Lipid fingerprint-based histology accurately classifies nevus, primary melanoma, and metastatic melanoma samples.

Probably, the most important factor for the survival of a melanoma patient is early detection and precise diagnosis. Although in most cases these tasks are readily carried out by pathologists and dermatologists, there are still difficult cases in which no consensus among experts is achieved. To deal with such cases, new methodologies are required. Following this motivation, we explore here the use of lipid imaging mass spectrometry as a complementary tool for the aid in the diagnosis. Thus, 53 samples (15 nevus, 24 primary melanomas, and 14 metastasis) were explored with the aid of a mass spectrometer, using negative polarity. The rich lipid fingerprint obtained from the samples allowed us to set up an artificial intelligence-based classification model that achieved 100% of specificity and precision both in training and validation data sets. A deeper analysis of the image data shows that the technique reports important information on the tumor microenvironment that may give invaluable insights in the prognosis of the lesion, with the correct interpretation.

Online Gambling: A Systematic Review of Risk and Protective Factors in the Adult Population.

In recent decades, internet gambling has seen strong growth and diffusion due to intrinsic characteristics that make it particularly attractive to players (accessibility, anonymity, variety of games). This paper aims to present the current state of knowledge of the risk and protective factors of online gambling. A literature search conducted in the PubMed, PsychInfo, and Scopus databases found 42 articles, which were included in the review. Methodological aspects and risk and protective factors were analysed cross-sectionally. The results concerning risk and protective factors were distinguished by the level of analysis: individual, relational, and contextual. Two types of comparisons were considered: online vs. offline gamblers and online nonproblematic vs. problematic gamblers. The results of the two comparisons were juxtaposed to analyse their consistency and the different associations with factors. In general, the review showed that risk factors and variables at the individual level are investigated to a greater extent, while protective factors at the relational and contextual level need more in-depth study in future research. More specifically, this review found that even if online and offline gamblers shared most risk and protective factors, there are variables that they would not have in common. These factors could be important to consider in preventive interventions aimed at online gamblers and online problematic gamblers.

Health promoting schools and COVID-19: preparing for the future.

We face an unprecedented period of history during which COVID-19 is clustered with other global conditions, such as obesity, undernutrition, an infodemic, and climate change. This syndemic (synergy of epidemics) calls for the development of children's and youth's health literacy and socioemotional skills, support for behavioural hygiene (e.g. washing hands, wearing masks), and adults' responsibility and caring. Moreover, it calls for creating conditions for healthy living and learning for all and paying extra attention to inequalities that have increased during the pandemic. Today, more than ever, there is an essential demand for schools to create environments that maintain and promote health for all. Within this commentary, we argue that whole-school approaches, such as the health promoting school, are essential to fight against the pandemic and to prepare schools for future challenges.

Accessing Lanthanide-to-Lanthanide Energy Transfer in a Family of Site-Resolved [LnIII LnIII '] Heterodimetallic Complexes.

The ligand H3 L (6-[3-oxo-3-(2-hydroxyphenyl)propionyl]pyridine-2-carboxylic acid), which exhibits two different coordination pockets, has been exploited to engender and study energy transfer (ET) in two dinuclear [LnIII LnIII '] analogues of interest, [EuYb] and [NdYb]. Their structural and physical properties have been compared with newly synthesised analogues featuring no possible ET ([EuLu], [NdLu], and [GdYb]) and with the corresponding homometallic [EuEu] and [NdNd] analogues, which have been previously reported. Photophysical data suggest that ET between EuIII and YbIII does not occur to a significant extent, whereas emission from YbIII originates from sensitisation of the ligand. In contrast, energy migration seems to be occurring between the two NdIII centres in [NdNd], as well as in [NdYb], in which YbIII luminescence is thus, in part, sensitised by ET from Nd. This study shows the versatility of this molecular platform to further the investigation of lanthanide-to-lanthanide ET phenomena in defined molecular systems.

