Ultrastructural and Molecular Investigation on Peripheral Leukocytes in Alzheimer's Disease Patients.

Thriving literature underlines white blood cell involvement in the inflammatory processes of Alzheimer's Disease (AD). Among leukocytes, lymphocytes have been considered sentinels of neuroinflammation for years, but recent findings highlighted the pivotal role of neutrophils. Since neutrophils that infiltrate the brain through the brain vascular vessels may affect the immune function of microglia in the brain, a close investigation of the interaction between these cells is important in understanding neuroinflammatory phenomena and the immunological aftermaths that follow. This study aimed to observe how peripheral leukocyte features change at different stages of AD to identify potential molecular markers when the first features of pathological neurodegeneration arise. For this purpose, the examined patients were divided into Mild Cognitive Impairment (MCI) and severely impaired patients (DAT) based on their Cognitive Dementia Rating (CDR). The evaluation of the neutrophil-to-lymphocytes ratio and the morphology and function of leukocytes showed a close relationship between the ultrastructural and the molecular features in AD progression and suggested putative markers for the early stages of the disease.

Feeding disorders in preschoolers: a short-term outcome study in an Italian Family Care Program.

PURPOSE: To provide a description about a cohort of preschoolers with feeding disorders (FD) recruited from the therapeutic nursery "Cerco Asilo" of a tertiary care University Hospital, and to evaluate the short-term clinical outcome after 6 months of multidisciplinary treatment. METHODS: The present inception cohort study was based on an observational longitudinal research design comparing families who underwent the multidisciplinary treatment and those who did not. 42 children (47.6% female; 52.4% males-mean age 36.7 months, SD 17.2, range 2.3-65 months) underwent FD assessment according to the DC-0-3R diagnostic criteria (T0). At the end of the assessment, 62% of families with FD children agreed to be included in the family-based treatment. Both treated and untreated children with FD underwent a follow-up clinical evaluation after 6 months (T1) from baseline. Comparison of clinical features at T0 between groups of subjects resolving or not the FD was performed. To evaluate baseline factors associated with FD resolution, principal components analysis (PCA) was used to identify new synthetic variables that were then used in a logistics analysis. Moreover, clinical differences between T1 and T0 were compared with a t test. RESULTS: Two third of the cases (66.7%) resolved the FD, while one third (33.3%) did not. Children who had the FD resolved displayed at T0 significant differences in clinical features with respect to those who did not. Specifically, the FD subtype Feeding Disorder of Caregiver-Infant Reciprocity was strongly associated with resolution, while the subtype Infantile Anorexia was not. In addition, the component depicting "Anxious-Depressed", "Mood" and "Isolation" problems was independently associated with a significantly higher probability of resolution, similar to children having FD other than anorexia. CONCLUSIONS: FD in preschoolers are associated with problems in emotional development and in the relationship with parents. These difficulties tend to accentuate if the disorder persists. The study suggests the need to investigate the maintaining factors of FD in preschool age. LEVEL OF EVIDENCE: Level IV: Evidence obtained from multiple time series with and without the intervention.

Excessive physical activity in young girls with restrictive-type anorexia nervosa: its role on cardiac structure and performance.

PURPOSE: The aim of this study was to investigate the influence of hyperactivity on left ventricular mass (LVM) in Anorexia Nervosa restricting-type (AN-R) and the correlation between LVM and auxologic parameters/circulating hormones. METHODS: Echocardiography was performed in 44 AN-R girls, subgrouped in 24 hyperactive (ANH+) and 20 non-hyperactive (ANH-), and in 20 controls (HC). LVM indexed to Body Surface Area (LVMi) and LVM indexed to height (LVMh) were calculated. RESULTS: LVMi and LVMh were significantly lower in the AN-R subjects compared to HC. Moreover, both LVMi and LVMh were higher in the ANH+ than in the ANH-. In the HC, LVMi was higher when compared to the ANH- subjects than to the ANH+. Stepwise analysis revealed that in the ANH+ group, fT4 was the only independent predictor of LVMh, while in the ANH- group, height was the only independent predictors of LVMi. CONCLUSIONS: Despite its negative influence on disease severity and outcome, hyperactivity from the standpoint of cardiac function makes the LVM of AN-R young girls more similar to HC. LEVEL OF EVIDENCE: Level III, case-control study.

