Energy drinks consumption in Italian adolescents: preliminary data of social, psychological and behavioral features.

BACKGROUND: The aim of this study was to investigate the prevalence of energy drink (ED) consumption and the associations with social, psychological and behavioral features among an Italian adolescent sample. METHODS: A cross-sectional prevalence study of 450 Italian adolescents attending middle school was conducted. The Italian versions of the European Food Safety Authority's adolescent Energy Drinks Questionnaire and of the Depression and Anxiety in Youth Scale (DAYS) were administered to evaluate ED use and its psychological correlates. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using a logistic model to estimate the associations between ED consumption and socio-demographic characteristics, psychological factors and risky behaviors. RESULTS: The prevalence of ED consumers was 57%, of whom 49% used alcohol mixed with ED. A total of 9% exhibited high chronic consumption, 31% average chronic consumption and 8% high acute consumption. Males were significantly more likely to use ED (OR=2.7, 95% CI: 1.8-4.0, P=0.00) and to engage in high acute consumption (OR=4.0, 95% CI: 1.1-13.8, P=0.03). Regular smoking was associated with ED use (OR=3.4, 95% CI: 1.2-9.1, P=0.02). No relationship was observed between ED use and depression (OR=1.6, 95% CI: 0.9-3.0, P=0.10) and anxiety (OR=0.8, 95% CI: 0.5-1.4, P=0.44), although those who were depressed with a suggestive but not statistically significant increased risk of acute ED use (OR=2.7, 95% CI: 1.0-7.4, P=0.06). CONCLUSIONS: The prevalence of ED consumption among middle school Italian students was high and it was associated with another risky behavior, smoking, but not with anxiety or depression. About half of ED consumers used alcohol mixed with ED.

[Health status and access to health services by the population of L'Aquila (Abruzzo Region, Italy) six years after the earthquake]. / Stato di salute e accesso alle prestazioni sanitarie nella popolazione terremotata del comune di L'Aquila. Un bilancio a sei anni dal sisma.

Natural disasters, such as the earthquake that occurred in the province of L'Aquila in central Italy, in 2009, generally increase the demand for healthcare. A survey was conducted to assess perception of health status an d use of health services in a sample of L'Aquila's resident population, five years after the event, and in a comparison population consisting of a sample of the resident population of Avezzano, a town in the same region, not affected by the earthquake. No differences were found in perception of health status between the two populations. Both groups reported difficulties in accessing specialized healthcare and rehabilitation services.

Prevalence and risk factors of vision impairment among children of employees of Telecom, Italy.

PURPOSE: To define the prevalence, causes, and risk factors of vision impairment (VI) in children. METHODS: In this study, relatives of Association for Supplemental Health Insurance to the Employees of Telecom members aged 5-16 years were examined in all Italian regions. A standardized record card was used to collect data on medical history; keratometry; objective refraction; uncorrected, presenting, and best-corrected visual acuity (VA); examination of the pupils, adnexa, and anterior segment; direct ophthalmoscopy; posterior segment and fundus examination; and assessment for ocular pathology. Binocular and monocular VI were defined by a VA <5/10 (or <20/40). RESULTS: The campaign included 17,508 children, 12,798 of whom (73.1%) were examined (and 12,740 on whom all VA data were gathered). The prevalence of uncorrected, presenting, and best-corrected VI in the better eye was 9.0%, 2.51%, and 0.10%, respectively. The following variables were associated with presenting VI: age 10-16 years, family history of myopia, female sex, family history of keratoconus, and hypertension. Myopia is the main cause of VI (82.6%). A total of 96% of children with presenting VI had correctable VI. CONCLUSIONS: Correctable VI because of myopia is an important public health problem in school-age children in Italy.

Temporal trends in hospitalization for rotavirus gastroenteritis: A nationwide study in Italy, 2005-2012.

