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Establishing healthy eating habits during early childhood is essential for long-term health and prevention of non-communicable diseases. The Mediterranean Diet (MD) is recognized as one of the healthiest dietary patterns worldwide. This study aimed to evaluate dietary habits and adherence to the MD among preschool children using the Mediterranean Diet Quality Index (KIDMED) and to explore the influence of parental sociodemographic and anthropometric factors on children's dietary adherence. This cross-sectional study included 114 preschool children (24-60 months) from Sarajevo and Orašje, Bosnia and Herzegovina. Data were collected using a modified KIDMED questionnaire, assessing dietary habits and general sociodemographic information. Children's anthropometric parameters were obtained from medical records, and Body Mass Index (BMI) z-scores were calculated using WHO AnthroPlus. Descriptive statistics, group comparisons, and multiple linear regression were performed in RStudio (version 2024.12.0+467), with statistical significance set at p<0.05. The mean KIDMED score was 5.17±2.98 (median 6, interquartile range IQR 3-8), indicating moderate adherence to the MD. Thirty-four percent of children had a poor-quality diet, 36.8% required improvement, and 28.9% showed optimal adherence. Fruit and vegetable consumption was high, but intake of fish, whole grains, nuts, and olive oil was low. Parental education, employment, economic status, and BMI were not significantly associated with children's KIDMED scores (Regression correlation coefficient=0.249, p=0.433). Preschool children demonstrated moderate adherence to the MD, with clear signs of dietary westernization. Early, family-centered nutritional education is essential to promote and maintain healthy eating habits from early childhood.
Although notable efforts have been made to harmonise regulatory processes for the approval of new therapeutic drugs by the competent authorities, some discrepancies concerning risk-benefit assessments and regulatory actions remain. This analysis compared the approaches of the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) in the approval of new active substances and identified potential clinical implications associated with these differences in "Indication", "Contraindications" and "Posology and administration of drugs" sections of drug summary of products characteristics (SmPC). The overall analysis showed major differences in 63.9% for the indications, in 75% for contraindications and in 13.9% for posology. Considering the more represented therapeutic areas (cancer and haematology/haemostaseology drugs), the percentage of major differences for the indications was 70% in cancer area and 50% in haematology/haemostaseology area. For contraindications major differences were observed in 90% of cancer drugs, and 60% in haematology/haemostaseology drugs. Our findings highlight the need of further efforts on harmonizing decision making driven by scientific data between regulatory authorities in the interest of patients in a public health perspective.
Well-designed population-based seroepidemiological studies can be useful to refine estimates of infectious agent transmission and disease severity, thus representing an important component of epidemiological surveillance. However, the interpretation of results may be hampered by heterogeneous data quality and the lack of standardized methodology in some cases. The development and use of highly sensitive and accurate tools, refined over the past decades, have facilitated the study of current and past exposure to infectious agents in target populations. In particular, seroepidemiological studies provide a detailed overview of past and current infection burdens (i.e., respiratory infectious diseases), helping to identify high-risk groups and biomarkers of disease severity. They also help to understand the evolutionary dynamics of the disease over time, providing crucial information on its spread and community impact. Investing time and resources in seroepidemiological studies is essential, not only for monitoring the population's immunological status, but also for implementing strategies that promote public health and predict future infectious diseases scenarios.
The OECD Report "Digital and AI skills in health occupations: What do we know about new demand?" published in 2025 analyses the impact of digital technologies, AI, and advanced robotics on health occupations across OECD (Organisation for Economic Co-operation and Development) countries, with a particular focus on Canada, United Kingdom, and United States. Drawing on the analysis of more than 55 million online job postings (2018-2023), the study examines trends in the demand for digital skills and classifies health occupations according to their susceptibility to automation or augmentation. Conclusions indicate that, while a limited share of roles faces automation risks, a variety of health professions are expected to benefit from forms of task augmentation. The report highlights the need for tailored policies on lifelong training, data governance, and human-centred bioethical approaches to ensure the sustainable integration of AI into healthcare systems.
