Communication, understanding and engagement of patients with pancreatic cancer at time of diagnosis.

BACKGROUND: Objectives: To investigate communication clarity and understanding at the time of pancreatic adenocarcinoma (PDAC) diagnosis and whether they can influence patient engagement and compliance. METHODS: Consecutive PDAC patients were enrolled at the time of diagnosis after obtaining informed consent in a single-center study. The patients completed a validated scale (PHE-s®), and the understanding rate was assessed using standardized tools. Patient compliance was evaluated, and the correlation between the PHE-s®, understanding, and compliance was calculated. RESULTS: Thirty patients were enrolled (15 female) with a mean age 64.4, 13 were metastatic. The mean visit time was 31 min, being longer if visiting doctor was an oncologist (p = 0.002). The engagement level was high in 70% of the patients, and all but one were compliant. The analysis of doctor-patient interactions showed a median of 121 conversational turns for doctors, 75 for patients, and 20 for caregivers (p < 0.0001), and the median percentage of speaking time was 77% for doctors, 13% for patients, and 2% for caregivers (p < 0.0001). Female caregivers spent more time speaking than did male caregivers (median 11.6% vs. 1.3%; p = 0.06). There were 290 instances of problematic understanding, most of which occurred during the taking of patients' personal medical history for doctors, while for patients and caregivers, these occurred mainly during the discussion of diagnosis/treatment (p < 0.0001). In a multivariable analysis, only origin from central or southern Italy was associated with high engagement (p = 0.0087). CONCLUSION: In this first attempt to measure clarity of communication and engagement in patients with PDAC, typical features of conversation and problematic understanding emerged, which deserves further investigation.

Comment on "Reflections on patient engagement by patient partners: How it can go wrong".

As patient-advocacy, public policy and clinical researchers with special knowledge on Responsible Research Innovation (RRI) governance and the public health and psychology underlying patient engagement, we read with interest the comment contribution by Richards et al., "Reflections on patient engagement by patient partners: How it can go wrong" (Richards et al. in Res Involv Engagem 9:41, 2023. https://doi.org/10.1186/s40900-023-00454-13 ). As a way to help meet the "take-away actions for readers" included by the authors at the end of the article, we would like to further stimulate discussion with relevant stakeholder communities about the need to rethink the use of "expert patient". Based on our experience, the lack of a governance model engaging patients who are representative of the target patient community, as opposed to expert patients, is at the root of the tokenistic approach, the "patient partner as a checkmark statement" and the "lack of recognizing the vulnerability of patient partners", which results in "patient engagement going wrong". According to our experience, the Responsible Research Innovation (RRI) MULTI-ACT model has the potential to help meet these challenges.

In their article, Richards et al. (Res Involv Engagem 9:41, 2023. https://doi.org/10.1186/s40900-023-00454-13 ) reflect on the practices of patient engagement in research, highlighting not only the value and opportunity of including people suffering from a disease as coinvestigators in the research process but also the risks and errors that must be avoided in such a process. Along this line of discussion­and based on our experience of research, teaching and patient advocacy­we further reflect on the nature of the concept of "expert patient" in this paper. In particular, we argue for the importance of guaranteeing the wide inclusion of all the different kinds of "experiential knowledge" that patients may bring into the research project, and we question the risk of a poorly representative approach if only guided to select patients with acquired knowledge and expertise about the scientific research process itself. Based on our experience, the Responsible Research Innovation (RRI) governance models have the potential to help meet these challenges.

Alexithymia, Burnout, and Hopelessness in a Large Sample of Healthcare Workers during the Third Wave of COVID-19 in Italy.

