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Demoralization comprises multiple dimensions. Among them, Subjective Incompetence (SI) is the perception of being incapable of appropriate action in demanding circumstances. SI may be an early sign of demoralization preceding hopelessness, thus we aimed at integrating items related to Subjective Incompetence into the clinical assessment of demoralization. We assessed 414 subjects from the general population with the Demoralization Scale, 24 items (DS24) and the Subjective Incompetence Scale, 12 items (SIS12). We used multiple approaches to detect the optimal number of factors and their item structure, then conducted Bayesian Item Response Theory analyses to study item psychometric properties. Item Response Theory models were used to extrapolate latent severity ratings of clinical dimensions. We modelled the DS24 with five factors (Disheartenment, Sense of Failure, Helplessness, Irritability, Loss of Purpose) and the SIS12 with three (Subjective Incompetence, Inability to plan, Inability to Deal). The more complex IRT model had the best predictive value and helped to identify the items with better discrimination properties across the different dimensions. Twenty items were retained and used to develop the combined Demoralization and Subjective Incompetence Scale (DSIS20), which maintained high correlation with raw and latent trait scores of the longer versions. We combined selected items of the DS24 and the SIS12 to develop the DSIS20, a shorter assessment instrument that includes Subjective Incompetence as well as other clinical dimensions of demoralization. Further study may clarify if DSIS20 may be helpful for the early detection of demoralization. [ABSTRACT FROM AUTHOR]

Background: Pictorial warnings may contribute to lower attractiveness of smoking, particularly among adolescents. The present study compared the impact of two different label styles of tobacco product warnings (textual and pictorial) among adolescents in a new standardized way, using the Adolescent Label Impact Index (ALII). Methods: A school-based cross-sectional study was conducted. Adolescent aged 10-20 years completed an online questionnaire. The ALII score was used to assess the impact of only-textual (ALII-T) and pictorial advertisements (ALII-P). Results: A total of 1,759 students (68.4% response-rate) declared that graphic warnings have a significant impact than textual ones (p < 0.05). The younger group, which has never smoked or just tried and believed in the harmful effects of tobacco, is associated with both scales of ALII scales (T and P) (p < 0.01). The socioeconomic status was associated with ALIIT (p < 0.01), but not ALII-P; female gender, smoker-peers, perception of the body weight are related to the ALII-P (p < 0.05) but not ALII-T. Conclusions: The pictorial labels represent a policy of tobacco use control that has potential effects, in particular in reducing communication inequalities between socio-economic categories, reinforcing the knowledge about the damage of smoking, discouraging adolescents, especially the younger ones who do not have never smoked or have just tried to become smokers. [This article was co-written by Collaborative Group including: Siriana Campioni, Armando Platania, Ilenia Bellini, Omar Enzo Santangelo, and Clara Ferrara.]

In the current context of joint efforts towards the decarbonisation of buildings, integrating occupants' comfort and health with latest technological advancements for energy efficiency is at the center of the latest development of research, policies and professional practice. Radiant systems are encountering great success since the low-thickness systems can also be used in renovation projects for both heating and cooling, while guaranteeing optimal comfort. However, dehumidification is often required for optimal radiant cooling operation with no condensation risks, and the great potential of mechanical ventilation systems to optimally address the needs for dehumidification, air renewal, health and energy efficiency appears to be far from its full exploitation in the post-COVID-19 era. The present paper aims at providing a quantification of the energy and financial impacts of the implementation of a controlled mechanical ventilation system (CMV) coupled to a radiant system in a typical residential case study building in Italy. The results show that the sole CMV may decrease primary energy demand and energy costs by more than 30% and contribute to an increase in the smart readiness of the building by 8%, but further incentive policies must be developed to cover the still high investment and maintenance cost. [ABSTRACT FROM AUTHOR]

Introduction: Conducted under the auspices of the Italian Society of Consultation Liaison Psychiatry (SIPC) the aim of this study was to describe the characteristics of Consultation Liaison Psychiatry (CLP) activity in Italy (SIPC2—2018) over the past 20 years by comparing with data from the first Italian nation-wide study (SIPC-1—1998). Methods: We collected data on CLP visits of 3,943 patients from 10 Italian hospitals over a period of 1 year. Data were compared with those from the SIPC-1 1998 study (4,183 participants). Patients were assessed with the same ad hoc 60-item Patient Registration Form recording information from five different areas: Sociodemographic, hospitalization-related, consultation related, interventions and outcome. Results: Compared with participants from the previous study, SIPC-2- 2018 participants were significantly older (d = 0.54) and hospitalized for a longer duration (d = 0.20). The current study detected an increase in the proportion of referrals from surgical wards and for individuals affected by onco-hematologic diseases. Depressive disorders still represented the most frequent psychiatric diagnosis, followed by adjustment and stress disorders and delirium/dementia. Also, CLP psychiatrists prescribed more often antidepressants (8 = 0.13), antipsychotics (8 = 0.09), mood stabilizers (8 = 0.24), and less often benzodiazepines (8 = 0.07). Conclusion: CLP workload has increased considerably in the past 20 years in Italy, with changes in patient demographic and clinical characteristics. A trend toward increase in medication-based patient management was observed. These findings suggest that the psychiatric needs of patients admitted to the general hospital are more frequently addressed by referring physicians, although Italian CLP services still deserve better organization and autonomy. [ABSTRACT FROM AUTHOR]

