The hesitancy in the nutritional prevention.

Abstract: Our letter discusses the concept of 'Nutritional Prevention Hesitancy', comparing it to the well-studied phenomenon of 'Vaccine Hesitancy'. Both hesitancies can be fueled by 'infodemics', the rapid spread of accurate and inaccurate information that can lead to public confusion and mistrust in authoritative sources. Drawing parallels between the two, the text highlights that nutritional prevention hesitancy can result in individuals not adopting evidence-based nutritional strategies, potentially leading to poorer health outcomes. The text emphasizes the critical role of diet in preventing diseases such as heart disease, diabetes, and certain types of cancer, and underscores the need for multifaceted strategies to combat misinformation and promote healthier dietary habits.

The "Nutritional Prevention" within Italy's National Prevention Plan 2020-25.

Abstract: Italy's National Prevention Plan 2020-25 is the first to address nutritional prevention, highlighting its importance in combating chronic diseases. This letter discusses the relationship between food safety, nutritional security, and the need for nutritional prevention in the plan. Chronic diseases, such as cardiovascular disease, cancer, and diabetes, are significant public health concerns in Italy, with poor nutrition being a critical risk factor. Incorporating nutritional prevention can promote healthy eating habits, food security and sustainability, reduce healthcare costs, and promote social cohesion and equality. Successful implementation will require cooperation among the government, the private sector, and the civil society to ensure healthier food choices and prevent chronic diseases in Italy.

E-Coaching: the DianaWeb study to prevent breast cancer recurrences.

INTRODUCTION: Breast cancer is the most common cancer in women worldwide, for which the survival rate is increasing over time. Growing evidence are showing that the effect of lifestyle could have the same weight of the effect of the usual clinical-pathological risk factors on survival rate. The DianaWeb study responds to the pressing request of patients diagnosed with breast cancer to know the most advanced point of scientific research on the prevention of recurrences, to have a virtual space to meet, where to receive advice and practical information for the daily management the lifestyle change. DianaWeb is a community-based participatory research, dedicated to breast cancer patients, aimed to monitor lifestyle, provide them tips to encourage sustainable lifestyle changes, and to analyze clinical outcomes. In order to achieve these aims, DianaWeb uses a specific interactive website (http://www.dianaweb.org/). METHODS: The web architecture has been designed essential and light, with a rigorous implantation that brings the figure of the woman to the center. In order to humanized the project the acronym used to identify the study was Diana (Diet and Androgens), a classical female name, who was illustrated as a female avatar, aimed to symbolize all women. The graphical interface was developed using seven pastel tones colors, which become a fundamental elements of the layout, such as frame, navigation menu, and separation interspaces. RESULTS: The project started in 2015, and in 4 days the web site was visited by more than 1000 people. A total of 2823 persons enrolled in the study, but 2182 did not send the full documentations, 61 persons abandoned the study, 641 timely answered to the questionnaires. CONCLUSIONS: The high number of participants' interaction within the web page, confirmed the high usability of the web page and the great interest of patients. Prevention of breast cancer recurrences with low cost technologies, easily available to everybody, is a priority for both public health and public finances.

"PErCEIVE in Umbria": evaluation of anti-influenza vaccination's perception among Umbrian pharmacists.

Vaccines recommendations are available for both healthcare professionals and the general public, but although the vaccination is the most effective method to prevent infectious diseases, the coverage is still behind the recommended rate. In Italy, according to a recent study, the anti-flu vaccination rate among healthcare worker range between 9% to 30%. The aim of our study was to identify knowledge, attitude and behaviours regarding influenza vaccination among community pharmacists in order to increase the coverage rate among healthcare professional. "PErCEIVE (Pharmacist Perception on Influenza Vaccine) in Umbria" was a cross sectional survey among community pharmacists in Umbria conducted between 16th November 2015 to 29th February 2016. The questionnaire was anonymous, on-line self-administered survey. Statistical analysis were performed using STATA/SE 12 software. The response rate was 28.91% (n = 72/249). Among the studied population 76.39% (n = 55) had never performed influenza vaccine during the previous 5 years. Regarding source of information, only 15.28% of the subjects (n = 11) consulted the scientific publications, vs 52.78% (n = 38) who did not show any kind of interest upon the influenza vaccine. Our results show a low attitude to be vaccinated among pharmacists together with a low grade of awareness regarding the important role that pharmacists might play in order to reduce influenza burden, to promote health literacy among their patients and to decrease the risk of patients infection. Pharmacists might be crucial healthcare workers involved in health promotion, in vaccines' uptake and practices progression.