In the present study, we aimed to assess the frequency of and the relationships between alexithymia, burnout, and hopelessness in a large sample of healthcare workers (HCWs) during the third wave of COVID-19 in Italy. Alexithymia was evaluated by the Italian version of the 20-item Toronto Alexithymia Scale (TAS-20) and its subscales Difficulty in Identifying Feelings (DIF), Difficulty in Describing Feelings (DDF), and Externally Oriented Thinking (EOT), burnout was measured with the scales emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA) of the Maslach Burnout Test (MBI), hopelessness was measured using the Beck Hopelessness Scale (BHS), and irritability (IRR), depression (DEP), and anxiety (ANX) were evaluated with the Italian version of the Irritability' Depression' Anxiety Scale (IDA). This cross-sectional study recruited a sample of 1445 HCWs from a large urban healthcare facility in Italy from 1 May to 31 June 2021. The comparison between individuals that were positive (n = 214, 14.8%) or not for alexithymia (n = 1231, 85.2%), controlling for age, gender, and working seniority, revealed that positive subjects showed higher scores on BHS, EE, DP IRR, DEP, ANX, DIF, DDF, and EOT and lower on PA than the not positive ones (p < 0.001). In the linear regression model, higher working seniority as well as higher EE, IRR, DEP, ANX, and DDF scores and lower PA were associated with higher hopelessness. In conclusion, increased hopelessness was associated with higher burnout and alexithymia. Comprehensive strategies should be implemented to support HCWs' mental health and mitigate the negative consequences of alexithymia, burnout, and hopelessness.

Cardiac rehabilitation engagement and associated factors among heart failure patients: a cross-sectional study.

BACKGROUND: Chronic Heart Failure (CHF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Cardiac rehabilitation (CR) is known to improve disease-related symptoms, quality of life and clinical outcomes, yet implementation is suboptimal, a frequently low engagement in rehabilitation programs has been found globally. OBJECTIVE: To quantify diverse CR-engaged processes and elucidate associated factors of the various levels of CR engagement in CHF patients. METHODS: Discharged patients admitted from cardiology departments between May 2022 to July 2022 were enrolled by mobile phone text messaging, CHF patients from same department between August 2022 to December 2022 were enrolled by face-to-face. Individuals who met the inclusion criteria filled the questionnaires, including the generalized anxiety disorders scale, patient health questionnaire, cardiac rehabilitation inventory, patient activation measure, Tampa scale for kinesiophobia heart, social frailty, Patient Health Engagement Scale (PHE-s®). We obtained sociodemographic characteristics and clinical data from medical records. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with CR engagement phases. RESULTS: A total of 684 patients were included in the study. 52.49% patients were in the Adhesion phase. At the multivariate level, compared with the blackout phase process anxiety, monthly income (RMB yuan) equal to or more than 5,000 were the most important factor impacting CHF patients CR engagement. Compared with the Blackout phase, regular exercise or not, severe depression, previous cardiac-related hospitalizations 1 or 2 times, Age influenced patient CR engagement in the Arousal phase. Besides, compared with the Blackout phase, outcome anxiety and activation level were independent factors in the Eudaimonic Project phase. CONCLUSION: This study characterized CR engagement, and explored demographic, medical, and psychological factors-with the most important being process anxiety, monthly income, patient activation, severe depression, and previous cardiac-related hospitalizations. The associated factors of CR engagement were not identical among different phases. Our findings suggested that factors could potentially be targeted in clinical practice to identify low CR engagement patients, and strategies implemented to strengthen or overcome these associations to address low CR engagement in CHF patients.

Providing freedom or financial remuneration? A cross-sectional study on the role of monetary and legal incentives on COVID-19 further booster vaccination intention in the Italian context.