The recent guideline from the Italian Medicines Agency (Agenzia Italiana del Farmaco, AIFA) on observational studies prompts a broader reflection on the impact of regulations on clinical research and real-world evidence. While regulations are necessary to ensure ethical and scientific standards, their effectiveness in improving research quality is unclear. It is also uncertain whether these regulations strengthen clinical research or create bureaucratic obstacles. This quantitative, "before and after" study investigates the impact of the 2008 AIFA guideline and the 2018 General Data Protection Regulation (GDPR) on the complexity of ethical evaluation processes. As a secondary outcome, we also aimed to investigate whether the duration and probability of suspensions were influenced by intrinsic study characteristics (study design, rare disease, genetic data, post-authorization safety study). The study analyzed the ethical evaluation process of 112 observational multicenter studies with 2,875 submissions from 2002 to 2022, included in the database of Medineos srl. The number of suspensions observed in each evaluation process was a surrogate endpoint of complexity of evaluation process. Descriptive analyses and survival analysis were used to evaluate the total evaluation time, and a logistic model was applied to assess the probability of receiving a suspension. The median (and interquartile range) evaluation time for "pre-AIFA" submissions was 70 (41-133) days, whereas it was 75 (45-122) days for "post-AIFA" submissions. The median evaluation time was 68 (41-113) days without suspension and 127 (84-180) days with suspension. Post-AIFA submissions had a higher likelihood of suspension. The median evaluation time for "pre-GDPR" submissions was 70 (42-123) days, whereas it was 90 (63-140) days for "post-GDPR" submissions. AIFA guidelines slightly increased evaluation time and the likelihood of suspension, suggesting improved quality control. GDPR increased evaluation time due to privacy evaluations but did not affect suspension probability. Intrinsic study factors did not impact evaluation duration or suspension probability. Although more extensive analyses are necessary, this study suggests that past changes in Italian regulations have affected the evaluation by the Ethics Committee (EC) and have also impacted the conduct of the observational studies. The data generated can be useful for monitoring the future impact of the recently published new AIFA guideline.
The European guidelines on breast cancer and diagnosis recommend digital mammography (DM) or digital breast tomosynthesis (DBT) for screening asymptomatic women with an average risk of breast cancer. The research project innovation in mammography: tomosynthesis pathways (IMPETO) includes an interventional randomised trial conducted in Tuscany, Italy, aiming to assess the feasibility and impact of DBT in screening. Limited evidence exists on women's preferences and acceptability of this new technology. To address this gap, as part of the IMPETO trial, a questionnaire was administered to 441 women aged 45 at their first inclusion in the screening programme, to investigate women's awareness of tomosynthesis and their attitudes toward early diagnosis. This cross-sectional study was nested within the IMPETO trial, whose participants were randomly sampled. From October 2021 to February 2022 all women who participated in the face-to-face enrolment for the IMPETO trial were asked to fill out a structured questionnaire collecting socio-demographic information and assessing awareness of tomosynthesis, breast density, attitudes toward breast cancer early diagnosis, and sources of information on breast health. Multiple logistic regression was performed to identify predictors of tomosynthesis awareness and attitudes toward early diagnosis. Out of the 441 women surveyed, only 12% knew what tomosynthesis was and this awareness was positively associated with prior mammography experience (OR=2.092; 95% CI: 1.036-4.11). More than half of the participants (56.7%) had undergone mammography before joining the screening programme. Education attainment emerged as a significant predictor, with women holding a secondary degree being more likely to undergo mammography before age 45 (OR=2.18; 95% CI: 1.04-4.56). Among those who had undergone mammography before 45, 38.8% were advised by their gynaecologist, 27.6% made the decision independently, and 13.6% followed the advice of their general practitioner. This study highlights the need for improved education on screening appropriateness and associated risks and the importance of tailored communication to reduce knowledge differences across educational levels without increasing inappropriate use.
The COVID-19 pandemic had a profound impact on global health, notably affecting patients with non-COVID-19 conditions, who faced substantial disruptions in their treatment and care. The aim of this narrative review was to identify the main indicators used in literature to evaluate the indirect impact of COVID-19 on health and wellbeing. A literature search was conducted using PubMed from January 2021 to November 2022. The indicators were categorized into five main groups: burden of disease (BoD), life expectancy (LE), health-related quality of life (HRQoL), cost of illness and mental health status and were retrieved from 20 scientific articles. Disability-adjusted life years (DALYs) revealed substantial health losses; a decrease in LE was observed, with inequalities across population subgroups; HRQoL showed impairments in physical functioning, daily activities and emotional well-being; productivity losses were economically relevant and varied by context and elevated symptoms of anxiety and depression were reported. The compiled indicators may contribute to the development of sustainable pandemic mitigation policies.
