Non-adherence to Mediterranean diet and synergy with lifestyle habits in the occurrence of breast cancer: a case-control study in Italy.

OBJECTIVE: The aim of this study was to assess the synergistic effect of non-adherence to the Mediterranean Diet (MD) and lifestyle habits on the occurrence of breast cancer (BC). PATIENTS AND METHODS: A case-control study was carried out from September 2018 to February 2019 at the Teaching Hospital "Umberto I" in Rome. A Food Frequency Questionnaire was used for assessing the level of adherence to MD, the IPAQ Questionnaire to measure physical activity, and AUDIT-C to estimate alcohol consumption. The possible interaction between risk factors was tested using the synergism index. RESULTS: A total of 94 cases and 88 controls were enrolled (median age 55.8 for cases and 57.9 for controls). The MD Score over 6 was associated with low odds of having breast cancer (OR = 0.29; 95% CI: 0.12-0.69). There is a clear indication for the additivity and synergism between non-adherence to MD and many risk factors on the occurrence of BC: current smoker (S = 2.02; 95% CI 0.62-8.07), physical inactivity (S = 2.14; 95% CI 0.71 2-8.28) and alcohol consumption (S = 3.02; 95% CI 0.91-12.95). CONCLUSIONS: Primary prevention of BC can benefit from intervention targeting nutritional and lifestyle factors that act synergistically.

Results of the Italian project 'GiochiAMO' to improve nutrition and PA among children.

BACKGROUND: Prevalence of overweight and obesity during childhood is still elevated in high-income countries. GiochiAMO is a health promotion program that uses knowledge-based education and games to teach healthy nutrition and physical activity among children (6-8 years old). METHODS: This study was a single arm field trial. Second and third grade classes of primary school attended an oral presentation about nutrition and physical activity and then were involved in three game sessions. Two multiple-choice questionnaires were administered at the beginning and at the end of the trail. The following scores were measured: nutrition behavior score (NTs), physical activity behavior score (PAs) and delta score (Ds). Wilcoxon, T-test and Mann Whitney were used to perform the univariate analysis. RESULTS: A total number of 74 and 76 children participated in the physical activity and nutrition interventions. NTs was 4.17 (SD: 2.23) before and 5.03 (SD: 2.79) after the intervention (P = 0.005). PAs was 27.4 (SD: 9.6) before and 30.5 (SD: 10.7) after the intervention (P = 0.003). No significant differences were obtained comparing males and females for all scores. Ds was 0.86 for nutrition and 3.1 for physical activity. Univariate analysis of Delta scores obtained no significant differences. CONCLUSIONS: The present results confirm the effectiveness of 'GiochiAMO' to change nutrition and physical activity behavior.

Return to work after kidney transplant: a systematic review.

BACKGROUND: Renal transplant is the gold standard treatment for patients with end-stage renal disease. Employment after transplant is an important marker of recovery and a key component of general well-being with important social implications. AIMS: To evaluate employment status after renal transplant and to investigate facilitators of and barriers to return to work for renal transplant patients. METHODS: We searched PubMed, Scopus and the Cochrane Library in March 2019 using the following algorithms: 'return to work' AND kidney AND transplant. Eligible studies were selected by two independent researchers. Quality assessment was performed using the following tools: International Narrative Systematic Assessment (INSA) and Newcastle-Ottawa Scale (NOS) for cross-sectional and cohort studies. RESULTS: The review included 18 papers: 10 cross-sectional studies, 6 cohort studies and 2 narrative reviews. The weighted mean percentage for return to work within 1 year was 39.4% (95% CI 39.3-39.6%). Employment status was influenced by modifiable and non-modifiable factors, such as pre-transplant employment, sociodemographic characteristics, clinical conditions and comorbidities, operative technique (invasive or not), type of transplants (living donor or cadaver), pre-transplant dialysis, psychosocial support, educational level and participation in education programmes. CONCLUSION: Return to work after kidney transplant is a dynamic process influenced by numerous factors. It is vital to implement multidimensional interventions focused on rehabilitation and influencing modifiable factors to improve return to work after kidney transplant. This systematic review updates knowledge in the field of transplant and of disability management.

Perception of Climate Change: validation of a questionnaire in Italy.