Vaccine hesitancy became a more and more important issue during the COVID-19 pandemic. Due to the emergence of new variants, many international health agencies have already begun administering booster doses of the vaccine in response to these threats. Studies have emphasized the effectiveness of different types of incentive-based strategies to increase vaccination behaviors. The purpose of the present study was to identify the correlation between different types of incentives (legal or financial) with people's intentions to get a COVID-19 booster vaccine. We conducted a cross-sectional study between 29 January 2022 and 03 February 2022. An online quantitative survey was carried out in Italy. One thousand and twenty-two Italian adults were recruited by a professional panel provider. Descriptive statistics were computed for the five variables concerning the incentives (monetary, tax, fee, health certification, travel) toward vaccination. A general linear model (GLM) was then computed to compare the scores of the five different variables within the subjects. The general linear model showed a significant within-subjects main effect. Post-hoc comparisons showed that among the financial incentive, the monetary reward is rated lower than all the others. Tax and fees both resulted lower than both the legal incentives. Finally, COVID-19 health certification and travel did not result significantly different from each other. This study offers an important contribution to public policy literature and to policymakers in their efforts to explain and steer booster vaccination acceptance while facing an ongoing pandemic.

The role of free-from symbols on consumer perceptions of healthiness, quality and intention to buy baked food products.

Little is known about the impact of "free-from" symbols on people's consumption choices - particularly for controversial ingredients such as palm oil. We investigated how "free-from" symbols influence consumers' perceptions of food products and whether the absence of an ingredient, whether real or fabricated, is seen as a sign of improved healthiness or quality. We conducted an experiment with a sample of 1215 adults representing the Italian population, showing them two products - crackers and sweet snacks - each with four different symbols. We created the "free-from CO2" and "free-from polyunsaturated fats" symbols, while "palm oil-free" and blank symbols were used for comparison. "free-from" symbols influence consumers' perceptions of the food as being of better quality and healthiness, regardless of the ingredient removed. This symbol also influenced purchasing intentions. Consumers' perceptions of the product were influenced by the "free-from" wording, rather than the type of ingredient or product presented.

Patient Experience of Integrated Care: Findings from a Cross-Sectional Study Involving People with Rheumatic and Musculoskeletal Diseases.

Introduction: Although the patient experience of integrated care has been documented for several chronic conditions, little is known in the context of rheumatic and musculoskeletal diseases (RMDs). This study provides a first overview of the patient experience of integrated care according to the perspective of people living with RMDs in Italy. Methods: A cross-sectional survey was administered to 433 participants who reported their experiences together with the importance assigned to different attributes of integrated care. Explorative factor analysis (EFA) and non-parametric ANOVA and ANCOVA statistical tests were employed to account for the differences in the answers provided by sample subgroups. Results: Two factors (namely, "Person-centred care" and "Health service delivery") were extracted in the EFA. Participants attributed high importance to both of them. Overall positive experiences were reported only for Person-centred care. The delivery of health services instead received a poor evaluation. Significantly worse experiences were observed for women and people that were either older, unemployed, with comorbidities or lower self-reported health, or less engaged in their healthcare management. Conclusions: Italians with RMDs described integrated care as an important approach to care. However, further effort is needed to allow them to perceive an actual benefit from integrated care practices. Specific attention should be paid to disadvantaged and/or frail population groups.

Determinants of the willingness to buy products certified by omics technology: differences between regular and occasional consumers of organic food.

Consumers' demand for organic food has increased in the last years, together with a growing request for food authentication and safety. Omics technologies represent a viable analytical strategy to respond to such needs, strengthen food safety information transmission between consumers and industry, and differentiate between organic and conventional products. However, little is known about consumers' perception of such a novel certification approach. The present research ought to provide insights into the perspectives of consumers, exploring the antecedents of their intention to purchase organic vegetables certified through omics technologies and differentiating between regular and occasional consumers of organic foods. Data were collected from a representative sample of 807 Italian respondents who completed a self-report questionnaire, and Structural Equation Modeling was performed to analyze the data. Results show that several factors influence consumers' approach to omics technology, among which trust in actors in the food industry, attitudes towards the technology and environmental food concerns. In addition, the study drew attention to the differential path impacting consumers with distinct eating habits. Indeed, the degree of importance attributed to food in one's life and the interest towards innovative food are significant predictors of the intention to adopt omics technology only for people consuming organic products with higher frequency. Also, trust in industry actors follows a different path for regular and occasional organic food consumers. The present study sheds light on consumers' perspective on omics technologies, a relatively unexplored topic. Moreover, it allowed to differentiate consumers based on their organic consumption habits, which has been rarely done in previous research. The evidence collected suggests the need for tailored communication programs to stimulate the adoption of omics technologies and foster consumers' confidence in novel food technologies.