To describe breastfeeding and associated factors in a large representative sample of children aged 0-2 years in Italy. Data from the 2022 Italian surveillance of children aged 0-2 years, comprised of 35,550 mothers, were analysed to estimate rates of EBF (exclusive breastfeeding), any breastfeeding (BF) and never breastfed (NBF). Logistic regression was used to investigate the association of EBF, BF and NBF with potential predictors. EBF among children aged 2-3 months varied from 36.4% in the South Italy to 54.0% in the North, decreasing respectively to 19.6% and 35.8% at 4-5 months. At 12-15 months BF ranged between 29.2% (South) and about 40% (Centre and North). Women with Italian citizenship, having a lower educational level, those who never attended antenatal classes (AC), and those residing in the South were significantly less likely to exclusively breastfeed or to breastfeed after the first year of life of the child. The data underscore the gap between recommendations and actual breastfeeding practices, offering the first national perspective that highlights territorial disparities. The findings emphasize the need for targeted interventions, particularly in light of identified regional and socio-economic differences.
Neurocognitive disorders are typical of older people. Psychological distress increased during the pandemic, particularly in young people. Although often underestimated, the impact of psychological distress on neurological disorders should be considered. As part of a longitudinal study conducted by the Italian Twin Registry (ITR) on the health effects of COVID-19 pandemic, we explored the onset of lasting neurological symptoms in relation with pre-existing psychological symptoms and/or SARS-Cov-2 infection. Online surveys on adult subjects of the ITR: in June 2020 we investigated symptoms of depression, anxiety and post-traumatic distress and, in December 2021, the onset of six persisting neurocognitive symptoms. SARS-CoV-2 infection was examined in both surveys. Associations of psychological symptoms and of viral infection with subsequent neurological manifestations were tested through logistic regression analysis. Among 1,784 participants (mean age 46.6), 42.8% reported neurological symptoms and 15.7% SARS-Cov-2 infection. Odds of neurological manifestations increased in participants with depressive or anxiety symptoms (ORs: 1.44 to 3.72), and in those with COVID-19 (ORs: 1.73 to 2.32). Anxiety symptoms explained more cases of cognitive symptoms (26.9% to 37.9%) than COVID-19 (9.1% to 15.5%). Smell/taste changes were strongly associated with viral infection (OR: 43.2). During the pandemic, widespread psychological distress contributed more than COVID-19 to the appearance of some cognitive symptoms in a relatively young population. Our findings indicates that preservation of neurological well-being cannot ignore mental health interventions.
Evidence for spontaneous seizure detection by dogs remains limited. This study examined whether ictal odor cues elicit behavioral responses in untrained companion dogs. To test whether dogs naïve to human epilepsy show spontaneous discrimination of ictal versus interictal odor. Thirty dogs, without prior seizure exposure, freely investigated three odor stations (ictal, interictal, blank) using sweat samples from a single unfamiliar donor in controlled, non-social conditions. Dogs were more likely to investigate the ictal odor first than expected by chance (Monte Carlo p=0.029), indicating an early orienting bias. No differences emerged in sustained engagement. Structured exploratory patterns occurred only in odor conditions (ictal p=0.001; interictal p=0.002), not in the control (p=0.715). Ictal odor may carry salience sufficient to influence initial attention in naïve dogs. However, findings are based on a single donor and require replication with multiple individuals to assess generalizability.
Intimate partner violence (IPV) profoundly impacts women's health, increasing the risk of chronic and non-communicable diseases. Recent findings underscore the promise of epigenetic indicators to uncover the enduring effects of trauma on the human genome, especially concerning stress-related conditions such as post-traumatic stress disorder (PTSD). To evaluate the lasting health impacts of violence against women, developing a digital tool specifically structured to consolidate crucial details about the contexts of violence, the relationship between victim and perpetrator, and health outcomes. A Microsoft Forms-based questionnaire was developed, organized into nine sections addressing socio-personal information, external conditions of violence, health statuses, and psychological evaluations, incorporating PTSD assessment via the International Trauma Questionnaire and depression measurement through the Center for epidemiologic studies depression scale revised (CESD-R) module. Data is securely archived, and participation includes optional consent for epigenetic analysis through blood samples. The assessment tool presents a thorough tool for gathering information on IPV, evaluating health outcomes, and identifying PTSD and depression in survivors. It also aids in the collection of biological specimens for epigenetic exploration. This instrument could enhance intervention strategies and contribute to precision medicine methodologies, facilitating early detection of chronic health risks in women who have experienced violence.