Pre-pregnancy body mass index, gestational weight gain and adverse birth outcomes: some evidence from Italy.

BACKGROUND: Overweight and obese women present an increased risk of poor maternal and child health outcomes. The aim of this paper is to analyze the joint effects of pre-pregnancy body mass index and inadequate gestational weight gain on birth weight and gestational age in an Italian sample of pregnant women. METHODS: Data were obtained from a sample of about 2,000 pregnant women at the University Teaching Hospital of Perugia University (Italy) in 2013. We used the revised classification proposed by Institute of Medicine to identify gestational weight gains considered as appropriate. Logistic regression models were used to estimate the adjusted odds-ratios of women belonging to any BMI class different from normal (used as the reference category) and of women who increased their weight by an amount smaller or greater than normal, controlling for a large set of observable confounders. RESULTS: Higher probability of low birth weight was associated with both obesity (OR = 1.9124, s.e. = 0.526) and less than normal weight gains (OR = 2.3614, s.e. = 0.388). The probability of fetal macrosomia was found to be positively associated with more than normal weight increases (OR = 2.6232, s.e. = 0.465). Pre-term deliveries were associated with less than normal gestational weight gains (OR 1.7338, s.e. = 0.320). CONCLUSION: Overweight and obesity represent a big issue for public health. In particular, weight management during pregnancy and pre-pregnancy could determine negative health outcomes in newborns. In our study we found that inadequate weight variations during pregnancy, according to the Classification of the Institute of Medicine, negatively influence health conditions at birth. Stronger initiatives, especially in terms of midwifery, nurse training and informative policies should be adopted by policy makers.

Sleep disorder, Mediterranean Diet and learning performance among nursing students: inSOMNIA, a cross-sectional study.

BACKGROUND: The International Classification of Sleep disorders, the International Classification of Diseases and the Diagnostic and Statistical manual of Mental Disorders defines insomnia as an experience of insufficient or poor sleep quality, characterized by at least one of the following symptoms: difficulty in initiating or maintaining sleep, early awakenings and poor restorative sleep. In Italy, the Morfeo 1 study detects a prevalence of 20% of insomnia and a 40% of cases with day-time symptoms. The chronic sleep deprivation is responsible for cognitive disorders with effects on social life. Being common knowledge, lifestyle can also influence sleep. Some of the "sleep hygiene rules" involve a control on smoking, coffee consumption and diet. The Mediterranean Diet (MD), thanks to its high level of tryptophan, has a positive influence on sleep and can protect against stress and anxiety. STUDY DESIGN: The aim of InSOMNIA study was to determine the prevalence of sleep disorders among nursing students of the University of Perugia and, therefore, to evaluate how lifestyle, eating habits, health status and academics performance are linked to night-time and daytime symptoms of the interrupted sleep. METHODS: We adopted a cross sectional survey, collecting data from "Sleep and Daytime Habits Questionnaire" to evaluate the sleep disorders and from PREDIMED questionnaire to assess the adherence to MD. RESULTS: We found a statistical significant association between PREDIMED score and BMI (p-value=0.0127), smoking habit (p-value = 0.0125), quality of life (p-value = 0.0480) and academic progress (p-value = 0.0092). CONCLUSIONS: We found a high prevalence of sleep disturbances statistically associated with diet and poor academic progress.

Quality handbook in radiotherapy: personal experience.