BACKGROUND AND AIMS: Climate Change (CC) is a worldwide concern with important consequences for Public Health. A more sustainable and responsible way of living is necessary in order to reduce CC consequences, and adequation to this is directly related to risk perception and knowledge about the phenomenon. The aim of this study was to validate a questionnaire to measure the knowledge of Italians on CC and its consequences. MATERIAL AND METHODS: The questionnaire was administered online to high school students, their parents and teachers that were participating to a meeting at Sapienza University. The questionnaire contained a sociodemographic section and 19 questions on causes and consequences of CC and ways to fight it. The statistical analysis was performed with Statistical Package for Social Sciences (SPSS) version 25. RESULTS: Sixty-four individuals answered the online questionnaire. The analysis of internal consistency was performed by 12 dichotomous variables that measured the knowledge level on CC. The analysis showed a standardized Cronbach's alpha equal to 0.39, corresponding to a low reliability. When females were excluded, the alpha value rose to 0.497, and ascended to the reliable value of 0.639 when refining the selection of the included questions. CONCLUSIONS: The Cronbach's alpha value found showed a low reliability but achieves acceptable levels when considering only males and excluding some of the initial questions. Future studies should be performed in order to highlight the reliability of this tool to assess the knowledge about CC among the population.

Work Related Violence As A Predictor Of Stress And Correlated Disorders In Emergency Department Healthcare Professionals.

AIMS: The aim of the study was to investigate the frequency, type, causes and consequences of violence and aggression experienced by Emergency Department workers during their interactions with patient, their relatives or companions and whether the phenomenon of violence at work is a specific risk factor predicting stress and possible stress related pathologies in emergency health workers. The study proposes a model of effective intervention for the prevention and management of violence and stress. METHODS: A cross-sectional retrospective study was performed with a sample of 323 healthcare workers at Department of Emergency and Acceptance of Level II and the Psychiatric Services of Diagnosis and Care of the University Hospital Policlinico Umberto I, in Rome, Italy, between June 2016 and February 2017. Data collection was conducted by a psychiatrist by means of a questionnaire method administered to each participant and by carrying out individual interviews. The two questionnaires used, both the Health Violence Questionnaire (QVS) and the Workers' Stress Perception Questionnaire (SPQR) were designed ad hoc, after some test sessions intended for the creation of their content. RESULTS: Eighty-seven percent of emergency healthcare workers experienced workplace violence by patients or their relatives. More than half of healthcare workers reported multiple consequences on their emotional sphere, in particular female healthcare professionals and all those who have suffered frequent incidents of violence. Regarding the effects on lifestyle, one third reported an increase in consumption of tobacco, food and sleep disorders and changes from social relationships to social isolation and avoidance of some places. More than one third of healthcare workers reported consequences on their well-being and health, especially the female workers. Distress was associated with frequent workplace violence. Healthcare workers who experienced frequent violence indicated lack of support from hospital administration and ED management as barriers to reporting workplace violence. CONCLUSIONS: The study confirms the diffusion of the workplace violence by patients and/or their relatives against the emergency healthcare professionals, related to the gender, the professional qualification, the role in the organization and the workplace. Almost all male and female healthcare workers reported they had suffered the effects on lifestyle, working habits and wellbeing and health following the workplace violence. Precipitating factors to violent incidents identified by healthcare professionals are consistent with the research literature. Commitment from hospital administrators, ED managers and hospital security is necessary to facilitate improvement and ensure a safer workplace for ED healthcare workers. Our study emphasizes the importance of analyzing, in addition to general job demands, the specific job demands such as the phenomenon of violence, considered a key risk factor, predictor of stress and possible mental disorders in healthcare workers operating in high-risk environments. This study confirms the importance of application of the modified model by Brough and Biggs of integrated multidimensional intervention on the prevention and management of workplace violence and work stress and shall be implemented on all three levels: individual, organizational and situational. The study also highlights the need to implement support strategies for the victims of violence.

Returning to work after breast cancer: A systematic review of reviews.

BACKGROUND: Due to improvements in breast cancer diagnosis and treatment, the healthcare system faces a growing number of cancer survivors. Breast cancer survivors experience many difficulties when returning to work, including discrimination at work and lack of support by employers and colleagues. OBJECTIVE: To point out the knowledge in literature up to date about return to work (RTW) after breast cancer, the factors influencing it and the interventions to facilitate it. METHODS: A literature search was conducted in January 2017 using the databases Medline (PubMed) and Scopus. Studies were included if they analyzed the problem of RTW in women treated for breast cancer. RESULTS: Twenty-six articles met the inclusion criteria. The studies were divided into four themes: factors facilitating or impeding RTW; interventions to enhance RTW; lived experiences of RTW; economic aspects related to cancer survivors and RTW. CONCLUSIONS: The heterogeneity of the interventions suggests the need for a better definition of the concept of RTW. To compare interventions, studies should use a rigorous approach and better outcome measures should be identified to evaluate RTW.

Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4): Italian version validation.

BACKGROUND: Improvements in breast cancer diagnosis and treatment led to an increased incidence of survivors' rate. The healthcare system has to face new problems related not only to the treatment of the disease, but also to the management of the quality of life after the diagnosis. The aim of this study was to validate the Italian version of the Functional Assessment of Cancer Therapy - Breast (FACT-B+4) questionnaire and to evaluate its reliability. METHODS: The questionnaire was administered twice, with an interval of three days between each administration, to a cohort of women of the Breast Surgical Unit, PoliclincoUmberto I. Cronbach's alpha was used as a measure of the internal consistency of the Italian version. RESULTS: The Italian version of the tool was administered to 55 subjects. The Cronbach's alpha for most scores registered values >0.7, both at baseline and at the follow-up analysis, therefore the subscale showed good internal consistency. CONCLUSIONS: The Italian version of FACT-B+4 demonstrated acceptable reliability properties in the Breast Unit patients. The use of this questionnaire seemed to be effective and in line with the results derived from the English and Spanishversions. Internal consistency and validity had similar performance results.

"GiochiAMO": a school-based smoking and alcohol prevention program for children - a pilot randomized field trial. Part 2.

BACKGROUND: Young people who begin to smoke at an early age are at a higher risk of becoming occasional or regular smokers and establishing a premature dependence. It is fundamental to act as soon as possible, from very early childhood, to prevent harmful behaviors for health such as smoking and drinking alcohol. Young people must be encouraged to adopt healthy lifestyles. OBJECTIVES: The aim of the study is two-fold. First, increasing the knowledge about the negative health effects of cigarette smoking and alcohol consumption among children aged 9-10 years; and second, to introduce and reinforce life skills in order to learn how to tackle social influences that encourage children to smoke and to drink alcohol. METHODS: A pilot randomized field trial was conducted in May-June 2017. Four primary school classes in Rome were randomized to either the intervention or the control group. Both groups participated in an oral presentation about the risks and consequences of smoking and alcohol consumption, and the concept of life skills. The intervention group participated in two gaming sessions, each lasting 1.5 hours. Children were involved in six games aiming to deliver and reinforce knowledge about the target themes of the study. A 21 multi-response questions questionnaire was handed out to both groups at the beginning and at the end of the study. Eleven questions were about smoking; five questions about alcohol; five questions about life skills. Each question item included one correct answer. For each domain, a score was computed (total; smoking; alcohol; life skills). RESULTS: 67 children participated in the study (34 in the intervention and 33 in the control group). Univariate analyses showed significant differences among the intervention group before and after the intervention for total score (p<0.001), smoke score (p<0.001), and life skills score (p=0.003). No significant differences among the intervention group before and after the intervention were reported for alcohol score (p=0.076). Regarding the control group univariate analysis showed significant differences in total score (p=0,001) and life skills score (p=0.005). Multivariate analysis revealed that enrollment in the intervention was the only variable that had a significant positive influence on smoking knowledge score (beta=1.070, p=0.05). CONCLUSION: This pilot study shows that the intervention was effective among the intervention group for all the scores: total score, smoke score and life skills score, but ineffective for alcohol. Overall, the combination of a presentation and games was effective in increasing life skills knowledge.

Improving knowledge and behaviors on diet and physical activity in children: results of a pilot randomized field trial.

BACKGROUND: The aim of this study was to increase the knowledge of healthy eating, to encourage change in nutritional behavior in accordance with the Mediterranean diet and to promote physical activity in children aged 7 to 9 years and their parents in a school setting through the use of cards and board games of the project Giochiamo (Let us play). METHODS: This experimental randomized field trial enrolled children in a school setting. The trial consisted of two phases. The first phase, including both intervention and control groups, encompassed a informative session about the food pyramid and physical activity (PA) by experts of public health and preventive medicine. The second phase, including only the experimental groups, involved games focusing on the main concepts of the food pyramid and PA. A questionnaire was administered before the intervention and after one month in order to assess changing in knowledge and behavior scores. RESULTS: Eighty-nine children were randomly allocated in the intervention (22 children of the fourth year, 22 children of the second year) and the control group (23 children of the fourth year, 22 children of the second year). The univariate analyses showed significant differences (p = 0,004) between intervention and control groups for behavior score after the intervention. In particular, in a stratified analysis classes of the second year showed significant differences for knowledge score (p = 0,005) and for behavior score (p = 0,002), resulting higher among the intervention group. No significant differences resulted in classes of the fourth year for both scores. CONCLUSIONS: The results of the Giochiamo project clearly demonstrate that the lecture and the games were effective to improve knowledge and behavior habits on the Mediterranean diet and PA. Second year students showed significant differences for knowledge and behavior score in comparison to fourth year students suggesting that, the earlier the intervention occurs, the better are the results in terms of improvement of knowledge and eating habits and PA behaviors.