To present the strategy developed by the Local Health Authority AULSS6, Padua Province, Italy, for implementing artificial intelligence (AI) in healthcare systems. Between December 2024 and December 2025, a series of structured meetings of a multidisciplinary Steering Committee were conducted. Ideas, priorities and initiatives were systematically collected, categorized, and refined through consensus. The strategy produced several outcomes: an AI ethics and readiness checklist ensuring compliance with the EU AI Act, GDPR, (EU General Data Protection Regulation) and cybersecurity requirements; multi-level education programs for staff; systematic technology evaluation guidelines and HTA (Health Technology Assessment) evaluation studies planning; active participation in projects on AI for public health and clinical outcomes prediction and resource optimization; communication strategies designed to enhance transparency and trust. Collectively, these initiatives enabled AULSS6 to build institutional capacity for responsible AI adoption at the local level. AULSS6 shows that local health authorities can lead responsible AI implementation in healthcare. Its multidimensional approach close to the population offers a replicable, scalable model for health systems across Italy and Europe, advancing digital transformation through a bottom-up strategy close to the communities served.
The distribution of mycotoxins within cereal batches is highly heterogeneous. Therefore, to obtain representative samples and accurate analytical results, sample homogenization is a critical preparatory step. To provide reliable and standardized instructions for preparing an aggregate grain sample within official control framework, four different homogenization procedures were evaluated. The comparison considered variability in mycotoxin distribution, workload, and time constraints. The study was conducted on four aggregate samples, each weighing 10 kg, obtained from a maize grain batch according to regulatory provisions of Regulation (EU) 2023/2782. Analytical variability of aflatoxin (B1 and B2) and fumonisin (B1 and B2) was measured. The contamination levels in each pooled sample and the degree of homogeneity among the procedures were assessed and compared using the relative standard deviation of repeatability (RSDr) as acceptability criterion. The procedures involving fine grinding (particle size <0.5 mm) and aqueous slurry preparation yielded the best results in terms of homogeneity.
This paper summarizes the conclusions of the Expert Consensus (EC) on the use of platelet-rich plasma (PRP) in regenerative medicine. The initiative aimed to promote appropriate and effective clinical use of PRP based on current scientific evidence and expert experience. The main objectives are: to define a flexible operative range for PRP, allowing for personalized application; to establish principles for standardized clinical practice. The methods used to develop this EC involved the scientific literature review, the data quality assessment, the evaluation of practical experiences, the critical summary of reviewed literature, the development of questions for expert panel and the drafting of consensus statements. Recommendations emphasize compliance with legislation, proper device use and operator training. Adequate platelet load is essential for therapeutic efficacy; platelet recovery should be considered as quality standard. PRP has demonstrated effectiveness in managing diabetic and venous ulcers, osteoarthritis, and tendinopathies, although variability in protocols and inconsistent reporting limit the strength of evidence. Emerging applications include vasculitis, mucositis, and urogenital conditions, although further research is needed. The EC encourages multicentre research, strict publication standards, and international collaboration to strengthen scientific foundations for PRP use in regenerative medicine.
COVID-19 vaccines have proven effective and safe, enabling the resumption of normal life. However, misinformation has hindered vaccination efforts. This study aimed to investigate perceptions of vaccine safety among Italians through an anonymous online survey. An anonymous online survey was conducted from April to July 2022 and disseminated through social platforms, among adult individuals living in Italy. A total of 1,329 individuals participated. Younger individuals and healthcare professionals showed greater trust in vaccines. Education level was significantly associated with perceived vaccine safety. Most respondents, including many healthcare workers and highly educated individuals, believed vaccines to be safe, with confidence levels of 39.5% for mRNA, 32.9% for viral vector, and 39% for protein subunit vaccines. Younger age and trust in institutions were linked to higher confidence in all vaccine types. These findings may be useful to further investigate the drivers of vaccine safety perceptions and their relationship with vaccine hesitancy and may help to develop more effective communication campaigns in the future.
Accurate estimation of vaccine effectiveness (VE) in real-world settings is essential for guiding immunization strategies, especially in older populations. However, observational studies are prone to bias due to confounding factors, and the choice of statistical method can significantly influence VE estimates. We compared the performance of a multivariable Cox proportional hazards model with seven propensity score (PS)-based models to estimate the relative vaccine effectiveness (rVE) of the bivalent Original/Omicron BA.4-5 mRNA vaccine as a second or third booster, compared to a first mRNA booster received ≥120 days earlier. Data from 11,879,461 individuals aged ≥60 in Italy (April-June 2023) were analyzed. All models produced consistent rVE estimates, with values ranging from 16.4% to 22.1%. Over time, booster effectiveness declined, with the reference model showing a drop in rVE from 45.6% (15-60 days) to 14.3% (181-265 days). PS-based methods improved covariate balance but did not outperform the Cox model in terms of precision or interpretability. In large, relatively balanced datasets, traditional multivariable models remain a robust and reliable choice for estimating VE. While PS-based methods offer theoretical advantages, their practical benefit may be limited when confounding is well controlled.
