Statin-induced autoimmune myositis: a proposal of an "experience-based" diagnostic algorithm from the analysis of 69 patients.

Statin-induced autoimmune myositis (SIAM) represents a rare clinical entity that can be triggered by prolonged statin treatment. Its pathogenetic substrate consists of an autoimmune-mediated mechanism, evidenced by the detection of antibodies directed against the 3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR Ab), the target enzyme of statin therapies. To facilitate the diagnosis of nuanced SIAM clinical cases, the present study proposes an "experience-based" diagnostic algorithm for SIAM. We have analyzed the clinical data of 69 patients diagnosed with SIAM. Sixty-seven patients have been collected from the 55 available and complete case records regarding SIAM in the literature; the other 2 patients represent our direct clinical experience and their case records have been detailed. From the analysis of the clinical features of 69 patients, we have constructed the diagnostic algorithm, which starts from the recognition of suggestive symptoms of SIAM. Further steps provide for CK values dosage, musculoskeletal MR, EMG/ENG of upper-lower limbs and, Anti-HMGCR Ab testing and, where possible, the muscle biopsy. A global evaluation of the collected clinical features may suggest a more severe disease in female patients. Atorvastatin proved to be the most used hypolipidemic therapy.

Adolescents' Nutrition: The Role of Health Literacy, Family and Socio-Demographic Variables.

Adolescent obesity rates are increasing on an epidemic level and food intake is one of the most important causes of this condition. From an ecological perspective, food intake is, in turn, influenced by many factors that need to be considered. This study aims to evaluate the associations between socio-demographic factors (gender, family origin, socio-economic status, parent's education level), which consist of social stratifiers, health literacy and family context, as independent variables, and food intake (consumption of fruits, vegetables, soft drinks and sweets and breakfast frequency) and outcomes (Body Mass Index category), as dependent variables. Data were retrieved from 2145 students (13 and 15 years old) from the Lombardy region (Italy) who participated in the 2018 edition of Health Behaviour in School-Aged Children (HBSC). Six multiple binary logistic regression models were used in this study. Fruit, vegetable and soft drinks consumption models were related to all three-factor levels. Breakfast consumption frequency was associated with socio-demographic variables. BMI category was associated with socio-demographic and family variables. The results confirmed the existence of social inequalities, the importance of health literacy in predicting healthy behaviours and the relevance of the family context. The study confirms the importance of the ecological approach to understanding food intake and overweight/obesity status in adolescents.

Validation of the COVID-19 Digital Health Literacy Instrument in the Italian Language: A Cross-Sectional Study of Italian University Students.

The Coronavirus Disease 19 (COVID-19) pandemic and the associated "infodemic" have shown the importance of surveillance and promotion of health literacy, especially for young adults such as university students who use digital media to a very high degree. This study aimed to assess the validity and reliability of the Italian version of the COVID-19 adapted version of the Digital Health Literacy Instrument (DHLI). This cross-sectional study is part of the COVID-19 University Students Survey involving 3985 students from two Italian universities. First, item analysis and internal consistency were assessed. Then, Principal Component Analysis (PCA) and Confirmatory Factor Analyses (CFA) were performed comparing different models. The Italian DHLI showed good psychometric characteristics. The protecting privacy subscale was excluded, given the criticalities presented in the validation process. CFA confirmed the four-factor structure, also including a high-order factor. This result allows using the scale to measure a global level of digital health literacy and consider its levels separately for each construct component: searching the web for information, evaluating reliability, determining personal relevance, and adding self-generated content.

Health Literacy Levels among Italian Students: Monitoring and Promotion at School.

Health literacy was identified as an important determinant of health, particularly for adolescents. However, more efforts are needed to monitor this construct and provide inputs for policy development. This study aims to: (a) Assess the validity and reliability of the Italian version of the Health Literacy for School-Aged Children (HLSAC-I); (b) Identify the health literacy levels among Italian students and compare them with other countries' levels; and (c) Identify the associations between health literacy and multiple social determinants (social stratifiers, family, and school connectedness). Data came from the Health Behaviour School-Aged Children survey, carried out in the Lombardy region in northern Italy in 2018. A representative sample of 2,287 13- and 15-year-old Lombardian students was involved. The results support the validity and reliability of the HLSAC-I. A total of 18.7% of the sample reported low levels, and only 6.8% reported high levels. Italian students reported the lowest levels of health literacy compared with other countries. School connectedness and educational approach are the most relevant associated factors. This study confirms a school's role in reducing inequalities and promoting health. It highlights the importance of monitoring health literacy and implementing health promotion policies at school through a whole-school approach.