Controlled Heterometallic Composition in Linear Trinuclear [LnCeLn] Lanthanide Molecular Assemblies.

The combination of two different ß-diketone ligands facilitates the size-controlled assembly of pure heterometallic [LnLn'Ln] linear compounds thanks to two different coordination sites present in the molecular scaffold. [HoCeHo], [ErCeEr], and [YbCeYb] analogues are presented here and are characterized both in the solid state and in solution, demonstrating the selectivity of this unique method to produce heterometallic 4f molecular entities.

Selective Lanthanide Distribution within a Comprehensive Series of Heterometallic [LnPr] Complexes.

The preparation of heterometallic, lanthanide-only complexes is an extremely difficult synthetic challenge. By a ligand-based strategy, a complete isostructural series of dinuclear heterometallic [LnPr] complexes has been synthesized and structurally characterized. The two different coordination sites featured in this molecular entity allow study of the preferences of the praseodymium ion for a specific position depending on the ionic radii of the accompanying lanthanide partner. The purity of each heterometallic moiety has been evaluated in the solid state and in solution by means of crystallographic and spectrometric methods, respectively, revealing the limits of this strategy for ions with similar sizes. DFT calculations have been carried out to support the experimental results, confirming the nature of the site-selective lanthanide distribution. The predictable selectivity of this system has been exploited to assess the magnetic properties of the [DyPr] and [LuPr] derivatives, showing that the origin of the slow dynamics observed in the former arises from the dysprosium ion.

Delayed Allergic Reactions to Jellyfish Stings: Usefulness of Ultrasonographic Evaluation.

Jellyfish stings often cause immediate local skin reactions, and, less frequently, the affected individuals may develop delayed allergic reactions days or months after the sting. Here, we present 4 such cases. In all cases, color Doppler ultrasonography was performed at the time of diagnosis, and in 3 of the cases, clinical follow-ups with ultrasonographic evaluations were performed. Ultrasonography initially showed dermal thickening with decreased echogenicity that progressively normalized during follow-up. Ultrasonography was useful in quantifying inflammation by measuring the thickness of the dermis and was more precise than standard clinical follow-up of cutaneous lesions in these cases.

Thermodynamic Stability of Heterodimetallic [LnLn'] Complexes: Synthesis and DFT Studies.

The solid-state and solution configurations of the heterodimetallic complexes (Hpy)[LaEr(HL)3 (NO3 )(py)(H2 O)] (1), (Hpy)[CeEr(HL)3 (NO3 )(py)(H2 O)] (2), (Hpy)[CeGd(HL)3 (NO3 )(py)(H2 O)] (3), (Hpy)[PrSm(HL)3 (NO3 )(py)(H2 O)] (4), and (Hpy)2 [LaYb(HL)3 (NO3 )(H2 O)](NO3 ) (5), in which H3 L is 6-(3-oxo-3-(2-hydroxyphenyl)propionyl)pyridine-2-carboxylic acid and py is pyridine, were analyzed experimentally and by using DFT calculations. Complexes 3, 4, and 5 are described here for the first time, and were analyzed by using single-crystal X-ray diffraction and mass spectrometry. The theoretical study was also extended to the [LaCe] and [LaLu] analogues. The results are consistent with a remarkable selectivity of the metal distribution within the molecule in the solid state, enhanced by the size difference between the different ions. This selectivity was reduced in solution, particularly for ions with the most similar radii. This unique entry into 4f-4f'' heterometallic chemistry establishes for the first time the difference between the selectivity in solution and that in the solid state, as a result of changes to the coordination that follow the dissociation of terminal ligands upon dissolution of the complexes.

Preventing Adolescent Substance Use Through an Evidence-Based Program: Effects of the Italian Adaptation of Life Skills Training.