The effect of psychosocial interventions on depression, anxiety, and quality of life in hemodialysis patients: a systematic review and a meta-analysis.

PURPOSE: Hemodialysis has become a standard therapy for adults with end-stage renal diseases. Adults undergoing hemodialysis have to cope with unique psychological issues that make their care journey particularly fatiguing. In this systematic review and meta-analysis, we aimed to summarize and evaluate the effects of psychosocial interventions on the reduction of anxiety and depression in adults with HDs. METHODS: We included randomized controlled trials and quasi-experimental studies that measure change in depression, anxiety, and quality of life. RESULTS: We identify three categories of psychosocial interventions delivered to adults undergoing hemodialysis. Based on our analysis, there was a medium effect of psychosocial intervention on depression (SMD - 0.85, 95%CI - 1.17; - 0.52, I2 = 80%, p < 0.01) and anxiety (SMD - 0.99, 95%CI - 1.65; - 0.33, I2 = 88%, p < 0.01) in adults undergoing hemodialysis. CONCLUSIONS: Psychosocial interventions, such as psychological support or relaxation-based therapy, seems all to reduce depression and anxiety in adults undergoing HD. Preliminary evidence suggests that there may be a benefit of psychosocial interventions on the quality of life for adults undergoing HD.

Public views on the Covid-19 immunity certificate: A scoping review.

INTRODUCTION: Already in its first implementation, the introduction of the Covid-19 immunity certificate has generated some debate among the public. This debate might be a hindrance to the effective realization of this policy. This study aimed to systematically review published research evaluating public feeling of the Covid-19 immunity certificate policy measure and to find which factors might influence its acceptance. METHODS: We followed the scoping review methods manual by the Joanna Briggs Institute. We included studies with no time limits that presented novel data, and no exclusions have been made based on study design. We excluded articles that presented just expert opinions. RESULTS: We found and reviewed 17 articles. The included studies were conducted in two main countries (the United Kingdom and Switzerland), with the rest from Israel, Italy, Spain, Germany, Australia, Taiwan and China. Both qualitative and quantitative studies were included, and nonrepresentative samples were mostly used to explore the public feeling about the Covid-19 immunity certification. The included studies showed that public views on immunity certification are quite contradictory and influenced by age, gender, ethnicity, political orientation and attitudes towards Covid-19 vaccination. The topic more often addressed by the included studies was the public's views on the positive and negative implications of the Covid-19 immunity certificate in terms of ethical, legal and behavioural consequences of this measure. CONCLUSION: The varying acceptance rates are notable and may partly be linked to differences in demographics, Covid-19 concerns and ideological beliefs, as seen in other health-related tracking policies. Moreover, dominant factors behind the (un)success of this policy are complex and entangled with the cultural and political dimensions rather than being just technical. For this reason, it is important to expand psychosocial research to better understand the concerns behind health certifications and allow planning of culturally based and ethically sound suitable strategies. This would be very relevant to increasing public approval and compliance with this public health measure. PATIENT OR PUBLIC CONTRIBUTION: This does not apply to our work as it was a review paper.

Perceptions and Liking Distortion from Information about the Nutritional Upgrades in Biofortified Seafood Products.