Quality of life in patients with primary biliary cholangitis: A cross-geographical comparison.

BACKGROUND & AIMS: Several symptoms impair the quality of life (QoL) of patients with primary biliary cholangitis (PBC). They are reported to vary significantly in different countries. Aim of our study was to explore whether there is a geographical clustering that accounts for symptoms in PBC. METHODS: Data was analysed from four cohorts of PBC patients from the UK, Spain, Japan and Italy using the PBC-27 scale. RESULTS: Overall, 569 patients from four cohorts were identified, including 515 females (90.5%) with a mean age of 61 years. The analysis provided evidence for strict factorial invariance of the scale, a robust indicator of its validity for cross-cultural research. The mean of the fatigue domain of British patients was significantly greater than that of the Japanese (p â€‹< â€‹0.05), Italian (p â€‹< â€‹0.05), and Spanish patients (p â€‹< â€‹0.001). The mean of the cognitive domain after 54 years of age, was significantly greater in the British patients than in the Japanese (p â€‹< â€‹0.05) and Spanish patients (p â€‹< â€‹0.01). However, after 69 years of age, there were not significant differences between countries. The mean of the emotion domain after 54 years of age, was greater in the British that in the Spanish (p â€‹< â€‹0.01) and Italian patients (p â€‹< â€‹0.01). CONCLUSIONS: Differences in the four countries concerning fatigue, cognitive and emotional dysfunction were found. The association of latitude and symptoms might provide new insights into the role of sun exposure, genetics and/or cultural component into disease phenotype in PBC.

How difficult is it for adolescents to maintain attention? The differential effects of video games and sports.

Despite a large body of evidence suggests positive effects of playing action video games and practising sports on various visual attentional skills, the impact of these activities on the ability to maintain attention over prolonged periods of time (i.e., sustained attention) has been largely neglected. Here, we first explored free-time habits on a group of 310 adolescents by means of a self-reported questionnaire. We found an inverse relationship between the time spent with sports and video games, but not with other extra-scholastic activities: the time spent practising sports and playing video games clearly competed with each other, with the more-intensive-sport practitioners being less involved in video game play. Next, we directly measured sustained attention and other attentional skills in a subgroup of 76 participants, divided as a function of their time spent in sports and action video games. In particular, sustained attention was assessed by means of two tasks: a classic exogenous task, requiring participants to attend to a flashing visual stimulus; and an internal (endogenous) sustained attention task, requiring participants to synchronise their manual responses to the rhythm of auditory pulses presented in an earlier phase. As previously documented, we found that action video game players displayed worse ability to maintain attention over time, as compared with non-action players. In striking contrast, intensive sports practice was associated with an increased ability to maintain attention over time. Overall, these findings unveil distinct cascading effects on sustained attention induced by doing sport and playing action video games.

Stability and change of lifestyle profiles in cardiovascular patients after their first acute coronary event.

BACKGROUND: Acute coronary syndrome (ACS) is a major cause of morbidity and mortality. Lifestyle and health behavior changes play an important role in the primary and secondary prevention of ACS recurrence. Changes in unhealthy lifestyles after an acute coronary event have been analyzed by considering separate behaviors individually, even though research on the healthy population has demonstrated that unhealthy behaviors tend to co-occur. PURPOSE: The aim of this study was to identify lifestyle profiles of ACS patients and to explore their pathways of change for one year after their first coronary event by adopting a typological approach. METHODS: Two hundred and twenty-three patients (84% male; mean age = 57.14) completed self-report measures of health-related behaviors at the beginning of cardiac rehabilitation, and six months and twelve months after. At each wave depression, anxiety and heart rate were also evaluated. Cluster analysis was performed to identify lifestyle profiles and to analyze their change over time. Differences in psychological factors and heart rate among clusters were assessed. RESULTS: Patients' diet, physical activity, and smoking behavior greatly improved six months after their first coronary event. No further improvements were detected after one year. At each wave specific lifestyle profiles were identified, ranging from more maladaptive to healthier clusters. Patients with multiple unhealthy behaviors experience greater difficulties in maintaining a healthier lifestyle over time. Moreover, the results demonstrated the association between lifestyle profiles at twelve months after the acute coronary event and depression measured six months earlier. Finally, the most maladaptive lifestyle profile had many members with elevated heart rate at twelve months after the cardiac rehabilitation. CONCLUSIONS: Current findings may have a strong practical impact in the development and implementation of personalized secondary prevention programs targeting lifestyles of ACS patients.