Understanding pathogenetic background and risk factors is the primary step to a better behavioral and psychological symptoms of dementia (BPSD) management. To this aim, this exploratory study is designed to sketch some indicative correlations between BPSD severity and vascular, genetic and cognitive variables. A retrospective cross-sectional study conducted on medical reports of 135 Alzheimer Dementia (AD) patients from two memory clinics. Each subject underwent clinical examination and brain Magnetic Resonance Imaging (MRI), mini mental state examination (MMSE) and behavioral assessment using the neuropsychiatric inventory (NPI). This real-world cross-sectional study aimed to correlate the load of white matter lesions and global vascular compromise with clinical assessment. In addition, apolipoprotein E (ApoE) genotype was checked in 92 patients. Data were analysed performing Spearman correlation and principal component analysis (PCA). BPSD severity was independent from cognitive impairment, vascular impairment, white matter lesions and ApoE status. Our results do not confirm the possible role for vascular impairment in BPSD severity as previously reported. Studies focusing on different biological features in relation to other structural, psychosocial and environmental factors are needed in order to get a more reliable model.
The aim of this study is to describe data on occupational exposure to formaldehyde in the context of Italian economic activities. Measurement data of airborne concentrations (n=26,216) of formaldehyde in the period 1996-2024 were selected from the national register of occupational exposure to carcinogens (Sistema Informativo Registri di Esposizione Professionale, SIREP). Descriptive statistics were calculated for main exposure-related variables. The number of potentially exposed workers was estimated for the best-characterized sectors. The overall geometric mean was 0.028 mg/m3. Most of the exposure was found in the wood (n=4,912), chemical (n=4,090), and plastic industries (n=3,925). A different distribution of exposure was found according to gender, as women exposures were more common in the healthcare sector. The estimated number of potentially exposed workers in the selected sectors was approximately 100,000. The implementation of the new European Union (EU) regulation has enhanced the surveillance system, resulting in noteworthy improvements in the monitoring of occupational exposure to formaldehyde.
Disulfiram, acamprosate (ACM), naltrexone, and nalmefene are medications currently approved for the treatment of Alcohol Use Disorder (AUD). Baclofen and sodium oxybate (SO) have been approved for the treatment of AUD and alcohol withdrawal syndrome in France and Italy, respectively. However, concerning the effectiveness of combined therapies for AUD, data from the current literature are contrasting. To investigate the outcomes of combined therapy of SO and ACM for the maintenance of alcohol abstinence. A sample of 48 AUD patients consecutively enrolled and treated with SO (50-100 mg/kg of body weight, t.i.d.) plus ACM (666 mg three times daily; with dosage reduced in patients with body weight <60 kg) was observed for 12 weeks. At the 3-month visit, continuous abstinence from alcohol was maintained by 34 patients (70.8%). Fifteen patients (31.3%) reported side effects like nausea, dizziness, and abdominal pain, with no significant differences between abstinent and not abstinent patients. SO plus ACM may be an effective and safe pharmacological combination for maintaining alcohol abstinence in AUD patients. Future ad hoc clinical trials are needed to test this therapeutic association for AUD treatment.
Persons with autism spectrum disorder (ASD) may face significant challenges during transition from adolescence to adulthood. This phase necessitates tailored support to address all needs, underscoring the importance of a comprehensive life project (LP) planning. This scoping review aims to identify methods and tools used in the development of LP for persons with ASD. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) extension for scoping reviews was used. The literature search was performed across Embase, Scopus, Web of Science, PubMed, CINAHL, and PsycINFO. The selection process involved screening titles and s, followed by full-text reading, data extraction, and narrative synthesis of findings. A total of 899 records were identified, and 8 studies were included in the review. Preference assessment and ecological balance emerged as crucial elements in developing LP. This review highlights the importance of tools that accurately capture individual preferences and support needs for persons with ASD but also reveals a gap in the literature concerning the development of tailored LP for this population.