How parents and health professionals experience prematurity in an Italian neonatal intensive care: A grounded theory study.

PURPOSE: The aim of this study was to explore prematurity as a psycho-social process from the point of view of both parents and healthcare professionals. DESIGN AND METHODS: We conducted a Grounded Theory study through semi-structured interviews. Participants were from an Italian Neonatal Intensive Care Unit, including parents of premature children, and health professionals. Interviews were analyzed according to Grounded Theory coding strategies, to hypothesize a theoretical model. RESULTS: On one side, behaviors, emotions, and feelings of parental couples; on the other one, the activities and reactions of professionals have been interpreted in a four-phase negotiated process: 1) the initial breakup; 2) the floating family; 3) the event processing; 4) the reconstruction of a new family. CONCLUSIONS: Managing prematurity is a negotiated process which could be better managed through a family-centered approach as fundamental in neonatal and pediatric services. Being open in listening, coherent in the given answers, and knowing the entire process and story of being suddenly parents of a premature child can make the difference in the future definition of a new family. PRACTICE IMPLICATIONS: Perinatal care would benefit from the following suggested practical implications: i) reducing feelings of separation and solitude by integrating diverse professionals around the family systems; ii) expediting prematurity-related changes through peer-support during hospitalization and attention to rooms' organization; iii) enhancing information exchange between all professionals involved in the care of dyads/parents and new-borns, starting since the pregnancy and continuing after the child's birth by implementing multidisciplinary meetings or appropriate care pathways.

"Achieve the best while rushing against time": A grounded theory study on caring for low-income immigrant cancer patients at end of life.

BACKGROUND: Between 2000 and 2020, Europe experienced an annual net arrival of approximately 1.6 million immigrants per year. While having lower mortality rates, in the setting of severe diseases, immigrants bear a greater cancer-related burden due to linguistic and cultural barriers and socio-economic conditions. Professionals face a two-fold task: managing clinical conditions while considering the social, economic, cultural, and spiritual sphere of patients and their families. In this regard, little is known about the care provision to low-income immigrant cancer patients in real contexts. AIM: To investigate the perspective of professionals, family members, and stakeholders on the caring process of low-income immigrant cancer patients at the end of life. DESIGN: A Constructivist Grounded Theory study. SETTING/PARTICIPANTS: The study, conducted at a Hospital in Northern Italy, involved 27 participants among health professionals, family caregivers, and other stakeholders who had recently accompanied immigrant cancer patients in their terminal phase of illness. RESULTS: Findings evidenced that professionals feel they were not adequately trained to cope with immigrant cancer patients, nonetheless, they were highly committed in providing the best care they could, rushing against the (short) time the patients have left. Analyses evidenced four main categories: "providing and receiving hospitality," "understanding each other," "addressing diversity," and "around the patient," which we conceptualized under the core category "Achieve the best while rushing against time." CONCLUSIONS: The model reveals the activation of empathic and compassionate behavior by professionals. It evidences the need for empowering professionals with cultural competencies by employing interpreters and specific training programs.

Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns.

BACKGROUND: Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact-and thus the sustainability-of diets. OBJECTIVE: To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns. METHODS: We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it. CONCLUSIONS: The new environmental dimension of the MDP enhances food intake recommendations addressing both health and environmental issues. Compared to the previous 2011 version, it emphasizes more strongly a lower consumption of red meat and bovine dairy products, and a higher consumption of legumes and locally grown eco-friendly plant foods as much as possible.

Inhibition of Hepatocellular Carcinoma Growth by Ethyl Acetate Extracts of Apulian Brassica oleracea L. and Crithmum maritimum L.

Nowadays, a growing body of evidence supports the view that plants offer an extraordinary opportunity to discover and develop new promising therapeutic strategies for many diseases, including cancer. Here we tested the anticancer action against Hepatocellular carcinoma (HCC) of extracts obtained from two plants harvested in Apulia, namely Brassica oleracea L. and Crithmum maritimum L. B. oleracea was grown in biodynamical agriculture without any agrochemical input, instead C. maritimum was collected on Apulian coasts and is still commonly eaten in Apulia. HCC, one of the most frequent tumors worldwide, is estimated to become the third leading cause of cancer-related deaths in Western Countries by 2030. The approved synthetic drugs for the treatment of HCC are currently inadequate in terms of therapeutic results and tolerability. Hence, aim of the present study was to test the anticancer action against HCC of extracts obtained from Brassica oleracea L. and Crithmum maritimum L. We preliminary prepared extracts from both plants using four solvents with different polarity: hexane, ethyl acetate, methanol and ethanol. Then, we tested the effect of the different fractions in inhibiting HCC cell growth. Finally, we characterized the mechanism of action of the most effective fraction. We found that ethyl acetate fractions from both plants were the most effective in inhibiting HCC growth. In particular, we demonstrated that these fractions effectively reduce HCC growth by exerting, on one hand, a cytostatic effect through their action on the cell cycle, and on the other hand by triggering apoptosis and necrosis. Our findings support the notion that ethyl acetate fractions from Apulian B. oleracea and C. maritimum can be in perspective considered as promising tools to expand the opportunities to identify new and not toxic anticancer therapeutic approaches for HCC. Further pharmacological investigations will shed light on how this could be effectively achieved. Graphical Abstract Experimental workflow for the detection of the ethyl acetate extract of Brassica oleracea L. and Crithmum maritimum L. as an active fraction in inhibiting HCC cell growth.