Evidence-based preventive interventions for adolescent substance use, violence, and mental health issues are increasingly being adapted and disseminated internationally. In the present paper, we report the results of an effectiveness study that was part of a comprehensive initiative by a coalition of health promotion organizations in the Lombardy region of Italy to select, culturally adapt, implement, evaluate, and sustain an evidence-based drug abuse prevention program developed in the USA. Findings are presented from a large-scale effectiveness study of the Life Skills Training prevention program among over 3000 students attending 55 middle schools in Italy. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills. Relative to comparison group students, students who received the prevention program were less likely to initiate smoking at the post-test and 2-year follow-up, and less likely to initiate weekly drunkenness at the 1-year follow-up. The program had direct positive effects on several cognitive, attitudinal, and skill variables believed to play a protective role in adolescent substance use. The findings from this study show that a drug abuse prevention program originally designed for adolescents in the USA is effective in a sample of Italian youth when a rigorous and systematic approach to cultural adaptation is followed that incorporates the input of multiple stakeholders.

Emergency contraceptive pill safety profile. Comparison of the results of a follow-up study to those coming from spontaneous reporting.

BACKGROUND: The emergency contraceptive pill (ECP) containing levonorgestrel is dispensed without a prescription in Spain since 2009. An easy access could diminish unwanted pregnancies; however, there is a risk of misuse and, in any case, of developing some adverse events. The aim of the present study is to further learn the adverse effects of this ECP. METHODS: An ad hoc follow-up study was carried out in three community pharmacies in a city of Central Spain; the sample was composed of those women asking for the ECP; they were interviewed by telephone after at least a month since the last menses. We completed the safety profile obtained with that coming from spontaneous reporting in Spain. RESULTS: Out of 139 women surveyed, 113 developed any adverse event--two considered as severe; the most frequently reported events were menstrual disturbances, which accounted for 21% of all events. Through spontaneous reporting, 36 cases of whatever adverse events related to levonorgestrel as ECP were identified. Twenty-five cases were considered as severe. Both types of reaction and severity were significantly different in the follow-up study and in the spontaneous reporting. Some of the reactions identified, such as miscarriage, febrile neutropenia, and porphyria, are not included in the Summary of Product Characteristics. CONCLUSIONS: Levonorgestrel as an ECP is mostly safe. Attention should be paid to some severe events and particularly to those risk factors for them to appear. Combining spontaneous reporting with an ad hoc follow-up study, the whole safety profile of a given medication can be obtained.

Heterodimetallic [LnLn'] lanthanide complexes: toward a chemical design of two-qubit molecular spin quantum gates.

A major challenge for realizing quantum computation is finding suitable systems to embody quantum bits (qubits) and quantum gates (qugates) in a robust and scalable architecture. An emerging bottom-up approach uses the electronic spins of lanthanides. Universal qugates may then be engineered by arranging in a molecule two interacting and different lanthanide ions. Preparing heterometallic lanthanide species is, however, extremely challenging. We have discovered a method to obtain [LnLn'] complexes with the appropriate requirements. Compound [CeEr] is deemed to represent an ideal situation. Both ions have a doubly degenerate magnetic ground state and can be addressed individually. Their isotopes have mainly zero nuclear spin, which enhances the electronic spin coherence. The analogues [Ce2], [Er2], [CeY], and [LaEr] have also been prepared to assist in showing that [CeEr] meets the qugate requirements, as revealed through magnetic susceptibility, specific heat, and EPR. Molecules could now be used for quantum information processing.

Lanthanide contraction within a series of asymmetric dinuclear [Ln2] complexes.