Protocol for the evaluation of a chronic care model experience in Rome.

INTRODUCTION: Chronic diseases are the leading cause of death and disability in almost all over the world; in Europe causing over 9 million deaths per year according to WHO estimates. A promising health organization model for chronic disease management is represented by the Chronic Care Model (CCM). In the 12th district of the ASL Roma 2 since 4 years was implemented a CCM for the management of patients affected by diabetes and/or at high cardiovascular risk. OBJECTIVE: Aim of this study is to evaluate the effectiveness of the Chronic Care Model (CCM) for the management of chronic disease in terms of mortality reduction, avoidable hospitalizations reduction and improvement of clinical parameters. MATERIALS AND METHODS: A retrospective cohort study will involve patients of 12th district of the ASL Roma 2 affected by diabetes and at high cardiovascular risk assisted through the CCM. Their health outcomes will be compared with those of patients in the same clinical conditions, residents in the same district but not assisted with CCM. The sample will be composed by adults (> 18 years) with a diagnosis of diabetes mellitus type 2 (DM2) or metabolic syndrome and / or arterial hypertension (IT) and two or more risk factors. Outcomes will be mortality from all causes and from causes related to DM and IT, preventable hospitalizations as defined in the Prevention Quality Indicators (PQI) by the Agency for Healthcare Research and Quality, and 10 clinical parameters. The data sources will be the records of causes of death (RENCAM), the hospital discharge records (SDO) and information systems for primary healthcare. CONCLUSION: Data from the experience of CCM in Tuscany seem promising especially in the evaluation of patient satisfaction and clinical outcomes particularly on cardiovascular and neurological complications and long-term mortality.

2014-2017. How medically assisted reproduction changed in Italy. A short comparative synthesis with European countries.

More than ten years after law n. 40 of February 19, 2004 became effective, regulation on medically assisted reproduction has dramatically changed outlook. The authors report on the steps that led to these changes through Courts' rulings, the Supreme Court's verdicts and the European Court of Human Rights' decisions, as well as ministerial regulations and guidelines concerning medically assisted reproduction. The aforementioned jurisprudential evolution was set to reach a new balance between the embryo's right to its own dignity and the woman's right to health and freedom of self-determination in reproduction. No court ruling denies that embryos have also to be safeguarded. In fact, there are still numerous prohibitions, including using embryos for experimental purposes. Judges aim primarily at avoiding that embryos' rights overcome the right to parenthood. The authors review the legislation of the various European countries: some have adopted a legislation to regulate medically assisted reproduction, while others have developed in this field some recommendations or guidelines. This is why they call for enactment of a European law governing the implementation/operational methods of medically assisted reproduction in order to avoid the scourge of procreative tourism to countries that have a more permissive law.

Counseling interventions delivered in women with breast cancer to improve health-related quality of life: a systematic review.

BACKGROUND: Higher survival rates for breast cancer patients have led to concerns in dealing with short- and long-term side effects. The most common complications are impairment of shoulder functions, pain, lymphedema, and dysesthesia of the injured arm; psychological consequences concern: emotional distress, anxiety, and depression, thereby, deeply impacting/affecting daily living activity, and health-related quality of life. OBJECTIVE: To perform a systematic review for assessing the efficacy or effectiveness of interventions aiming at improving health-related quality of life, return to daily activity, and correct lifestyles among breast cancer patients. METHODS: A literature search was conducted in December 2016 using the databases PubMed and Scopus. Search terms included: (counseling) AND (breast cancer) AND (quality of life). Articles on counseling interventions to improve quality of life, physical and psychological outcomes were included. RESULTS: Thirty-five articles met the inclusion criteria. The interventions were grouped in five main areas: concerning lifestyle counseling interventions, related to combined interventions (physical activity and nutritional counseling), physical therapy, peer counseling, multidisciplinary approach, included psychological, psycho-educational interventions, and cognitive-behavior therapy (CBT). Exercise counseling as well as physical therapy are effective to improve shoulder mobility, healing wounds, and limb strength. Psychological therapies such as psychoeducation and CBT may help to realize a social and psychological rehabilitation. CONCLUSION: A multidisciplinary approach can help in sustaining and restoring impaired physical, psychosocial, and occupational outcomes of breast cancer patients.

