P.A.V.I.A. Study: Pervasiveness and Associated Factors of Video Slot Machine Use in a Large Sample of Italian Adolescents.

Video slot machines (VSM) are considered a particularly harmful gambling format; however, scant data is available on their use among underage Italian individuals. Two surveys were conducted in 2018 and 2022 involving 7,959 underage high school students (57.8% female) in Pavia, Northern Italy. We estimated adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI) for lifetime experience and current regular (at least monthly) use of VSM, according to family, educational and behavioral factors. Overall, participants reporting lifetime VSM experience were 13.2% (95% CI: 12.5 - 13.9), 15.2% (95% CI: 14.0-16.4%) in 2018, and 12.0% (95% CI: 11.1-13.0%) in 2022. Current regular VSM users were 1.4% (95% CI: 1.1-1.7) in total, 1.2% (95% CI: 0.8-1.6%) in 2018 and 1.5% (95% CI: 1.1-1.8%) in 2022. VSM lifetime experience and current regular use were significantly more frequent in males (aORs: 1.55 and 4.81, respectively), students who failed a year (aORs: 2.07 and 3.44), or with daily gambling parents/siblings (aORs: 2.83 and 4.86). Lifetime use of alcohol, tobacco, or illicit substances was significantly directly associated with lifetime VSM use (aORs between 2.64 and 4.75); monthly alcohol, tobacco, or illicit substances use was significantly directly associated with current regular VSM use (aORs between 4.47 and 18.21). Sexting and voluntary self-injury were significantly more frequent among VSM lifetime/current regular users. VSM use, which is directly associated with other risky behaviors, may be pervasive among Italian minors. Such public health concern calls for legislative enforcements and integrated multidisciplinary health promotion and prevention strategies.

Cannabis reduction among adolescents as spillover from successful tobacco control.

BACKGROUND: National programs that reduce adolescent cannabis use warrant renewed attention in light of current discussions to reform cannabis legislation, including the possibility of legalization for recreational use. This study measures the size of a decrease in a country's prevalence of adolescent cannabis use that accompanies a decrease in its prevalence of adolescents who had ever smoked a cigarette. METHODS: Data are from the European School Survey Project on Alcohol and Other Drugs (ESPAD), which is a collaborative effort of more than 40 European countries to surveil adolescent substance use. This study uses data from the seven survey administrations in 1995, 1999, 2003, 2007, 2011, 2015, and 2019. The main analysis is a fixed-effect regression analysis of country-level, four-year changes in adolescent lifetime cannabis use prevalence on country-level, four-year changes in adolescent lifetime cigarette use prevalence. RESULTS: Decreases in the national prevalence of adolescents who had ever smoked a cigarette were accompanied by decreases half as large in national prevalence of adolescent lifetime cannabis use. CONCLUSION: For European countries considering the legalization of adult recreational cannabis use, tobacco control can offer a tool to help counter potential increases in cannabis use among adolescents.

Impaired Well-Being and Insomnia as Residuals of Resolved Medical Conditions: Survey in the Italian Population.

BACKGROUND: Well-being encompasses physical, mental, social, and cultural aspects. Sleep quality and pathologies are among the objective conditions jeopardising it. Chronic insomnia, inflammatory-based diseases, and mood disorders often occur in a single cluster, and inflammation can negatively impact sleep, potentially harming well-being. Some evidence from specific clinical populations suggests that also some resolved past diseases could still have an impact on present sleep quality and well-being. The aim of the present study is to investigate, in the general population, whether and to what degree well-being and insomnia are associated with resolved pathologies. METHODS: A cross-sectional survey (IPSAD®) was carried out using anonymous postal questionnaires that investigated past and present general health, well-being, and insomnia. A total of 10,467 subjects answered the questionnaire. RESULTS: Several classes of both current and resolved pathologies resulted in increased odds ratios for current insomnia (odds ratios = 1.90; 1.43, respectively) and impaired well-being (odds ratios = 1.75; 1.33, respectively), proportional to the number of the displayed pathologies. Notably, both current and resolved past psychiatric disorders were strongly associated with both current impaired well-being (odds ratios = 5.38; 1.70, respectively) and insomnia (odds ratios = 4.99; 2.15, respectively). CONCLUSIONS: To explain these associations, we suggest that systemic inflammation conveyed by several medical conditions disrupts homeostatic processes, with final effects on sleep quality and behaviour.

Consequences of COVID-19 pandemic on weight gain and physical activity: a prospective cohort study from Italy.

INTRODUCTION: It is crucial to monitor changes in body weight and physical activity (PA) to understand if short-term effects of COVID-19 pandemic have had implications over time. METHODS: This longitudinal study is based on data from 4,831 Italians aged 18-74 years interviewed during the first phase of COVID-19 pandemic (April-May 2020) and two years later (February-March 2022). Changes in body weight and PA were assessed through multivariable analyses in association with socio-demographic and psychological characteristics. RESULTS: Over the two years, 17.4% reported a weight gain of at least 5 kg and 32.8% a decreased PA by at least 4 hours per week. Weight gain and decreased PA were more frequent in participants from the less wealthy areas, with lower educational level and those who reported a worsening in mental health. CONCLUSIONS: After two years from the start of the pandemic, in Italy we observed a trend toward a renormalization of body weight and PA. The segments of the population mostly affected by the pandemic are subjects with more disadvantaged socio-economic status and with an impaired mental health.

Executive functions and addictions: a Structural Equation Modeling Approach and the Italian validation of the Adult Executive Functioning Inventory (ADEXI).