A complete isostructural series of dinuclear asymmetric lanthanide complexes has been synthesized by using the ligand 6-[3-oxo-3-(2-hydroxyphenyl)propionyl]pyridine-2-carboxylic acid (H3L). All complexes have the formula [Ln2(HL)2(H2L)(NO3)(py)(H2O)] (Ln = La (1), Ce (2), Pr (3), Nd (4), Sm (5), Eu (6), Gd (7), Tb (8), Dy (9), Ho (10), Er (11), Tm (12), Yb (13), Lu (14), Y (15); py = pyridine). Complexes of La to Yb and Y have been crystallographically characterized to reveal that the two metal ions are encapsulated within two distinct coordination environments of differing size. Whereas one site maintains the coordination number (nine) through the whole series, the other one increases from nine to ten owing to a change in the coordination mode of an NO3(-) ligand. This series offers a unique opportunity to study in detail the lanthanide contraction within complexes of more than one metal. This analysis shows that various representative parameters proportional to this contraction follow a quadratic decay as a function of the number n of f electrons. Slater's model for the atomic radii has been used to extract, from these decays, the shielding constant of 4f electrons. The average of O⋅⋅⋅O distances within the coordination polyhedra shared by both metals and of the Ln⋅⋅⋅Ln separations follow also a quadratic decay, therefore showing that such dependence holds also for parameters that receive the contribution of two lanthanide ions simultaneously. The magnetic behavior has been studied for all nondiamagnetic complexes. It reveals the effect of the spin-orbit coupling and a weak antiferromagnetic interaction between both metals. Photoluminescent studies of all the complexes in the series reveal a single broad emission band in the visible region, which is related to the coordinated ligand. On the other hand, the Nd, Er, and Yb complexes show features in the near-IR region due to metal-based transitions.

The importance of school leaders in school health promotion. A European call for systematic integration of health in professional development.

School leaders such as principals are key not only for educational and school quality but also for initiating and sustainably anchoring any innovation in schools. Although there is widespread agreement about the importance of holistic approaches to school health promotion, the role of principals has received increased, but not yet systematic, attention. In this context, it is unclear which leadership competencies are needed and to what extent they are taught. Hence, this paper aims to reflect whether and to what extend health promotion plays a role in preservice and inservice training of principals in Europe. Based on the results we call for a more systematic analysis of existing teaching opportunities and teaching needs for health-promoting leadership, the development of a European competence framework for health-promoting leadership, the development and implementation of a European system that monitors and evaluates the effectiveness of those preservice and inservice training programs, and the development of case-studies to stimulate a mutual learning process.

Melanoma Clinical Decision Support System: An Artificial Intelligence-Based Tool to Diagnose and Predict Disease Outcome in Early-Stage Melanoma Patients.

This study set out to assess the performance of an artificial intelligence (AI) algorithm based on clinical data and dermatoscopic imaging for the early diagnosis of melanoma, and its capacity to define the metastatic progression of melanoma through serological and histopathological biomarkers, enabling dermatologists to make more informed decisions about patient management. Integrated analysis of demographic data, images of the skin lesions, and serum and histopathological markers were analyzed in a group of 196 patients with melanoma. The interleukins (ILs) IL-4, IL-6, IL-10, and IL-17A as well as IFNγ (interferon), GM-CSF (granulocyte and macrophage colony-stimulating factor), TGFß (transforming growth factor), and the protein DCD (dermcidin) were quantified in the serum of melanoma patients at the time of diagnosis, and the expression of the RKIP, PIRIN, BCL2, BCL3, MITF, and ANXA5 proteins was detected by immunohistochemistry (IHC) in melanoma biopsies. An AI algorithm was used to improve the early diagnosis of melanoma and to predict the risk of metastasis and of disease-free survival. Two models were obtained to predict metastasis (including "all patients" or only patients "at early stages of melanoma"), and a series of attributes were seen to predict the progression of metastasis: Breslow thickness, infiltrating BCL-2 expressing lymphocytes, and IL-4 and IL-6 serum levels. Importantly, a decrease in serum GM-CSF seems to be a marker of poor prognosis in patients with early-stage melanomas.