Feelings of uselessness and 3-year mortality in an Italian community older people: the role of the functional status.

BACKGROUND: Sense of self-worth influences the health status of the elderly and may be associated with mortality. The aim of the study was to investigate whether the association between subjective feelings of uselessness and mortality was confounded or modified by functional limitation in non-institutionalized older people. METHODS: Participants were community-dwelling older people, aged 70 years and older, who lived in neighbourhoods of Massa and Carrara municipalities in northern Tuscany, Italy. At baseline, 2335 non-institutionalized older people were assessed with a short self-administered questionnaire; the analysis included 2132 older persons for whom vital statistical data were available after a 3-year follow-up. RESULTS: The feeling of uselessness was associated with an increased mortality at the 3-year follow-up, but only in older people who reported disability problems (adjusted hazard ratio = 1.97, 95% confidence interval = 1.48-2.63, P < 0.0001). CONCLUSIONS: People who reported disability problems and a feeling of uselessness may be vulnerable to an increased risk for poor health outcomes in later life. This study outlined the importance of enquiring about feelings of uselessness, which is a relational variable that is linked to both psychological and physical health status, especially in older people who need help in daily activities.

Assessment of mental disorders in preschoolers: the multiaxial profiles of diagnostic classification 0-3.

A group of 291 preschoolers consecutively enrolled at the Early Childhood Mental Health Service of IRCSS Stella Maris (Italy) were assessed using the Diagnostic Classification Zero to Three (DC:0-3; ZERO TO THREE, 1994). All active variables were extracted from its five axes, and a multiple correspondence analysis was performed. This analysis evidenced four multiaxial clinical profiles: (a) Multisystem developmental disorders (Axis I) were correlated with the underinvolved quality of relationship (Axis II), medical conditions (Axis III), and a low level of emotional functioning (Axis V); (b) regulatory disorders (Axis I) were correlated with maladaptive or angry/hostile relationship (Axis II), medical conditions (Axis III), and an immature level of emotional functioning (Axis V); (c) affective disorders (Axis I) were correlated with anxious/tense relationship (Axis II), stress factors (Axis IV), and emotional functioning vulnerable to stress (Axis V); and (d) adjustment, feeding, and sleeping disorders (Axis I) were correlated with mild relationship disorders (Axis II) and important impact of stress factors (Axis IV). These findings support DC:0-3 as a valid tool to detect multiaxial profiles that could be useful to plan comprehensive treatments of the disorders.

COVID-19 Vaccine Hesitancy among Unvaccinated Adults: A Cross-Sectional Exploratory Analysis of Vaccination Intentions in Italy Related to Fear of Infection.

From the initial COVID-19 outbreak, Italy was the first Western country to be seriously affected by the pandemic. Understanding vaccine hesitancy can help efforts to achieve broad vaccination coverage. The objectives of this research were to determine the extent of vaccine hesitancy in Italy and to understand the characteristics of those segments of the population with some hesitancy. Between January and February 2021, 41,473 subjects answered the second questionnaire delivered in phase II of the web-based EPICOVID19 survey. Among the included adult volunteers living in Italy, 4653 (11.2%) reported having previously received at least one dose of the COVID-19 vaccine. In the sample of 36,820 respondents, all not vaccinated (age 51.1 ± 13.5; 59.7% female; 63.6% high level of education), the comparison between hesitant and inclined participants was accompanied by percentages and odds ratios. A total of 2449 individuals were hesitant (6.7% of the unvaccinated ones). Hesitancy was higher among women (OR = 1.48; 95%CI: 1.36-1.62); it was highest in the 50-59 and 40-49 age groups and among those with a lower educational level. A higher level of education was associated with a lower proportion of hesitancy (5.54%) compared with 9.44% among respondents with a low level of education (OR = 0.56; 95%CI: 0.46-0.68). Hesitancy was most common in subjects who did not report fear of infection (12.4%, OR = 4.0; 95%CI: 3.46-4.61). The results can guide the design of tailored information and communication campaigns through considering objective and subjective characteristics.