(1) Background: As biofortified fish meat is becoming increasingly available, the use of supplements within fish feed may impact consumers' perceptions and their willingness to pay (WTP) for the product. This study focused on evaluating the sensory liking of, and WTP for, fish produced with fortified feed while understanding the role played by the acquired information on fish fortification. (2) Methods: Hedonic ratings and WTP were measured in an experimental bid. The participants (n = 91) were asked to rate pleasantness and WTP during two different rounds: (i) appearance-information-tasting and (ii) appearance-tasting-information. A total of three fish species (carp, seabream, and trout) were presented to the consumers as being either fortified (with iodine, selenium, and omega-3 fatty acids) or conventional products. (3) Results: For pleasantness, no significant differences were found between the fortified and conventional fish. In contrast, substantial differences emerged when information regarding the products was provided. Providing the relevant information before tasting affected how much the consumers liked the conventional fish, resulting in a preference for it over the fortified fish. Additionally, consumers are willing to pay more for fortified fish, especially when information with respect to fortification is available. Nevertheless, when information about fortification was provided before tasting, the consumer's expectations were not fulfilled. (4) Conclusions: The outcomes of this study clearly indicate that the presence of relevant information impacts how much people like fortified versus conventional fish, as well as their WTP.

Public Perceptions of Harms and Benefit of COVID-19 Immunity Certificate: A Cross-Sectional Study in the Italian Setting.

A cross-sectional survey between 29 January 2022 and 3 February 2022 was conducted to understand the public rationale for accepting or rejecting the use of COVID-19 immunity certificates and to identify the psychosocial factors that mostly predict the positive/negative individuals' perceptions of this measure. One thousand twenty-two Italian adults were recruited by a professional panel provider by employing a stratified sampling strategy controlled for gender, age, geographical area of residence, size of the urban centre of residence, employment, and wage. Eight Welch's ANOVAs were then carried out to compare the perception of benefits and the perception of harms among different population groups. Multiple linear regression was carried out to measure the explained variance of benefits perception and harms perception by age, trust in institutions, and concern for health emergencies. The results shows that age, trust in institution, and concern for the COVID-19 emergency explain more variance of perceived benefits than of perceived harms of COVID-19 immunity certificates but the opposite regarding political orientation which explains perceived harms better than perceived benefits. The need for policy improvements is pressing because a large share of the world's population remains unvaccinated. Moreover, our results can serve as vital information for similar health crises that may occur in the future. In addition, our results are expected to offer useful insights into public feelings around the use of digital health information tools.

A nurse-led, telephone-based patient support program for improving adherence in patients with relapsing-remitting multiple sclerosis using interferon beta-1a: Lessons from a consumer-based survey on adveva® PSP.

Background: Evidence suggests that organizational models that provide care interventions including patient support programs may increase patient adherence to multiple sclerosis (MS) therapies by providing tailored symptom management, informational support, psychological and/or social support, lifestyle changes, emotional adjustment, health education, and tailored coaching, thus improving patients' overall quality of life across the disease course. Objective: The main objective of this study was to describe MS patients' self-reported experience of a nurse-led, telephone-based PSP and to explore its potential role in improving disease and therapy management skills. Methods: Survey data were analyzed from a subset of patients relapsing-remitting MS (RRMS) using interferon beta-1a already registered in the adveva® PSP from three Italian multiple sclerosis centers with a consolidated experience in RRMS disease, treatment management, and PSP programs. Results: In total, 244 patient data at baseline were analyzed, of which 115 had a follow-up of at least 6 months. Results from this study provide an early view into the role of this PSP in improving the patients reported overall experience regarding disease management and injectable therapy, thus potentially ameliorating treatment adherence and decreasing health care cost. Moreover, study findings confirm the role of providing a patient-focused support by addressing non-medication-related topics in the PSP consultations. Indeed, patients involved in the adveva® PSP program reported a better psychological status in the follow up as demonstrated by an increased optimism regarding their future, tolerance of disease uncertainty, and their perceived ability to benefit from external help and social support (informal caregivers). Conclusions: As such, it is reasonable to conclude that the involvement in the adveva® PSP and the PSP's assistance in guiding patients on proper treatment self-management techniques is of great value to patients as it might contribute to improving engagement in their health care journey in terms of perceived self-care skills, emotional coping toward the future and the unpredictability of the disease course and their general attitudes toward the injection itself, involving pain tolerance.