Trends in the consumption of attention deficit hyperactivity disorder medications in Castilla y León (Spain): changes in the consumption pattern following the introduction of extended release methylphenidate.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is the most diagnosed behavioural disorder in children and adolescents; prevalence has been estimated around 5%. Studies have shown an increase in the use of ADHD medications during the last years. The aim of the present study was to learn the pattern and the evolution of ADHD medication consumption in Castilla y León (Spain). METHOD: Consumption data for the period 1992-2009 were obtained from databases containing information upon consumption and cost of medications dispensed by pharmacies at the expense of the Spanish National Health System. The data were expressed in defined daily doses (DDDs) per 1000 inhabitants per day (DDD/1000 inhabitants/day). A model to forecast consumption was built. RESULTS: Attention deficit hyperactivity disorder medication consumption increased in Castilla y León from 0.1 DDD/1000 inhabitants/day in 1992 to 1.5 DDD/1000 inhabitants/day in 2009; expected consumption will reach 2.5 DDD/1000 inhabitants/day by 2013. The drugs accounting for this increase were mainly made up of methylphenidate preparations (1.4 DDD/1000 inhabitants/day in 2009). From 1992 to 1999, there was a slight reduction in methylphenidate use; following amphetamine withdrawal, the consumption of stimulants began to increase, and figures showed a sharp rise after marketing of extended-release formulations in 2003. CONCLUSIONS: There has been an enormous increase in ADHD medication consumption in Castilla y León in the last few years; increase rocketed when extended-release methylphenidate was marketed. A rapid increase in the consumption is a warning on possible overdiagnosis and inappropriate prescription.

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.

Impact of the COVID-19 pandemic on care and psychological impact on cancer patients.

PURPOSE OF REVIEW: To summarize the current literature on the psychological impact of COVID-19 on patients with cancer, both in terms of the impact of the virus itself and of changes in the healthcare system; and to describe current recommendations for supporting patients with cancer during the pandemic. RECENT FINDINGS: Multiple studies have shown that patients with cancer experience high levels of psychological distress during COVID-19. Factors of greater vulnerability have been described as: being young, being female, low socioeconomic status, lower educational level, having low levels of hope or optimism, lower social support, and having cancer with curative intent. The severe acute respiratory syndrome-coronavirus-2pandemic has accelerated the healthcare digitization process. All departments involved in the diagnosis and treatment of cancer have made contingency plans to minimize the impact on patients. SUMMARY: Psychological distress is one of the most frequently occurring symptoms in patients with cancer during the pandemic. The COVID-19 pandemic has led to a restructuring of the healthcare system. The paradigm shift may pose a challenge for both healthcare professionals and patients.

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.

Multiple Health Behavior Programs in School Settings: Strategies to Promote Transfer-of-Learning Through Life Skills Education.

Typically, schools implement health promotion programs that focus on a single behavioral domain. Multiple related health topics may be addressed using separate interventions, potentially producing overlap in program content. However, integrative approaches in health promotion have the potential to produce interventions capable of improving multiple health behaviors. In particular, more research is needed to identify the conditions and the factors that can promote the transfer of learning to broaden the target outcomes of health promotion programs. The present study aims to identify the characteristics of an evidence-based life skills education program that can facilitate the transfer of learning to different health behaviors not initially targeted by the program, and the strategies for achieving successful transfer. A two round Delphi method was used with a diverse group of 21 experts in health promotion, life skills education, and methods of pedagogy for early adolescent students. Questionnaires with open and closed-ended questions were administered on-line. Content qualitative analysis was run, integrating codes, subcategories, and categories of the two rounds of the study. Results showed strong consensus among experts about the potential for promoting the transfer of skills from one health domain to another. Many elements were identified as important factors that facilitate the transfer of learning. Strategies for successful transfer were related to teaching methods, educational approaches, and consistency with the broader school curriculum. Findings suggest that the successful transfer of learning to a new health domain requires that educators recognize its importance and explicitly designate it as an educational aim.