The application of observational data in translational medicine: analyzing tobacco-use behaviors of adolescents.

BACKGROUND: Translational Medicine focuses on "bench to bedside", converting experimental results into clinical use. The "bedside to bench" transition remains challenging, requiring clinicians to define true clinical need for laboratory study. In this study, we show how observational data (an eleven-year data survey program on adolescent smoking behaviours), can identify knowledge gaps and research questions leading directly to clinical implementation and improved health care. We studied gender-specific trends (2000-2010) in Italian students to evaluate the specific impact of various anti-smoking programs, including evaluation of perceptions of access to cigarettes and health risk. METHODS: The study used, ESPAD-Italia® (European School Survey Project on Alcohol and other Drugs), is a nationally representative sample of high-school students. The permutation test for joinpoint regression was used to calculate the annual percent change in smoking. Changes in smoking habits by age, perceived availability and risk over a 11-year period were tested using a gender-specific logistic model and a multinomial model. RESULTS: Gender-stratified analysis showed 1) decrease of lifetime prevalence, then stabilization (both genders); 2) decrease in last month and occasional use (both genders); 3) reduction of moderate use (females); 4) no significant change in moderate use (males) and in heavy use (both genders). Perceived availability positively associates with prevalence, while perceived risk negatively associates, but interact with different effects depending on smoking patterns. In addition, government implementation of public policies concerning access to tobacco products in this age group during this period presented a unique background to examine their specific impact on behaviours. CONCLUSION: Large observational databases are a rich resource in support of translational research. From these observations, key clinically relevant issues can be identified and form the basis for further clinical studies. The ability to identify patterns of behaviour and gaps in available data translates into new experiments, but also impacts development of public policy and reveals patterns of clinical reality. The observed global decrease in use is countered by stabilization in number of heavy smokers. Increased cigarette cost has not reduced use. While perceived risk of smoking may prevent initial experimentation, how government policies impact the perception of risk is not easily quantifiable.

Characteristics of alcoholics attending 'clubs of alcoholics in treatment' in Italy: a national survey.

AIMS: To provide an overview of alcoholics attending a socio-ecological treatment programme [Clubs of Alcoholics in Treatment (CATs)] and to identify factors associated with abstinence and self-perceived improvement in lifestyle. METHODS: A national sample of 7522 subjects (76% males and 24% females, mean age 53.2 ± 11.3 years ± SD) attending CATs was evaluated using a self-administered questionnaire completed at a weekly meeting in 2006. RESULTS: Of participants, >70% reported no alcohol use in the last year and around 90% indicated no use in the previous month, whereas 4% of them declared no alcohol use before club attendance. Abstinence and lifestyle improvement were related positively to the number of years of club attendance but negatively to the presence of other problems in addition to the alcohol-related one. Moreover, being older or female was associated with more likely achievement of abstinence as well as with the perception of a better lifestyle. Finally, attending the club with one or more family members was associated with achievement of better lifestyle. CONCLUSION: These data provide an overview of alcoholics attending the CAT programme and are a first step toward developing a surveillance system. In addition, on the basis of this preliminary picture further research (notably longitudinal studies) can be planned considering this method and its effectiveness.

Risk Associations between Vehicular Traffic Noise Exposure and Cardiovascular Diseases: A Residential Retrospective Cohort Study.