A Type A and Type D Combined Personality Typology in Essential Hypertension and Acute Coronary Syndrome Patients: Associations with Demographic, Psychological, Clinical, and Lifestyle Indicators.

Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed.

A longitudinal study on the information needs and preferences of patients after an acute coronary syndrome.

BACKGROUND: Research has shown that the provision of pertinent health information to patients with cardiovascular disease is associated with better adherence to medical prescriptions, behavioral changes, and enhanced perception of control over the disease. Yet there is no clear knowledge on how to improve information pertinence. Identifying and meeting the information needs of patients and their preferences for sources of information is pivotal to developing patient-led services. This prospective, observational study was aimed at exploring the information needs and perceived relevance of different information sources for patients during the twenty-four months following an acute coronary syndrome. METHODS: Two hundred and seventeen newly diagnosed patients with acute coronary syndrome were enrolled in the study. The patients were primarily men (83.41 %) with a mean age of 57.28 years (range 35-75; SD = 7.98). Patients' needs for information and the perceived relevance of information sources were evaluated between 2 and 8 weeks after hospitalization (baseline) and during three follow-ups at 6, 12 and 24 months after baseline. Repeated measures ANOVA, Bonferroni post hoc tests and Cochran's Q Test were performed to test differences in variables of interest over time. RESULTS: Results showed a reduction in information needs, but this decrease was significant only for topics related to daily activities, behavioral habits, risk and complication. At baseline, the primary sources of information were specialists and general practitioners, followed by family members and information leaflets given by physicians. Relevance of other sources changed differently over time. CONCLUSION: The present longitudinal study is an original contribution to the investigation of changes in information needs and preferences for sources of information among patients who are diagnosed with acute coronary syndrome. One of the main results of this study is that information on self-disease management is perceived as a minor theme for patients even two years after the event. Knowledge on how patients' information needs and perceived relevance of information sources change over time could enhance the quality of chronic disease management, leading health-care systems to move toward more patient-tailored care.

Changes in Dietary Behavior among Coronary and Hypertensive Patients: A Longitudinal Investigation Using the Health Action Process Approach.

BACKGROUND: Cardiovascular diseases (CVDs) are a major cause of worldwide morbidity and mortality. Nutrition plays an important role in the primary, secondary, and tertiary prevention of CVDs. The present longitudinal study used the Health Action Process Approach (HAPA) to investigate changes in dietary behavior in coronary patients (CPs) affected by acute coronary syndrome and hypertensive patients (HPs) affected by essential arterial hypertension. METHODS: CPs (N = 250) and HPs (N = 246) completed a questionnaire during three measurement points (baseline, 6-month follow-up, and 12-month follow-up). Statistical analyses included a repeated measures ANOVA and a multi-sample structural equation model. RESULTS: HPs showed no changes in dietary behavior, whereas CPs improved their nutrition at 6 months and then maintained the healthier diet. The multi-sample analysis indicated equivalence of the HAPA model for both patient populations. CONCLUSIONS: These findings provide further evidence for the generalisability of the HAPA model, shedding light on dietary behavior among CVD patients and particularly on hypertensive patients which has received little attention. Moreover, the equivalence of the model suggests that the process of change is almost identical for individuals who are at high risk for a coronary event (i.e. HPs) and individuals who have already had the event (i.e. CPs).

Typical and atypical lymphatic flows in breast carcinoma.

AIM: The study of sentinel lymph node has greatly increased the knowledge about lymphatic drainage in breast cancer. MATERIAL OF STUDY: The experience of 181 patients operated for breast carcinoma in the last two years, of which 70 undergoing SLN biopsy, allowed us to highlight some peculiarities of lymphatic drainage of the breast and led us to physiological and pathological considerations about lymphatic flow in patients for breast carcinoma. We studied patients undergoing lymphoscintigraphic mapping with SLN biopsy who were candidates for breast cancer surgery. RESULTS: Searching for SLN's location, we found that in 88.6% cases the SLN was at level I, in 8.6% it was at level II, in no case it was at level III and in 2.8% we found lymphatic drainage to the contralateral axilla. DISCUSSION: Thanks to this dynamic study we were able to highlight a preferential subcutaneous lymphatic path from the breast parenchyma reaching the contralateral axilla, crossing anteriorly the thorax. Literature review showed CAM incidence ranges from 3.6% to 6% and can be caused by occult primary cancer of the contralateral breast, contralateral spread of breast cancer and presence of another kind of tumor. CONCLUSIONS: The presence of contralateral axillary metastasis, although known, allowed us to scintigrafically document (for the first time) the pathway of an alternative lymph flow and to suppose the possible causes. Thanks to this observation, considerations can be drawn about clinical, pathophysiological and oncological implications, with an impact on post-operative follow-up.