The health-nutrition dimension: a methodological approach to assess the nutritional sustainability of typical agro-food products and the Mediterranean diet.

BACKGROUND: The aim of this paper is to provide a methodological approach to evaluate the nutritional sustainability of typical agro-food products, representing Mediterranean eating habits and included in the Mediterranean food pyramid. RESULTS: For each group of foods, suitable and easily measurable indicators were identified. Two macro-indicators were used to assess the nutritional sustainability of each product. The first macro-indicator, called 'business distinctiveness', takes into account the application of different regulations and standards regarding quality, safety and traceability as well as the origin of raw materials. The second macro-indicator, called 'nutritional quality', assesses product nutritional quality taking into account the contents of key compounds including micronutrients and bioactive phytochemicals. For each indicator a 0-10 scoring system was set up, with scores from 0 (unsustainable) to 10 (very sustainable), with 5 as a sustainability benchmark value. The benchmark value is the value from which a product can be considered sustainable. A simple formula was developed to produce a sustainability index. CONCLUSION: The proposed sustainability index could be considered a useful tool to describe both the qualitative and quantitative value of micronutrients and bioactive phytochemical present in foodstuffs. This methodological approach can also be applied beyond the Mediterranean, to food products in other world regions. © 2018 Society of Chemical Industry.

Mediterranean countries' food consumption and sourcing patterns:An Ecological Footprint viewpoint.

Securing food for growing populations while minimizing environmental externalities is becoming a key topic in the current sustainability debate. This is particularly true in the Mediterranean region, which is characterized by scarce natural resources and increasing climate-related impacts. This paper focuses on the pressure Mediterranean people place on the Earth ecosystems because of their food consumption and sourcing patterns and then explores ways in which such pressure can be reduced. To do so, it uses an Ecological-Footprint-Extended Multi-Regional Input-Output (EF-MRIO) approach applied to 15 Mediterranean countries. Results indicate that food consumption is a substantial driver of the region's ecological deficit, whereby demand for renewable resources and ecosystems services outpaces the capacity of its ecosystems to provide them. Portugal, Malta and Greece are found to have the highest per capita food Footprints (1.50, 1.25 and 1.22 global hectares (gha), respectively), while Slovenia, Egypt and Israel have the lowest (0.63, 0.64 and 0.79gha, respectively). With the exception of France, all Mediterranean countries rely on the biocapacity of foreign countries to satisfy their residents' demand for food. By analyzing the effect of shifting to a calorie-adequate diet or changing dietary patterns, we finally point out that the region's Ecological Footprint - and therefore its ecological deficit - could be reduced by 8% to 10%.

Natural resources - food nexus: food-related environmental footprints in the mediterranean countries.

Immediate action is required in the Mediterranean to address environmental degradation that is mainly driven by consumption patterns. Increasing stress on biological and social systems is put by unsustainable consumption patterns. Food consumption patterns are important drivers of environment degradation. The objective of this review paper is to explore natural resources-food nexus in the Mediterranean region by highlighting the environmental footprints of the current consumption and production patterns. Secondary data from different sources such as FAOSTAT, the World Bank, Water Footprint Network (WFN), and Global Footprint Network were used to analyze the situation in 21 Mediterranean countries. The region faces many environmental challenges, e.g., land degradation, water scarcity, environment pollution, biodiversity loss, and climate change. The current consumption patterns imply high ecological, carbon, and water footprints of consumption and unfavorable national virtual-water balances. Food Balance Sheets data show that the contribution of vegetal and animal-based food product groups to food supply is variable among the Mediterranean countries. This has implications also in terms of the WF of food supply, which was calculated for Bosnia, Egypt, Italy, Morocco, and Turkey. The WF of the current diet resulted lower than that of the proposed Mediterranean one in the case of Italy. There is a strong scientific evidence supporting assumption that it is so also for other Mediterranean countries. The Mediterranean is characterized by a high resource use intensity that is further exacerbated by food losses and waste (FLW). In fact, FLW implies the loss of precious resources (water, land, energy) and inputs (fertilizers). Therefore, it is crucial to increase adherence to the traditional Mediterranean diet and to reduce FLW in order to foster transition to more sustainable food consumption patterns thus reducing pressure on the scarce resources of the Mediterranean region.