Environmental noise can induce detrimental health effects such as cardiovascular disease (CVD). The relationship between vehicular traffic noise pollution and CVD was investigated through a retrospective residential cohort study in the city of Pisa. Four exposure classes were defined for noise pollution, using noise propagation maps. The association between noise exposures and cause-specific mortality or hospitalization of the subjects of the cohort was calculated using the hazard ratio (HR) for night and day through a multiple time-dependent and sex-specific Cox regression adjusting for age, the socio-economic deprivation index, and traffic air pollution. Mortality excess for CVD and risk trends for a 1 decibel noise increment were observed among the most exposed women (mortality: HRnightclass4 1.15 (1.03-1.28); Trendnight 1.007 (1.002-1.012); HRdayclass4 1.14 (1.02-1.27); Trendday 1.008 (1.003-1.013)), particularly for ischaemic disease (mortality: Trendnight 1.008 (0.999-1.017); Trendday 1.009 (0.999-1.018)) and cerebrovascular disease (mortality: HRnightclass3 1.23 (1.02-1.48), HRdayclass3 1.24 (1.03-1.49)). Hospitalization analyses confirm mortality results. A decreased risk for hospitalization was also observed among the most exposed men (HRdayclass4 0.94 (0.88-1.01), particularly for ischaemic disease (HRnightclass4 0.90 (0.80-1.02); HRdayclass4 0.86 (0.77-0.97)) and cerebrovascular disease (HRnightclass4 0.89 (0.78-1.01)). Authors recommend the adoption of prevention measures aimed at mitigating noise and the activation of a monitoring of the risk profile in the Pisa population updating both the residential cohort and health data.

Community Concern about the Health Effects of Pollutants: Risk Perception in an Italian Geothermal Area.

Geothermal fluids for electricity and heat production have long been exploited in the Mt. Amiata area (Tuscany, Italy). Public concern about the health impact of geothermal plants has been present from the outset. Several factors influence the way people perceive risk; therefore, the objective of the present research is to develop indicators of risk perception and assess indices differences in relation to some questionnaire variables. A cross-sectional survey was conducted in the Amiata area on 2029 subjects aged 18-77. From the questionnaire section about risk perception from environmental hazards, four indicators were developed and analysed. A total of 64% of the subjects considered the environmental situation to be acceptable or excellent, 32% serious but reversible, and 4% serious and irreversible; as the values of the various perception indicators increased, an upward trend was observed in the averages. Risk perception was higher among women and young people, and was associated with higher education. Those who smelled bad odours in their surroundings reported higher risk perception. Furthermore, risk perception was higher in four municipalities. The results represent the basis for further investigations to analyse the link among risk perception indicators, exposure parameters, and health status.

Anorexia Nervosa, Body Image Perception and Virtual Reality Therapeutic Applications: State of the Art and Operational Proposal.

Anorexia Nervosa (AN) patients exhibit distorted body representation. The purpose of this study was to explore studies that analyze virtual reality (VR) applications, related to body image issues, to propose a new tool in this field. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Scopus, and Web of Science databases were explored; the review included 25 studies. Research has increased over the last five years. The selected studies, clinical observational studies (n = 16), mostly concerning patients' population with AN (n = 14) or eating disorders (EDs) diagnosis, presented multiple designs, populations involved, and procedures. Some of these studies included healthy control groups (n = 7). Studies on community sample populations were also selected if oriented toward clinical applications (n = 9). The VR technologies in the examined period (about 20 years) have evolved significantly, going from very complex and bulky systems, requiring very powerful computers, to agile systems. The advent of low-cost VR devices has given a big boost to research works. Moreover, the operational proposal that emerges from this work supports the use of biofeedback techniques aimed at evaluating the results of therapeutic interventions in the treatment of adolescent patients diagnosed with AN.

Horticultural Therapy May Reduce Psychological and Physiological Stress in Adolescents with Anorexia Nervosa: A Pilot Study.