AGE severity is linked to etiology, and Rotavirus (RV) accounts for most of severe cases. In 2009 the World Health Organization recommended RV vaccination for all children. Worldwide a number of Countries implemented RV vaccination in their pediatric immunisation programmes, but only a limited number in Europe. This study was designed to estimate the proportion of RVGE among children aged <6 y who were diagnosed with AGE and admitted to hospitals in Italy during the years 2005-2012. A total of 334,982 hospital discharge forms were collected, being 79,344 hospitalizations associated with RV. The average hospitalization rate (HR) was 146/100,000 children for RVGE in primary diagnosis (PD) and 150/100,000 children for RVGE in secondary diagnosis (SD). Since 2008 the RVGE hospitalization figures and rates (HRs) in SD exceed those in PD. The majority of RVGE hospitalizations (33.67%) were reported among children aged ≤ 2 years. Despite some limitations due to the hospital discharge database (HDD) synthetic contents and low potential for clinical interpretation, the analysis of national HDD, including PD and SD, documents that RV still represents a consistent cause of pediatric hospitalizations in Italy.

Health-related quality of life in children and adolescents with celiac disease: survey of a population from central Italy.

BACKGROUND: Celiac Disease (CD) is an increasingly common autoimmune disorder. It requires a strict lifelong adherence to a gluten-free diet (GFD) which can influence health-related quality of life (HRQOL). This study assesses HRQOL in children and adolescents with CD and explores how several demographic and clinical characteristics and GFD adherence affect their perceived health status. METHODS: We recruited 140 consecutive children and adolescents with CD confirmed by small bowel biopsy. HRQOL was assessed using the SF-12 questionnaire plus some CD-specific questions exploring wellbeing and lifestyle. Patients, aged 10 to 18 years, were identified by pediatric gastroenterologists and guided in filling out the questionnaire by trained psychologists. Parametric or non-parametric tests were applied to analyze continuous variables and frequencies as appropriate. RESULTS: The SF-12 mean mental component summary score (MCS12) was lower than in the general Italian population (p < 0.001), whereas differences in terms of physical health were not significant (p = 0.220). More than one third of those interviewed reported feeling angry "always" or "most of the time" about having to follow the GFD, and nearly 20% reported feeling different from others and misunderstood because of CD "always" or "most of the time". CONCLUSIONS: Our findings highlight the need for health professionals to identify adolescents with major disease-related problems. The food industry should improve its range of gluten-free food products and public bodies and institutions should promote informative campaigns and help promote the overall quality of life of children and adolescents with CD.

[Asbestos and harmful health effects: from denial theories to epidemiological evidence]. / Amianto e danni alla salute, tra tesi negazioniste ed evidenze epidemiologiche.

The recent episode involving Eternit, a factory in Casale Monferrato (Turin, Italy), culminated in February 2012 with a guilty verdict for the owners of the factory. The indiscriminate use of asbestos, however, continues worldwide, despite evidence of increased risk for conditions such as asbestosis and malignant pleural mesothelioma. In this study we investigate the relationship between epidemiological evidence and denial theories, over the decades and until the present time. Many countries in the world still promote the use of asbestos, with a view to profit and globalization but at the expense of public health.

Cross-cultural adaptation and measurement properties of the italian version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire.

BACKGROUND: The Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire is a tool designed for self-assessment of forearm pain and disability in patients with lateral elbow tendinopathy (LET). However, an Italian version of this questionnaire has not been available. OBJECTIVE: The aims of this study were: (1) to translate and cross-culturally adapt the PRTEE questionnaire into Italian and (2) to evaluate its measurement properties. DESIGN: This was a longitudinal, observational measurement study. METHODS: The PRTEE questionnaire was cross-culturally adapted to Italian according to established guidelines. Ninety-five individuals (41 women, 54 men) with unilateral, imaging-confirmed, chronic LET were selected consecutively to assess the measurement properties of the PRTEE questionnaire. Internal consistency, test-retest reliability, construct validity, and responsiveness were estimated. RESULTS: The Italian version of the PRTEE displayed a high degree of internal consistency, with a Cronbach alpha of .95. The test-retest reliability was high for both short-term and medium-term, with intraclass correlation coefficients (2,1) of .95 and .93, respectively. The PRTEE exhibited a strong correlation (r=.77-.91, P<.0001) with the Disabilities of the Arm, Shoulder and Hand (DASH) at the baseline and a moderate correlation (r=.58-.74, P<.0001) at discharge. The responsiveness was higher for the PRTEE than for the DASH. Limitations A methodological limitation of the study is that due to the small sample size, a factor analysis was not performed to assess convergent validity. CONCLUSIONS: The Italian version of the PRTEE questionnaire is internally consistent, demonstrates expected correlations with other measures, and is more responsive than the DASH in Italian patients with chronic LET.