The Quality Handbook includes the description of the activities carried out in Radiotherapy and the methodology used to ensure the Quality Assurance according to the principles indicated in national and international documents of reference and the recommendations of accreditation agencies. The structure of the Quality Handbook, the main aspects of single chapters, the selected quality indicators undergoing inspections are analysed and procedures to be followed for changes and updating of the Quality Handbook are described. The Quality Assurance program is illustrated in another article of this issue.

Quality handbook in radiotherapy. Brachytherapy: personal experience.

Brachytherapy is a conventional method of radiation therapy characterized by peculiar technical, clinical, operational and radioprotection problems. Therefore, the management of a service or department of brachytherapy requires a specific organization aimed at Quality Assurance. In this report, the personal experience with the drawing up of a Quality Handbook of brachytherapy with reference to the method used and the structure of the document, is described.

Quality assurance in radiotherapy: personal experience.

The approach to the implementation of a Quality Assurance Program applied from 1 October 2000 at the Radiotherapy Service of the "Università Cattolica del S. Cuore, Policlinico "A. Gemelli" of Rome, is described. Some major aspects of this program are analyzed.

A genetically detoxified derivative of heat-labile Escherichia coli enterotoxin induces neutralizing antibodies against the A subunit.

Escherichia coli enterotoxin (LT) and the homologous cholera toxin (CT) are A-B toxins that cause travelers' diarrhea and cholera, respectively. So far, experimental live and killed vaccines against these diseases have been developed using only the nontoxic B portion of these toxins. The enzymatically active A subunit has not been used because it is responsible for the toxicity and it is reported to induce a negligible titer of toxin neutralizing antibodies. We used site-directed mutagenesis to inactivate the ADP-ribosyltransferase activity of the A subunit and obtained nontoxic derivatives of LT that elicited a good titer of neutralizing antibodies recognizing the A subunit. These LT mutants and equivalent mutants of CT may be used to improve live and killed vaccines against cholera and enterotoxinogenic E. coli.

Differential inhibition of IL-1 beta activities and receptor binding by monoclonal antibodies mapping within a discrete region of the protein.

The importance of the region in position 148-192 for the biological activities and receptor-binding capacity of the human IL-1 beta protein has been assessed by the use of mAbs. Four mAbs have been used, which recognize different epitopes within the 148-192 region. None of the mAbs could inhibit binding of IL-1 beta to IL-1RI (expressed on T cells and fibroblasts), suggesting that the 148-192 region does not contain IL-1RI binding sites. Conversely, mAbs Vhp20 (recognizing the fragment 166-169) and BRhD2 (directed to an epitope in the sequence 177-186) recognize sites partially involved in binding to IL-1RII (expressed on B cells, macrophages, and PMN). Only mAbs BRhD2 and FIB 1 (which recognizes an epitope in the sequence 174-186) can inhibit IL-1 beta-induced thymocyte proliferation, whereas all four can inhibit the adjuvant capacity of IL-1 beta in vivo. It is concluded that the region 148-192 encompasses domains important for T cell activation but not for binding to the IL-1RI on T cells, others involved in immunostimulation in vivo, and others important for binding to IL-1RII, although not directly involved in it.

Characterization of genetically inactivated pertussis toxin mutants: candidates for a new vaccine against whooping cough.

the introduction of two amino acid substitutions within the enzymatically active subunit S1 of pertussis toxin (PT) abolishes its ADP-ribosyltransferase activity and toxicity on CHO cells (Pizza et al., Science 246:497-500, 1989). These genetically inactivated molecules are also devoid of other in vivo adverse reactions typical of PT, such as induction of leukocytosis, potentiation of anaphylaxis, stimulation of insulin secretion, and histamine sensitivity. However, the mutant PT molecules are indistinguishable from wild-type PT in sodium dodecyl sulfate-polyacrylamide gel electrophoresis and maintain all the physical and chemical properties of PT, including affinity for toxin-neutralizing poly- and monoclonal antibodies. Either alone or stabilized with formaldehyde, PT mutants are able to induce high levels of neutralizing antibodies and to protect mice in a dose-dependent fashion against intracerebral challenge with virulent B. pertussis. These results clearly show that these genetically inactivated PT molecules are nontoxic but still immunogenic and justify their development as a component of a new, safer acellular vaccine against whooping cough.

