout Prevalence and Profile in the Sicilian Population of Ambulance Driver-Rescuers.

INTRODUCTION: Burnout is present at a high rate in emergency medicine. The ambulance driver-rescuers, who furnish first aid to the victims, are the non-medical part of the Italian 118-service staff. There is a lack of research on burnout risk in Italian Emergency Medical Services and, particularly, for this category of workers. The two Italian studies, including a little group of ambulance driver-rescuers, reported inconsistent findings. HYPOTHESIS: This survey investigated for the first time the prevalence and exact profile of burnout in a large sample of Italian driver-rescuers. As a secondary aim, the study described how the items of the Italian version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) cluster in components in this sample. METHODS: This cross-sectional census survey was conducted from June 2015 through May 2016 and involved all the driver-rescuers operating in Sicily, the biggest and most southern region of Italy. The subjects received a classification according to different profiles of burnout by using the Italian version of the MBI-HSS (burnout, engagement, disengagement, over-extension, and work-inefficacy). In order to explore the existence of independent factors, a Principal Component Analysis (PCA) was conducted on the survey to obtain eigenvalues >one for each component in the data. RESULTS: The final sample comprised 2,361 responders (96.6% of the initial sample). Of them, 29.8% were in burnout (95% confidence interval [CI], 27.8% to 31.8%) and 1.7% presented a severe form (95% CI, 1.1% to 2.3%); 30.0% were engaged in their work (95% CI, 21.0% to 34.8%), 24.7% of responders were disengaged (95% CI, 22.9% to 26.5%), 1.2% presented an over-extension profile (95% CI, 0.8% to 1.7%), and 12.6% felt work-inefficacy (95% CI, 11.3% to 14.1%). The factors loaded into a five-factor solution at PCA, explaining 48.1% of the variance and partially replicating the three-factor structure. The Emotional Exhaustion (EE) component was confirmed. New dimensions from Personal Accomplishment (PA) and Depersonalization (DP) sub-scales described empathy and disengagement with patients, respectively, and were responsible for the increased risk of burnout. CONCLUSIONS: These results endorse the importance of screening and psychological interventions for this population of emergency workers, where burnout could manifest itself more insidiously. It is also possible to speculate that sub-optimal empathy skills could be related to the disengagement and work-inefficacy feelings registered.