The relationship between anger and heterosexual behavior. An investigation in a nonclinical sample of urban Italian undergraduates.

INTRODUCTION: The relationship between anger and sexual behavior has never been thoroughly addressed, although it may deserve special attention because of its theoretical and practical consequences. AIM: We were interested in determining the extent in which trait anger was associated with dysfunctional sexual behavior, taking into account possible gender differences. METHOD: In this correlational study, 410 volunteers (199 men and 211 women) recruited from the students of the University of Messina, Italy, participated in the study. Median age of participants was 24 years. Men and women did not differ significantly in age (U = 18996, P = 0.606). MAIN OUTCOME MEASURES: The individuals' sexual behavior was assessed using the Sex and the Average Woman (or Man) questionnaire. RESULTS: We found no association between trait anger and either measure of sexual motivation: sexual excitement, r (396) = 0.11, P = 0.016, and sexual fulfillment, r (396) = -0.06, P = 0.134. Also, gender had no effect on either of these two variables. Trait anger had a positive significant correlation with neurotic sex, r (396) = 0.29, P < 0.002, impersonal sex, r (396) = 0.20, P < 0.002, and aggressive sex, r (396) = 0.28, P < 0.002. As we predicted, the associations between trait anger and these last three variables were stronger for men than for women (although only aggressive sex had a significant result). In multivariate analyses, impersonal sex ceased to be a significant correlate of trait anger. CONCLUSIONS: Trait anger has a negative effect on sexual behavior. It seems to exert its worst effects on the nature of sexual interpersonal behavior rather than on sexual motivation. We found no effect of gender on sexual motivation. However, the positive correlation between anger and relational sexual behavior was stronger for men than for women.

Maintenance immunotherapy in recurrent ovarian cancer: long term follow-up of a phase II study.

OBJECTIVES: Vascular endothelial growth factor (VEGF), a mediator of tumor-associated immunodeficiency, plays a key role in angiogenesis and is a prognostic factor in advanced ovarian cancer (AOC). Previously, we showed that low-dose interleukin-2 (IL-2) and 13-cis-retinoic acid (RA) improved the tumor-associated immunodeficiency and decreased VEGF in patients with AOC. Here, we report long term follow-up of a group of patients with platinum-sensitive AOC who were treated with IL-2 and RA. METHODS: Sixty-five patients with AOC who had a clinical benefit from second line chemotherapy and elevated serum levels of VEGF were entered into the study from 04/98 to 04/05. Therapy consisted of low-dose subcutaneous IL-2 and oral RA, administered on intermittent schedules for up to 5 years. RESULTS: A statistically significant improvement in lymphocyte and NK counts and a decrease in VEGF levels were observed with respect to baseline values among the 65 evaluable patients. Five-year progression-free survival and overall survival rate were 29% and 38%, respectively. CONCLUSIONS: These data show that patients treated with low-dose IL-2 and RA have a statistically significant improvement in their lymphocyte and NK counts, a decrease in VEGF, and seem to have an improved clinical outcome.

The Italian version of the lower extremity functional scale was reliable, valid, and responsive.

OBJECTIVE: To determine the measurement properties of an Italian Version of the Lower Extremity Functional Scale (LEFS) in patients with lower extremity musculoskeletal dysfunction. STUDY DESIGN AND SETTING: This is a prospective methodological study of repeated measures with a sample of 250 consecutive patients. Reliability, validity, and responsiveness were evaluated. RESULTS: The Italian version of the LEFS showed a high degree of internal consistency with a Cronbach alpha of 0.94 (95% confidence interval [CI]: 0.91, 0.96). The test-retest reliability was high for both intra-interviewer and inter-interviewer measures with an ICC((2,1 and 2,k)) of 0.91 (95% CI: 0.86, 0.93) and 0.89 (95% CI: 0.83, 0.91), respectively. The LEFS showed a better correlation with the 36-Item Short-Form Health Survey (SF-36) physical component summary score rather than with the SF-36 mental component summary score both at the initial assessment (r=0.61 and 0.26, respectively) and at the discharge (r=0.72 and 0.22, respectively). Receiver operating characteristic curve analysis revealed a large responsiveness for the LEFS (area under the curve [AUC]=0.97) and a moderate responsiveness for the SF-36 (AUC=0.68). CONCLUSION: The Italian version of the LEFS is a valid, reliable, and responsive tool that can be used to measure function in Italian patients with lower extremity musculoskeletal dysfunction.