How does patient engagement work in a real-world setting? Recommendations, caveats, and challenges from a psychosocial perspective.

OBJECTIVE: To propose a possible taxonomy for diverse stakeholders outside the healthcare communication field and to promote meaningful patient engagement in healthcare settings. Moreover, to support them in making more coherent policy, strategy, and practice decisions to enhance patient participation in their healthcare systems. DISCUSSION: This paper is part of the pEACH Position Papers Series and provides a critical and experience-based reflection on patient engagement in different healthcare-related settings. We propose a framework that operationalises actionable patient engagement at the micro-meso-macro levels. Finally, the authors will highlight some "points of attention" that need to be addressed to support patient engagement implementation in healthcare organisations. CONCLUSION AND PRACTICE IMPLICATIONS: Understanding and systematising the established meanings of patient engagement through a psychosocial lens is critical to addressing the following questions: "how can various health care organisations ensure that authentic patient engagement informs decision-making and strategies", "how can these organisations build authentic connections with their patients", and importantly, "how can patients gain valuable and reliable insights through patient engagement"? Answering these questions can enable key stakeholders to make informed decisions that ensure the quality and effectiveness of patient engagement initiatives in different healthcare settings.

"Food is more than just a source of nutrients": A qualitative phenomenological study on Food Involvement.

The role of food in people's life has changed dramatically in recent years. In particular, it is becoming more symbolic and linked to subjective values. For this reason, recent scientific research has delved into the construct of Food Involvement. However, to the best of our knowledge, there are no empirical studies aimed at exploring this construct deepening the symbolic value assumed by it. Accordingly, the current study aims to qualitatively explore the personal meanings that consumers attribute to Food Involvement and to detect the psychological domains that characterize this lived experience. The study included a purposive sample of adults selected according to three different prototypical profiles until reaching data saturation: mothers, cooks or athletes, all with medium or high levels of Food Involvement. Fourteen in-depth phenomenological interviews were conducted and analyzed according to the principles of Interpretative Phenomenological Analysis (IPA). Results showed that Food Involvement is characterized by a deep relationship between the consumer and food that allows satisfying one's ambitious transformative project that involves the self, the other or both actors. This symbolic role played by Food Involvement was recognized by both those with medium or high involvement. However, the orientations in one's transformative process of mothers, athletes and cooks is different. In particular, the transformative project of mothers is oriented towards the other, that of cooks towards the self and athletes' project towards the self and others. This study gives a scientific contribution to the literature about Food Involvement to create effective measurement scales that assess the symbolic role that Food Involvement has in people's lives.

Patients' Engagement in Early Detection of COVID-19 Symptoms: An Observational Study in the Very Early Peak of the Pandemic in Italy in 2020.

COVID-19 exerted a strong impact on the Italian healthcare systems, which in turn resulted in a reduction in the citizens' trust towards healthcare authorities. Moreover, the focused attention on the typical COVID-19 symptoms (fever, cough) has also impacted the social representation of health priorities, potentially reducing the perceived importance and severity of other symptoms. This study aimed to determine the association of general-practitioner (GP) contact with various symptoms during the COVID-19 pandemic in Cremona, an Italian city at the very epicentre of the pandemic. Between April and June 2020, an anonymous survey was completed by 2161 respondents. Logistic-regression analyses were used to examine the associations of GP contact with sociodemographic characteristics and the presence of symptoms. Of the 2161 respondents (43.5% female, 75.0% aged less than 55 years), 959 (44.4%) reported experiencing various symptoms and 33.3% contacted a GP. GP contact was significantly associated with poor appetite (OR, 2.42; 95% CI 1.63 to 3.62; p < 0.001), taste dysfunctions (OR 1.67; 95% CI 1.20 to 2.34; p < 0.001) and sleepiness during the day (OR 4.15; 95% CI 2.13 to 8.09; p = 0.002). None of the gastrointestinal symptoms resulted in significantly increasing the likelihood of contacting a GP. This study offers a unique observation of citizens' attitudes and behaviours in early symptom communication/detection during the initial peak of the Italian COVID-19 pandemic.