Studies in psychiatric populations have found a positive effect of Horticultural therapy (HCT) on reductions in stress levels. The main objective of the present pilot study was to evaluate the impact of the addition of HCT to conventional clinical treatment (Treatment as Usual, TaU) in a sample of six female adolescents with anorexia nervosa restricting type (AN-R), as compared to six AN-R patients, matched for sex and age, under TaU only. This is a prospective, non-profit, pilot study on patients with a previous diagnosis of AN-R and BMI < 16, recruited in 2020 in clinical settings. At enrolment (T0) and after treatment completion (TF), psychiatric assessment was performed. At T0, all the patients underwent: baseline electrocardiogram acquisition with a wearable chest strap for recording heart rate and its variability; skin conductance registration and thermal mapping of the individual's face. An olfactory identification test was administered both to evaluate the olfactory sensoriality and to assess the induced stress. One-way analyses of variance (ANOVAs) were performed to analyze modifications in clinical and physiological variables, considering time (T0, TF) as a within-subjects factor and group (experimental vs. control) as between-subjects factors. When the ANOVA was significant, post hoc analysis was performed by Paired Sample T-tests. Only in the HCT group, stress response levels, as measured by the biological parameters, improved over time. The body uneasiness level and the affective problem measures displayed a significant improvement in the HCT subjects. HCT seems to have a positive influence on stress levels in AN-R.

Fear of COVID-19 for Individuals and Family Members: Indications from the National Cross-Sectional Study of the EPICOVID19 Web-Based Survey.

The study analyzed the association of the fear of contagion for oneself and for family members (FMs) during the first wave of the COVID-19 pandemic, with demographic and socioeconomic status (SES) and health factors. The study was performed within the EPICOVID19 web-based Italian survey, involving adults from April-June 2020. Out of 207,341 respondents, 95.9% completed the questionnaire (60% women with an average age of 47.3 vs. 48.9 years among men). The association between fear and demographic and SES characteristics, contacts with COVID-19 cases, nasopharyngeal swab, self-perceived health, flu vaccination, chronic diseases and specific symptoms was analyzed by logistic regression model; odds ratios adjusted for sex, age, education and occupation were calculated (aORs). Fear for FMs prevailed over fear for oneself and was higher among women than men. Fear for oneself decreased with higher levels of education and in those who perceived good health. Among those vaccinated for the flu, 40.8% responded they had feelings of fear for themselves vs. 34.2% of the not vaccinated. Fear increased when diseases were declared and it was higher when associated with symptoms such as chest pain, olfactory/taste disorders, heart palpitations (aORs > 1.5), lung or kidney diseases, hypertension, depression and/or anxiety. Trends in fear by region showed the highest percentage of positive responses in the southern regions. The knowledge gained from these results should be used to produce tailored messages and shared public health decisions.

Risk Perception of Air Pollution: A Systematic Review Focused on Particulate Matter Exposure.

The adverse health effects of exposure to air pollutants, notably to particulate matter (PM), are well-known, as well as the association with measured or estimated concentration levels. The role of perception can be relevant in exploring effects and pollution control actions. The purpose of this study was to explore studies that analyse people's perception, together with the measurement of air pollution, in order to elucidate the relationship between them. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In March 2020, PubMed, EMBASE, and Scopus databases were explored in an attempt to search for studies published from 2000 to 2020. The review included 38 studies, most of which were conducted in China (n = 13) and the United States (n = 11) and published over the last four years (n = 26). Three studies were multicenter investigations, while five articles were based on a national-level survey. The air quality (AQ) was assessed by monitoring stations (n = 24) or dispersion models (n = 7). Many studies were population questionnaire-based, air monitoring and time-series studies, and web-based investigations. A direct association between exposure and perception emerged in 20 studies. This systematic review has shown that most of the studies establish a relationship between risk perception measurement. A broad spectrum of concepts and notions related to perception also emerged, which is undoubtedly an indicator of the wealth of available knowledge and is promising for future research.

Mortality and Morbidity in a Population Exposed to Emission from a Municipal Waste Incinerator. A Retrospective Cohort Study.