Accuracy of N-terminal pro-brain natriuretic peptide in the identification of left ventricular dysfunction in high-risk asymptomatic patients.

OBJECTIVE: The role of natriuretic peptides in the screening of left ventricular dysfunction is still unclear. The aim of this study was to assess the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement in asymptomatic patients at high risk of developing left ventricular dysfunction. METHODS: One hundred and thirty-four consecutive ambulatory patients (mean age 56.1 +/- 7 years) were studied and selected on the basis of a history of hypertension of at least 5 years. Systolic dysfunction was defined as an ejection fraction of 45% or less. Statistical analysis was performed by both parametric and nonparametric approaches. Diagnostic accuracy was evaluated by receiver operating characteristic analysis. RESULTS: Echocardiography showed normal left ventricular function in 40 patients, diastolic dysfunction in 80 patients and systolic dysfunction in 14 patients. NT-proBNP levels were significantly higher in patients with systolic dysfunction (356.1 +/- 294.8 vs. 85.2 +/- 85.8 pg/ml; P < 0.05). Receiver operating characteristic analysis showed a high value of the area under the curve (0.89) for the detection of systolic dysfunction with a sensitivity of 83% and a specificity of 80% for a cut-off value of 114 pg/ml and with a negative predictive value of 0.98. CONCLUSION: In asymptomatic patients at high risk for heart failure because of a history of hypertension, the measurement of NT-proBNP levels may represent a useful screening test for left ventricular systolic dysfunction. Therefore, more expensive examinations, such as echocardiography, may be restricted only to patients with higher NT-proBNP levels.

Enhanced proatherogenic inflammation after recombinant human TSH administration in patients monitored for thyroid cancer remnant.

OBJECTIVE: To evaluate the effect of recombinant human TSH (rhTSH) on biomarkers of vascular endothelial cell and platelet activation in patients monitored for thyroid carcinoma remnant. METHODS: Circulating levels of soluble(s) intercellular adhesion molecule (sICAM)-1 and sE-selectin, as indices of vascular endothelial cell activation, of sP-selectin and sCD40 ligand (sCD40L), as indices of platelet activation, and of 8-iso-prostaglandin F(2alpha) (8-iso-PGF(2alpha)), as an index of lipid peroxidation, were evaluated in 20 patients (16 females, 48.0 +/- 13.6 years) at baseline and after intramuscular rhTSH injection (0.9 mg/day on two consecutive days). RESULTS: At baseline, serum TSH values were below normal whereas free T3 and free T4 were within the normal range. After rhTSH injection, serum TSH increased significantly but free T3 and free T4 remained unchanged. Concomitantly, plasma sICAM-1 concentrations increased significantly (from 155.9 +/- 39.1 to 183.6 +/- 38.1 ng/ml, P < 0.03), as did those of sE-selectin (from 74.8 +/- 15.4 to 91.4 +/- 12.2 ng/ml, P < 0.0006), sP-selectin (from 56.4 +/- 13.7 to 72.2 +/- 14.9 ng/ml, P < 0.002), sCD40L (from 2.1 +/- 0.9 to 2.8 +/- 1.1 ng/ml, P < 0.03) and total 8-iso-PGF(2alpha)(from 238.5 +/- 47.0 to 307.8 +/- 41.2 pg/l, P < 0.0001). Changes in circulating levels of sCD40L were directly correlated with changes in levels of plasma total 8-iso-PGF(2alpha) (r = 0.523, P < 0.02) and sP-selectin (r = 0.480, P < 0.03). CONCLUSIONS: Supraphysiological concentrations of rhTSH might exert proatherogenic effects by promoting activation of vascular endothelial cells and platelets probably through enhanced oxidative stress.