Rare chondrosarcoma of the breast treated with quadrantectomy instead of mastectomy: A case report.

Breast chondrosarcoma is a rare sarcoma that mainly occurs in females >50 years old. To the best of our knowledge, only 16 cases were reported in the literature prior to 2013 and all patients were surgically treated by mastectomy, with or without lymphadenectomy, which was occasionally preceded by neoadjuvant chemotherapy. However, the literature does not report the benefit of mastectomy compared with a more conservative surgery. The present study reports a novel case of extraskeletal chondrosarcoma of the breast. A 63-year-old female patient presented with a neoplasm localized in the upper-outer quadrant of the right breast. The palpable lesion with sharp margins was a firm parenchymatous mass, which was confirmed by ultrasonography and mammography. The patient underwent conservative quadrantectomy instead of mastectomy, followed by post-surgical chemotherapy. A positron emission tomography scan performed five months subsequent to the surgery revealed no remnants of the disease. The patient underwent a strict clinical and instrumental follow-up, and two and half years after surgery, there are no signs of recurrent disease. In conclusion, the present case is currently one of the two cases in which a more conservative quadrantectomy was performed, instead of mastectomy. This surgical approach did not lead to metastasis and resulted in a good follow-up for the patient.

Breast Mondor's disease: Diagnosis and management of six new cases of this underestimated pathology.

Mondor's disease is an unusual and little-known pathology of the breast, characterized by superficial thrombophlebitis. The causes are still unresolved. Most of the patients do not fall under case studies of the scientific literature, given the reported incidence rate between 0.5% and 0.8%. The Mondor's disease patients are not always properly identified, and they are frequently treated as outpatients, even considering the benign course of the disease which often spontaneously resolves without any medical therapy. We report here six new cases of Mondor's disease, two of them were likely due to a trauma and were easily resolved with the use of non-steroidal anti-inflammatory drugs; the third one was apparently due to the stretching of the mammary veins in a patient with gigantomastia; the fourth one was subsequent to hormonal stimulation for in vivo fertilization and following gestation; and the last two cases (one was a man) were diagnosed after undergoing surgery for breast carcinoma.

Social support and adherence to treatment in hypertensive patients: a meta-analysis.

BACKGROUND: It is important to examine factors associated with patient adherence to hypertension control strategies. PURPOSE: A meta-analysis was conducted to examine whether social support was related to adherence to healthy lifestyle and treatment medication in hypertensive patients. METHODS: Journal articles were searched in medical (CINAHL, MEDLINE), psychological (PsycINFO, PsycARTICLES), and educational (ERIC) electronic databases; in reference lists of selected papers; and in the reference list of a previous review. RESULTS: Findings of a set of meta-analyses indicated that (a) structural social support was not significantly related to overall adherence, (b) functional social support was significantly and positively related to overall adherence, (c) these findings were further confirmed in meta-analyses conducted on specific types of adherence, and (d) most results were characterized by heterogeneity across studies that was partially explained by moderator analyses. CONCLUSIONS: Functional social support, but not structural social support, was associated with adherence in hypertensive patients.

A short version of a HRQoL questionnaire for Italian and Japanese patients with Primary Biliary Cirrhosis.

BACKGROUND: The available self-report questionnaire for the quality of life in patients with primary biliary cirrhosis (PBC-40) is currently validated only in the British population but it lacks an evaluation of its dimensionality. AIMS: To validate the Italian and Japanese versions of PBC-40 and to assess the dimensionality of the original structure of PBC-40 by a confirmatory factor analysis. PBC-40 was translated to Italian and Japanese using the forward-backward method and then reviewed in focus groups in the framework of a large multicentric study. METHODS: A sample of 290 patients with PBC (125 Italian and 165 Japanese) was administered two questionnaires previously validated for PBC-specific (PBC-40) and general quality of life (SF-36). RESULTS: The confirmatory model failed to fit adequately the original hypothesized structure. A principal component analysis led to a seven-factor structure, with exclusion of 13 items characterized by lower load; PBC-27 questionnaire was the final instrument. The validity of the PBC-27 was supported by its strong correlation with the SF-36 scores. CONCLUSION: We here propose an alternative structure of the quality of life questionnaire for PBC, namely PBC-27, which appears to be effective in detecting the impact of PBC on quality of life in Italian and Japanese patients.