In the present research, we evaluated the health effects of exposure to the municipal waste incinerator (MWI) in Pisa, Italy, through a population-based cohort design. The individual exposure pattern in the area was estimated through CALPUFF dispersion models of NOχ (developed by Atmospheric Studies Group Earth Tech, Lowell, Massachusetts), used as pollution proxies of the MWI and the relevant industrial plant, and through land-use regression for NOχ due to traffic pollution. Using Cox regression analysis, hazard ratios (HR) were estimated adjusting for exposure to other sources of pollution, age, and socioeconomic deprivation. An adjusted linear trend of HR (HRt) over the categories of exposure, with the relative 95% CI and p-value, was also calculated. Mortality and hospital discharge were studied as impact outcomes. Mortality analysis on males showed increased trends of mortality due to natural causes (HRt p < 0.05), the tumor of the lymphohematopoietic system (HRt p = 0.01), cardiovascular diseases (HRt p < 0.01); in females, increased trends for acute respiratory diseases (HRt p = 0.04). Morbidity analysis showed a HRt for lymphohematopoietic system tumor in males (HRt p = 0.04). Some of the excesses are in agreement with previous evidence on the health effects of MWIs, although the observation in males but not in females, suggests a cautious interpretation. Confounding due to other sources of exposure cannot be ruled out. The evidence was considered important in the decision-making process of the waste cycle.

Parent-child Interaction Treatment for Preschoolers with Feeding Disorders.

BACKGROUND: This study examined the immediate outcome of Feeding Disorders (FD) in preschoolers referred to the family treatment program Cerco Asilo. METHOD: 21 children (mean age [SD=1]: 39 months [1]; range 9-65 months) with a diagnosis of FD were included in the treatment for 24 weeks. Specifically, seven subjects were diagnosed with Infantile Anorexia (IA), nine subjects with Sensory Food Aversion (SFA), and five subjects with Feeding Disorder of Caregiver-Infant Reciprocity (FDCIR). RESULTS: The great majority of patients with SFA and with FDCIR resolved the FD, whereas children with IA did not respond well to the treatment. LIMITATIONS: The study's main limitations are the relatively small sample size, and the lack of a control group. CONCLUSIONS: Findings suggest that changes in the parentchild relationship could generally promote FD resolution, other than IA. These data may have implications for clinical practice suggesting the need to develop ad hoc intervention protocols tailored to children with IA and their families.

Links between Psychotropic Substance Use and Sensation Seeking in a Prevalence Study: The Role of Some Features of Parenting Style in a Large Sample of Adolescents.

Aims. The objectives of the study were to (a) investigate the prevalence risk of current drug users and (b) explore the association between parental monitoring, adolescent-parent relationship, family structure, financial status, and sensation-seeking and psychotropic substance use. Methods. Data were drawn from the 2002 Italian student population survey of the European School Survey Project on Alcohol and Other Drugs. The sample size was 10,790 adolescents, aged 15-19 years. Multivariate logistic analyses were performed. Findings. The prevalence of users was 27.3% (34.2% males; 21.6% females). Single-parent and reconstructed families were related to the greatest likelihood of substance use. A medium financial status and, for females, a satisfying relationship with father were protective factors. Probability of engaging in risk-taking behavior increased when parental knowledge decreased. Exploring deeper how parental monitoring could modify the relation between different traits of sensation seeking and substances use revealed the following: "thrill and adventure seeking," within the case of a good monitoring, can help against the use of substances; "boredom susceptibility" is not associated with drug use, except when parental monitoring is weak. Conclusions. Specific subdimensions, associated with substance use, may be more amenable to prevention than general interventions on sensation-seeking personality. Family is the context that could promote health education.

The effects of the macro-environment on treatment retention for problem cocaine users.