INTRODUCTION: the work aims to observe the associations between psychoactive substance use and gambling and executive functioning as well as to validate the Italian version of the "Adult Executive Functioning Inventory" (ADEXI) scale. METHODS: data were collected through a representative cross-sectional study among 5,160 people (18-84 years old) called IPSAD® (Italian Population Survey on Alcohol and Other Drugs). Structural Equation Modeling (SEM) was performed to explore the associations between ADEXI and other behaviors measured with standardized questionnaires. Cronbach α has been performed to investigate the psychometric properties of the Italian version of the ADEXI scale. RESULTS: SEM showed that both WM and INH were correlated with problematic cannabis use (WM r = 0.112; INH r = 0.251) and gambling (WM r = 0.101; INH r = 0.168), while problematic alcohol use was correlated only with INH (r = 0.233). Cronbach α for the WM subscale was 0.833 (CI 0.826-0.840), while for INH was 0.694 (CI 0.680-0.708). CONCLUSION: results pointed out a strong correlation between addictions (substance-related and non-substance-related) and WM and INH impairments among the adult general population. Moreover, the ADEXI scale could be considered a valuable tool for general population surveys to detect working memory and inhibition characteristics.

Analysis of the direct economic impact of smoking-related hospitalizations in Italy.

INTRODUCTION: Tobacco-related diseases have a substantial economic impact in terms of medical expenses, loss of productivity, and premature death. Tobacco use is estimated to be responsible for more than 90000 deaths each year in Italy. We aimed to evaluate the annual direct economic impact on the National Health System of hospitalizations attributable to tobacco smoking in Italy. METHODS: We analyzed data from all the hospitalizations of patients aged ≥30 years that occurred in Italy for 12 selected tobacco-related diseases, during 2018. These diseases included oropharyngeal cancer, esophageal cancer, gastric cancer, lung cancer, pancreatic cancer, bladder cancer, laryngeal cancer, ischemic heart disease, stroke, diseases of arteries, arterioles, and capillaries, pneumonia and influenza, and chronic obstructive pulmonary disease. We obtained information on 984322 hospital discharge records, including each hospitalization's direct costs. Using relative risk estimates from the scientific literature, we computed the population attributable fraction for various tobacco-related diseases to estimate the economic impact attributable to tobacco smoking. RESULTS: One-third of all hospitalizations occurred in 2018 in Italy among people aged ≥30 years for 12 tobacco-related diseases were found to be attributable to smoking, accounting for a total cost of €1.64 billion. Among the diseases considered, those with the highest expenditures attributable to tobacco smoking were ischemic heart disease, cerebrovascular disease, and lung cancer, accounting for €556 million, €290 million, and €229 million, respectively. CONCLUSIONS: Tobacco has a substantial economic impact in Italy, accounting for around 6% of the total cost of hospitalizations in 2018. This figure is expected to be largely underestimated due to several conservative assumptions adopted in the statistical analyses. It is imperative to prioritize comprehensive tobacco control measures to counteract the huge healthcare costs due to tobacco smoking.

Sleep disorders during the COVID-19 pandemic: Results from the second phase of web-based EPICOVID19 study.

The COVID-19 pandemic has induced significant impairments, including sleep disturbances. The present study aimed to explore the impact of fear in relation to stress on sleep disorders among Italian adults and older participants in the second phase of the EPICOVID19 web-based survey (January-February 2021). Sleep disturbances during the pandemic were evaluated using the Jenkins Sleep Scale, perceived stress through the 10-item Perceived Stress Scale and fear of contagion and about economic and job situation with four ad hoc items. The strength of the pathways between stress, sleep disturbances and fear was explored using structural equation modelling, hypothesising that stress was related to sleep disturbances and that fear was associated with both stress and sleep problems. Out of 41,473 participants (74.7% women; mean age 49.7 ± 13.1 years), 8.1% reported sleep disturbances and were more frequently women, employed in a work category at risk of infection or unemployed, and showed higher deprivation scores. Considering an a priori hypotheses model defining sleep and stress scores as endogenous variables and fear as an exogenous variable, we found that fear was associated with sleep problems and stress, and stress was associated with sleep problems; almost half of the total impact of fear on sleep quality was mediated by stress. The impact of stress on sleep quality was more evident in the younger age group, among individuals with a lower socioeconomic status and healthcare workers. Fear related to COVID-19 seem to be associated with sleep disturbances directly and indirectly through stress.

Adaptive Machine Learning Approach for Importance Evaluation of Multimodal Breast Cancer Radiomic Features.

Breast cancer holds the highest diagnosis rate among female tumors and is the leading cause of death among women. Quantitative analysis of radiological images shows the potential to address several medical challenges, including the early detection and classification of breast tumors. In the P.I.N.K study, 66 women were enrolled. Their paired Automated Breast Volume Scanner (ABVS) and Digital Breast Tomosynthesis (DBT) images, annotated with cancerous lesions, populated the first ABVS+DBT dataset. This enabled not only a radiomic analysis for the malignant vs. benign breast cancer classification, but also the comparison of the two modalities. For this purpose, the models were trained using a leave-one-out nested cross-validation strategy combined with a proper threshold selection approach. This approach provides statistically significant results even with medium-sized data sets. Additionally it provides distributional variables of importance, thus identifying the most informative radiomic features. The analysis proved the predictive capacity of radiomic models even using a reduced number of features. Indeed, from tomography we achieved AUC-ROC 89.9 % using 19 features and 92.1 % using 7 of them; while from ABVS we attained an AUC-ROC of 72.3 % using 22 features and 85.8 % using only 3 features. Although the predictive power of DBT outperforms ABVS, when comparing the predictions at the patient level, only 8.7% of lesions are misclassified by both methods, suggesting a partial complementarity. Notably, promising results (AUC-ROC ABVS-DBT 71.8 % - 74.1 % ) were achieved using non-geometric features, thus opening the way to the integration of virtual biopsy in medical routine.