[Workplace Violence in the health sector: validation of the Italian version of the WHO questionnaire].

BACKGROUND: The phenomenon of violence and aggression in the workplace is frequent and constantly increasing. Healthcare professionals are most exposed to this phenomenon, especially those who work in urgent and psychiatric emergency departments. OBJECTIVE: To validate the Italian version of the questionnaire "Workplace Violence in the Health Sector Case Study Research Instruments Survey Questionnaire", conducted by WHO. OUTCOMES: 55 randomly selected workers took part in the validation of the questionnaire among physicians, nurses and nursing trainees. The internal consistency analysis of the demand of 5 dichotomous variables on binary values ​​for violence levels suggests that Cronbach's alpha is 0.61, and Cronbach's alpha calculated on standardized elements is 0.69, which means that Reliability shows sufficient levels. CONCLUSIONS: The Italian translation carried out in this WHO questionnaire study shows good internal reliability and consistency and could be considered a useful tool in assessing and preventing aggression and violence against health professionals.

[GiochiAMO! The protocol of a school based intervention for the promotion of physical activity and nutrition among children].

BACKGROUND: It is necessary to increase knowledge of healthy eating in children aged 5 to 9 years and their parents and to promote physical activity in order to tackle obesity and overweight in children. METHODS: This paper describes the research protocol of a field intervention that aims to: a) increase knowledge of food pyramid; b) change nutritional behavior according to the Mediterranean diet, particularly increasing fruit and vegetable consumption; c) promote physical activity. Children of primary schools will be included and will be randomly allocated to the intervention or the control groups. The intervention will include the use of games (cards and board games) and also physical activities. CONCLUSIONS: GiochiAMO represents an innovation in the Italian school panorama, in a context in which it is a priority to create environment and school policies aimed at promoting the Mediterranean diet pattern and physical activity.

[Risk of nasopharyngeal cancer, Leukemia and other tumors in a cohort of employees and students potentially exposed to (FA) formaldehyde in University laboratories].

FA was recently classified as carcinogen of second class (category 1B). A retrospective cohort study was conducted for the evaluation of the association between exposure to FA and cancer in professionally potentially exposed in a University setting. The cohort was composed of 140 exposed to FA and 364 not exposed in the period 1999-2015. The results showed no cancers of naso-pharynx and leukemias or lymphomas both among exposed and not exposed. Moreover, the exposure to FA is not significantly associated to an increase of other types of tumors.

Markers of mechanical asphyxia: immunohistochemical study on autoptic lung tissues.

Forensic pathologists are often asked to provide evidence of asphyxia death in the trial and a histological marker of asphyxiation would be of great help. Data from the literature indicate that the reaction of lung tissue cells to asphyxia may be of more interest for forensic purposes than migrating cells. The lungs of 62 medico-legal autopsy cases, 34 acute mechanical asphyxia (AMA), and 28 control cases (CC), were immunostained with anti-P-selectin, anti-E-selectin, anti-SP-A, and anti-HIF1-α antibodies, in order to verify if some of them may be used as markers of asphyxia death. Results show that P- and E-selectins expression in lung vessels, being activated by several types of trigger stimuli not specific to hypoxia, cannot be used as indicator of asphyxia. Intra-alveolar granular deposits of SP-A seem to be related to an intense hypoxic stimulus, and when massively present, they can suggest, together with other elements, a severe hypoxia as the mechanism of death. HIF1-α was expressed in small-, medium-, and large-caliber lung vessels of the vast majority of mechanical asphyxia deaths and CO intoxications, with the number and intensity of positive-stained vessels increasing with the duration of the hypoxia. Although further confirmation studies are required, these preliminary data indicate an interesting potential utility of HIF1-α as a screening test for asphyxia deaths.

Pulmonary embolisation of bone fragments from penetrating cranial gunshot wounds.

Bone embolism is a very rare event that usually occurs in trauma-induced septic bone lesions, after bone surgery or after bone marrow transplantation, and normally remains silent. To our knowledge, there are no previous reports of bone embolism after a gunshot to the head. We describe a case of pulmonary embolism associated with bone fragments after a gunshot to the head in which bone fragments surrounded by leukocytes, interstitial and intra-alveolar oedema and haemorrhage around the embolised vessels, leukostasis and fat and bone marrow embolism suggest that the survival time from the gunshot was sufficiently long to allow changes in lung microcirculation and lung tissue.