BACKGROUND: Client dropout is commonly used as an indicator of quality and effectiveness of drug treatment. Following increasing cocaine use in recent years, research has attempted to identify predictors of retention in treatment for cocaine users but there is no consensus about how individual characteristics and system variables (referral source, treatment setting), what we term here as the "macro-environment" - effect risk of dropout. This study sought to identify macro-environmental factors and examine the way these impact upon treatment retention. METHODS: A retrospective longitudinal study of an admission cohort among drug services in Vasta Romagna in Emilia Romagna Region, Italy (up to 8 years of treatment or until discharge) was conducted to determine the effect of macro-environmental variables on retention among first time admitted cocaine-dependent clients in different treatment settings. The sample consisted of 1178 clients meeting DSM-IV-R criteria for cocaine dependence. RESULTS: The joint effect of individual and system factors had a significant impact on dropout rates. In particular, lower rates of dropout were observed for those treated in prison and those who had a stable home, HR: 0.09 (0.02-0.48), or lived in rehabilitation units, HR: 0.36 (0.15-0.88), and among clients referred by the local authority and those living with parents, HR: 0.60 (0.38-0.95). CONCLUSION: The combined effect of individual and system factors on retention in treatment sets a critical background necessary to assess any impact of organizational dynamics and delineate the trajectory for future interventions.

Concordance and consistency of answers to the self-delivered ESPAD questionnaire on use of psychoactive substances.

Considering the prevalence of drug use in Italy, it is crucial to develop a reproducible screening test. Test-retest reliability and internal consistency are important indicators of a measurement's temporal stability and are a necessary condition for validity. The aim of the study was to assess the consistency and concordance of the European School Survey Project on Alcohol and Other Drugs (ESPAD) questionnaire; participating students completed the questionnaire twice, with a three-week interval. To verify the concordance for variables relating to use of alcohol, cigarettes and illicit drugs, the original ordinal variables as well as the same dichotomically recodified variables were used. Data analysis was done using Kappa and weighted Kappa. The method proposed by Lipsitz was used to evaluate the influence of gender and age on concordance. Questions about drug use, examined in ordinal form, show a good test-retest concordance and an excellent concordance for answers relating to the use of cigarettes, alcohol and cannabis. Regarding the effect of age adjusted for gender, 15-year-old subjects showed a lower concordance than 19-year-olds. ESPAD is a tool with a good reproducibility. Results focus on the effect of gender and age covariates on the concordance of answers regarding drug use and suggest the importance of examining the concordance in relation to the covariate levels.

Illegal substance use among Italian high school students: trends over 11 years (1999-2009).

PURPOSE: To monitor changes in habits in drug use among Italian high school students. METHODS: Cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) carried out in Italy annually for 11 years (1999-2009) with representative samples of youth attending high school. The sample size considered ranges from 15,752 to 41,365 students and response rate ranged from 85.5% to 98.6%. Data were analyzed to obtain measures of life-time prevalence (LT), use in the last year (LY), use in the last 30 days (LM), frequent use. Comparisons utilized difference in proportion tests. Tests for linear trends in proportion were performed using the Royston p trend test. RESULTS: When the time-averaged value was considered, cannabis (30% LT) was the most, and heroin the least (2%) frequently used, with cocaine (5%), hallucinogens (2%) and stimulants (2%) in between. A clear gender gap is evident for all drugs, more obvious for hallucinogens (average M/F LY prevalence ratio 2, range 1.7-2.4, p<0.05), less for cannabis (average M/F LY prevalence ratio 1.3, range 1.2-1.5, p<0.05). Data shows a change in trend between 2005 and 2008; in 2006 the trend for cannabis use and availability dropped and the price rose, while from 2005 cocaine and stimulant use prevalence showed a substantial increase and the price went down. After 2008 use of all substances seems to have decreased. CONCLUSIONS: Drug use is widespread among students in Italy, with cannabis being the most and heroin the least prevalent. Girls are less vulnerable than boys to illegal drug use. In recent years, a decrease in heroin use is overbalanced by a marked rise in hallucinogen and stimulant use.