Radiolabeling of the biologically active peptide 163-171 of human interleukin-1 beta.

N-succinimidyl[2,3-3H]propionate was used for the radiolabeling of the biologically active peptide fragment 163-171 of human interleukin-1 beta (VQGEESNDK). Suitable reaction conditions were studied to obtain useful labeling of the molecule. A mixture of mono- (70%) and bi- (30%) propionyl derivatives was obtained with a total 3H specific activity of 87 Ci/mmol of peptide. The conditions for an efficient chromatographic separation of labeled peptide from unreacted reagents and by-products were established. The labeled peptide maintained the same biological activity as that of the corresponding unlabeled molecule, indicating that the labeling procedure did not alter the biological characteristics of the peptide. This thus allows the use of the radiolabeled peptide for receptor binding studies.

Mutants of pertussis toxin suitable for vaccine development.

Immunization with chemically detoxified pertussis toxin can prevent severe whooping cough with an efficacy similar to that of the cellular pertussis vaccine, which normally gives unwanted side effects. To avoid the reversion to toxicity and the loss of immunogenicity that may follow chemical treatment of pertussis toxin, inactive toxins were constructed by genetic manipulation. A number of genetically engineered alleles of the pertussis toxin genes, constructed by replacing either one or two key amino acids within the enzymatically active S1 subunit, were introduced into the chromosome of strains of Bordetella pertussis, B. parapertussis, and B. bronchiseptica. These strains produce mutant pertussis toxin molecules that are nontoxic and immunogenic and that protect mice from the intracerebral challenge with virulent Bordetella pertussis. Such molecules are ideal for the development of new and safer vaccines against whooping cough.

One-step immunoaffinity purification of bioactive human recombinant IL-1 beta with a monoclonal antibody directed to a well-exposed domain of the protein.

A monoclonal antibody (mAb) specific for human recombinant IL-1 beta (hu rIL-1 beta) was produced by immunizing BALB/c mice with hu rIL-1 beta purified with classical methods. This mAb recognizes an epitope within the highly hydrophylic fragment spanning amino acid 133-147. The affinity constant of this mAb towards IL-1 beta was determined by RIA. An affinity column was prepared by covalent binding of the mAb to Sepharose CL-4B. The column was capable of selectively binding hu rIL-1 beta produced in Escherichia coli directly from crude homogenates. The IL-1 beta protein yield was higher than 90% with a very good recovery of IL-1 beta biological activity. Moreover, the immunosorbent retained at least two thirds of its IL-1 beta-binding capacity after 20 cycles of purification.

A monoclonal antibody to the IL-1 beta peptide 163-171 blocks adjuvanticity but not pyrogenicity of IL-1 beta in vivo.

The synthetic fragment VQGEESNDK, corresponding to the amino acid sequence in position 163-171 of human IL-1 beta, possesses the immunostimulatory but not the pyrogenic activity of the mature IL-1 beta polypeptide in vivo. To assess the relevance of this domain of IL-1 beta for its biologic activities, a mAb was raised against the synthetic peptide 163-171. The mAb Vhp20 could effectively recognize human rIL-1 beta in RIA and immunoblotting. In vivo, the mAb Vhp20 was able to selectively inhibit the immunostimulatory activity of IL-1 beta, but it could not affect the fever-inducing capacity of IL-1 beta. It is proposed that functional domains could be identified in the human IL-1 beta protein and that the fragment in position 163-171 is of major importance for the adjuvant capacity of the entire molecule, but irrelevant to its pyrogenic activity.

Different conformation of purified human recombinant interleukin 1 beta from Escherichia coli and Saccharomyces cerevisiae is related to different level of biological activity.