XML technologies for the Omaha System: a data model, a Java tool and several case studies supporting home healthcare.

The eXtensible markup language (XML) is a metalanguage which is useful to represent and exchange data between heterogeneous systems. XML may enable healthcare practitioners to document, monitor, evaluate, and archive medical information and services into distributed computer environments. Therefore, the most recent proposals on electronic health records (EHRs) are usually based on XML documents. Since none of the existing nomenclatures were specifically developed for use in automated clinical information systems, but were adapted to such use, numerous current EHRs are organized as a sequence of events, each represented through codes taken from international classification systems. In nursing, a hierarchically organized problem-solving approach is followed, which hardly couples with the sequential organization of such EHRs. Therefore, the paper presents an XML data model for the Omaha System taxonomy, which is one of the most important international nomenclatures used in the home healthcare nursing context. Such a data model represents the formal definition of EHRs specifically developed for nursing practice. Furthermore, the paper delineates a Java application prototype which is able to manage such documents, shows the possibility to transform such documents into readable web pages, and reports several case studies, one currently managed by the home care service of a Health Center in Central Italy.

Different effects of angiotensin converting enzyme inhibitors on endothelin-1 and nitric oxide balance in human vascular endothelial cells: evidence of an oxidant-sensitive pathway.

Angiotensin converting enzyme inhibitors (ACE-I) are able to reduce the formation of the potent vasoconstrictor endothelin-1 and increase nitric oxide bioavailability in human vascular endothelial cells (HUVECs). We tested the effects of two sulfhydryl-containing ACE-I, zofenoprilat, and captopril, and two nonsulfhydryl containing ACE-I, enalaprilat and lisinopril, on endothelin-1/nitric oxide balance and oxidative stress in HUVECs. All the four tested ACE-I reduced endothelin-1 secretion and increased nitric oxide metabolite production by HUVECs. However, zofenoprilat (-42% after 8 hours of incubation) was more effective (P < .05) than enalaprilat (-25%), lisinopril (-21%), and captopril (-30%) in reducing endothelin-1 secretion. Similarly, zofenoprilat (+110% after 8 hours of incubation) was more effective (P < .05) than enalaprilat (+64%), lisinopril (+63%), and captopril (+65%) in increasing nitric oxide metabolite production. The effect of ACE-I on endothelin-1 and nitric oxide metabolite production is mediated by the activation of bradykinin B(2) receptor being counteracted, at least in part, by a specific antagonist. Zofenoprilat and, to a lesser extent, captopril also reduced oxidative stress in HUVECs. In conclusion, among the four tested ACE-I, zofenoprilat was more effective in improving endothelin-1/nitric oxide balance in HUVECs likely because of its greater antioxidant properties.

A SOA statistical engine for biomedical data.

Currently, large efforts are spent to develop standards and architectures useful to achieve more effective interoperability among medical information systems. Despite such efforts, there are no researches produced so far to directly analyse, with statistical methods, biomedical data represented as eXtensible Markup Language (XML) documents. Thus, the paper proposes an architecture which offers a twofold approach to the statistical analysis of XML data, i.e. via a web service and by extending the query languages used in XML databases. To show how the architecture can be used, a sample system is also reported. Finally, the paper ends by reporting the advantages and drawbacks of the proposed approach in comparison with classic statistical packages.

Enhanced soluble CD40 ligand and Alzheimer's disease: evidence of a possible pathogenetic role.