Public Reaction towards the Potential Side Effects of a COVID-19 Vaccine: An Italian Cross-Sectional Study.

In March 2021, the possible link between the Oxford-AstraZeneca vaccine and some cases of blood clots lead several governments to suspend the administration of said vaccine, or to adjust their administration strategies, regardless of the fact that both EMA and WHO claimed the benefits of the vaccine to far outweigh its risks. The lack of a coordinated decision-making process between different health authorities possibly had an impact on people's trust in the health authorities themselves, and on their willingness to vaccinate against COVID-19. In this study, we assessed the impact of the Astrazeneca case on a sample of 1000 Italian participants. The results demonstrate that a large part of the population is willing to delay the vaccination to be granted a vaccine perceived as "better". We also assessed the importance of several socio-demographic and psychological factors in predicting hesitancy and discuss the implications for public communication strategies.

Food and Inflammatory Bowel Diseases: A scoping review on the impact of food on patients' psychosocial quality of life.

Growing bodies of literature show that a controlled diet is important in controlling the symptoms of Inflammatory Bowel Diseases (IBD). This leads patients to avoid foods considered potentially harmful. However, food is not just a nutrient but entails a series of hedonistic, cultural and social values. Thus, there is the concern that having to renounce certain foods might exert an impact on patients' psychosocial quality of life, particularly in younger patients. The aim of this paper is to review the existing literature to address which aspects of the patients' quality of life are affected by food restrictions. A scoping review was carried out. Five different databases were searched in January 2021. Retrieved papers were then screened to only include the relevant studies. Data were extracted and the main results of the studies were charted. A thematic analysis was carried out on the main results to identify the areas of psychosocial quality of life more often impacted by the food restrictions. From the initially identified 1967 unique entries, 14 studies were included. Results show that the perceived importance of food in controlling symptoms is confirmed by patients' accounts. The most common strategy adopted was, thus, the avoidance of trigger foods. The thematic analysis revealed three domains that are impacted by these restrictions: psychological quality of life, social life, family sphere. This study highlights the impact that food restrictions exert on IBD patients' quality of life, and warrants further studies to fill existing gaps, in particular regarding younger patients.

Evolution of Milk Consumption and Its Psychological Determinants: A Mini-Review.

The consumption of lactose-free products and in particular lactose-free milk is increasing worldwide. Although many studies claim that this dietary trend is mainly determined by the number of lactose intolerant people that is growing, others state that most of them self-report an intolerance that has not been diagnosed by medical tests. However, many researchers reported that the consumption of lactose-free milk may put the consumers' health at risk especially when the subjects are not intolerant. Consequently, understanding this new dietary trend considering its main determinants it is necessary to generate educational and intervention campaigns useful to guide people toward healthier and more adequate eating styles. For these reasons we conducted a narrative mini review to summarize the factors contributing to the consumption of lactose-free milk as an alternative to cow's milk, exploring intrinsic and extrinsic product characteristics, biological and physiological, as well as psychological, situational and socio-cultural factors. This narrative mini-review shows that there are six categories of factors that affect the consumption of lactose-free milk. In particular, the intrinsic aspects linked to the product and the socio-demographic characteristics of the consumer are the most explored. On the contrary, situational and socio-cultural factors are the least studied. Finally, this study argues that there are too few studies that investigates the emotional, identity and social aspects underlying these food choices, suggesting the development of future research that investigate the implicit consumer subjective levers to decipher lactose-free milk consumptions.