Human recombinant interleukin 1 beta produced in Escherichia coli and in Saccharomyces cerevisiae was purified to homogeneity by a combination of ion exchange, gel filtration and hydroxylapatite column chromatography. The two proteins, both expressed in the mature form, differ in that the protein secreted from yeast is glycosylated and lacks the first four amino acids. The biological activity of IL-1 obtained from E. coli is comparable to that of the natural protein, while the protein produced from yeast showed very low specific activity. The analysis of the state of oxidation of the two cysteine residues present in the IL-1 molecule and the evaluation of the immunoreactivity of the two proteins have proved that a different conformation is at the basis of the different biological activity of the two proteins.

Studies of the antigenic structure of two cross-reacting proteins, pertussis and cholera toxins, using synthetic peptides.

Peptide fragments of pertussis toxin subunit 1 (PT-S1) have been synthesized in order to investigate their antigenic and immunogenic activity, and to evaluate their possible use as components of a new vaccine. Two peptides (sequence 73-82, EAERAGRGTG and sequence 107-116, YVDTYGDNAG) were selected for their predictable exposure on the surface of the molecule, and a third (8-18, YRYDSRPPEDV) for its homology with the sequence 6-16 of cholera toxin subunit A (CT-A 6-16) (YRADSRPPDEI). Antipeptide polyclonal antibodies produced in rabbits, were tested in different immunoassays for their ability to interact with toxin proteins. All of them proved interactive with recombinant PT-S1 (rPT-S1); CT-A interact not only, as expected, with anti 8-18 antibodies, due to the high homology between the two toxins in this region, but also, unexpectedly, with anti 107-116 antibodies, in spite of the lack of homology of this peptide with the entire CT. We also found a direct cross-reactivity between the two toxins: anti PT and anti rPT-S1 antibodies interacted with CT-A, whereas anti CT antibodies did not recognize PT. Antipertussis antibodies also recognized the peptide 8-18, which therefore represents at least a part of an antigenic determinant of the toxin, while no interaction could be evidenced between anti-cholera antibodies and any of the peptides, thus demonstrating important differences in the antigenic structures of the two toxins. None of the antipeptide antibodies examined showed protective activity against the toxins in a Chinese hamster ovary (CHO) cell test.

Mapping of biologically relevant sites on human IL-1 beta using monoclonal antibodies.

mAb have been raised that recognize human IL-1 beta. Using overlapping peptide fragments expressed in yeast and bacteria, we have mapped the regions of the protein to which these antibodies bind. To assess the relevance of the different regions of IL-1 beta for the expression of its biologic activity, the ability of the antibodies to block IL-1 activity was assayed. Antibodies recognizing the regions 133-148 and 251-269 of human IL-1 beta could inhibit the activity of IL-1 beta, but not of IL-1 alpha, in two different biologic assays, the murine thymocyte proliferation and PGE2 release from human fibroblasts. Conversely, antibodies that recognize the region 218-243 have only a moderate inhibitory effect on the IL-1 beta biologic activity in both assays. Finally, an antibody mapping to the region 148-192 did not inhibit IL-1 beta activity either on thymocytes or on fibroblasts. It is suggested that IL-1 beta-induced cell activation involves different regions of the protein and that both N-terminal and C-terminal fragments are involved in the correct functioning of the IL-1 beta molecule.

Conformational changes in diphtheria toxoids. Analysis with monoclonal antibodies.

Monoclonal antibodies (Mab) were raised against CRM197, a non-toxic mutant of diphtheria toxin (DT). The ability of four Mabs to bind DT and the six functional mutants CRM197, CRM176, CRM228, CRM1001, CRM45 and CRM30 was assessed by immunoblotting and by a radioimmunoassay in which the protein antigen in solution competes with labeled CRM197 for the Mab binding site. The results show that the peptides recognized by Mab11.3, Mab53 and Mab23 are accessible in the mutant molecules in solution but not when they are part of the native DT structure, which could therefore be described for this purpose as 'closed' in contrast with an 'open' conformation of CRM197, CRM176 and CRM228. In particular, the behaviour of Mab53 indicates that the single amino acid substitutions in the A fragments of CRM197 and CRM176 also affect the conformation of their B fragments.