It has been suggested that cerebrovascular factors contribute to Alzheimer's disease. Soluble CD40 ligand (sCD40L) is directly involved in the development of vascular damage. We tested the hypothesis that sCD40L may be enhanced in Alzheimer's disease and predictive of its clinical course. Plasma sCD40L levels were evaluated in three groups of 40 consecutive patients each referring for mild or moderate or severe Alzheimer's disease, as assessed by the Clinical Dementia Rating (CDR), and in 40 healthy subjects. Seventy-seven patients with mild or moderate disease were re-evaluated after 2 years. Cross-sectional comparisons revealed higher plasma sCD40L levels in Alzheimer's disease patients than in controls (9.3+/-4.7 ng/mL versus 3.4+/-1.3 ng/mL, p<0.0001). Circulating sCD40L levels significantly increased through the three CDR stages (p=0.0011 or less) and were correlated with MMSE (r=-0.574, p<0.0001) and ADAS-cog subscale (r=0.538, p<0.0001) scores. Longitudinal evaluation identified sCD40L as an independent predictor of MMSE (beta=-0.157, t=-3.650, p=0.0005) and ADAS-cog subscale (beta=0.484, t=3.890, p=0.0002) score changes after 2 years. Patients with plasma sCD40L level>or=6.0 ng/mL, identified by ROC curve analysis as the best discriminating value for disease progression, had a three-fold increase in the risk of progression toward a worse CDR stage (odd ratio: 3.0, C.I. 95% 1.2-8.1). In conclusion, circulating sCD40L is enhanced in patients with Alzheimer's disease and independently associated with the severity and progression of the disease. These data might suggest a pathogenetic role for sCD40L in Alzheimer's disease.

[Prevalence of asthma, respiratory symptoms and allergic disorders among adolescents in the province of Aquila]. / Diffusione di asma, sintomi respiratori e patologie allergiche negli adolescenti della provincia dell'Aquila.

OBJECTIVE: Estimates the prevalence of asthma and other allergic disorders in a random group of adolescents living in the L'Aquila area, which was not covered by SIDRIA (Italian Studies on Respiratory Disorders in Children and the Environment). The second phase of the study showed considerable regional variations within Italy, with a higher prevalence of asthma and wheezing in Central Italy. DESIGN: This study used the same standardised questionnaire of SIDRIA and included 1100 adolescents aged 13-14 years, between January-March 2004. RESULTS: Prevalence of lifetime asthma was 6.7%, cumulative and current prevalence of wheezing were 19.1% and 9.0% respectively. A relatively high proportion of adolescents, 29.2%, reported night cough and 3.6% symptoms of severe asthma. Lifetime prevalence of hay fever and eczema were respectively 17.8% and 6.7%. Prevalence rates of allergic rhinitis and atopic-eczema symptoms were higher in females. The risk of asthma was associated to exposure to: pollen, to house dust mite and to paternal smoking, whereas current smoking in the adolescents was significantly associated to wheezing during the previous 12 months. CONCLUSION: Although asthma prevalence is relatively low in L'Aquila area, it represents an important public health problem that requires further researches into genetics, environmental and medical care factors.

Impaired plasma nitric oxide availability and extracellular superoxide dismutase activity in healthy humans with advancing age.

This study is aimed to verify the modifications of extracellular superoxide dismutase (EC-SOD) activity and its potential involvement on the mechanism responsible for the impairment of plasma nitric oxide (NO) availability occurring with advancing age in healthy humans. For this purpose, plasma samples were drawn from 40 healthy men, aged 20-92 years, in fasting state and used for measurements of stable end-product nitrite/nitrate (NOx), as expression of NO availability, EC-SOD activity, thiobarbituric acid reactive substances (TBARS) as marker of lipid peroxidation, Trolox equivalent antioxidant capacity (TEAC) as a measure of plasma total antioxidant capacity, and in vitro susceptibility of low density lipoprotein (LDL) to copper-mediated oxidation, evaluated as lag time. As indicated by our results, advancing age was significantly related to decreased plasma values of NOx (r = -0.877, P < 0.001), EC-SOD activity (r = -0.888, P < 0.001), TEAC (r = -0.647, P < 0.001) and lag time (r = -0.621, P < 0.001) as well as to an increased plasma amount of TBARS (r = 0.858, P < 0.001). NOx plasma level resulted independently predicted by EC-SOD activity and age. EC-SOD activity, in turn, was determined by age and TEAC. Taken together, findings of the present study give further insight into the mechanism related to age-associated endothelial dysfunction, indicating that the decreased EC-SOD activity may be involved in the progressive reduction of plasma NO availability with advancing age through the age-related impairment of oxidant/antioxidant balance.