The building sector has great potential for contributing to the 2030 EU goals of decreasing greenhouse gas emissions and increasing production from renewable sources. This is even more important considering the increasing cooling energy needs. Among the available technologies, solar cooling (SC) represents a good alternative to traditional electric chillers. However, its use in residential buildings is still limited. The aim of this paper is to analyse the potential of solar cooling system in multi-family buildings. A dynamic model of a complete SC system with auxiliary components was developed in TRNSYS to meet the energy demand of a representative nearly zero energy multi-family building in Italy. The performance of different system design alternatives was analysed in eight different climates with special focus on energy storages. The results show how solar cooling should be optimally designed and provide quantification of achievable renewable energy ratios and related costs in the different climates. • Weather is a determining factor for the design of Solar Cooling (SC) systems. • Solar Cooling represent a valuable alternative for nZEB space cooling. • Dynamic modelling for optimization of thermal storage is crucial to ensure SC performance. • Global design choices should include cost-optimal analysis. • A best design scenario has been identified economically and energetically. [ABSTRACT FROM AUTHOR]

Italy was one of the countries most affected by the number of people infected and dead during the first COVID-19 wave. The authors describe the rapid rollout of a population health clinical and organizational response in preparedness and capabilities to support the first wave of the COVID-19 pandemic in the Italian province of Modena. The authors review the processes, the challenges faced, and describe how excess demand for hospital services was successfully mitigated and thus overwhelming the healthcare services avoided the collapse of the local health care system. An analysis of bed occupancy in the region predicted during the first weeks of the epidemic. The SEIR model estimated the number of infected people under different containment measures. Community resources were mobilized to reduce provincial hospitals' burden of care. A population health approach, based on a radical reorganization of the workflow and emergency patient management, was implemented. The bed saturation of the Modena Healthcare Agency was measured by an ad hoc, newly implemented intensive care unit (ICU) bed occupancy and COVID-19 centralized governance dashboard. ICU bed occupancy increased by 114%, avoiding saturation of the Modena Healthcare Agency system. The Emilia-Romagna region achieved a higher rate of ICU bed availability at 2.15 ICU beds per 10,000 inhabitants as compared with community 1 ICU bed availability prior to the pandemic. Rapid and radical local reorganization of regional efforts helped inform the successful development and implementation of strategic choices within the hospital and the community to prevent the saturation of key facilities. [ABSTRACT FROM AUTHOR]

During the current COVID-19 disease emergency, it is not only an ethical imperative but also a public health responsibility to keep the network of community psychiatry services operational, particularly for the most vulnerable subjects (those with mental illness, disability, and chronic conditions). At the same time, it is necessary to reduce the spread of the COVID-19 disease within the outpatient and inpatient services affiliated with Mental Health Departments. These instructions, first published online on 16 March 2020 in their original Italian version, provide a detailed description of actions, proposed by the Italian Society of Epidemiological Psychiatry, addressed to Italian Mental Health Departments during the current COVID-19 pandemic. The overall goal of the operational instructions is to guarantee, during the current health emergency, the provision of the best health care possible, taking into account both public health necessities and the safety of procedures. These instructions could represent a useful resource to mental health providers, and stakeholders to face the current pandemic for which most of Mental Health Departments worldwide are not prepared to. These instructions could provide guidance and offer practical tools which can enable professionals and decision makers to foresee challenges, like those already experienced in Italy, which in part can be avoided or minimised if timely planned. These strategies can be shared and adopted, with the appropriate adjustments, by Mental Health Departments in other countries. [ABSTRACT FROM AUTHOR]

Background: Hip fractures (HF) are a major issue worldwide. We aimed at evaluating the practices in delivering care to patients with HF among several Italian Orthogeriatric centers. Methods: The study took place from February 2016 to July 2018. Seven performance indicators (pre-surgical cognitive assessment, surgery performed ≤ 48 h from fracture, removal of urinary catheter/absence of delirium/start of physiotherapy on the first post-operative day, prescription of bone protection at discharge, and discharge toward rehabilitation) were collected. Results: The 14 participating hospitals totally recruited 3.017 patients. Patients were old (median age 86 years; Inter Quartile Range [IQR] 80–90), mostly females (77%). Nearly 55% of them were already impaired in mobility and about 10% were nursing home residents. Median time-to-surgery was 41 h (IQR 23–62). Models of care greatly varied among centers, only 49.3% of patients being co-managed by geriatricians and orthopedics. There was high variability across centers in four indicators ("pre-surgical cognitive assessment", "bone protection prescription", "use of urinary catheter" and "start of physiotherapy"), moderate in two indicators ("surgery performed ≤ 48 h from fracture" and "discharge toward rehabilitation" and low in one ("absence of delirium on day following surgery"). Comparison with international studies suggests very different ways of providing care to HF Italian patients. Conclusions: The study results suggest high inter-center variability in the key-performance indicators, and different approaches in providing care to our HF patients in comparison to other countries. A National debate on the topic is required in Italy to harmonize practices of orthogeriatric care. [ABSTRACT FROM AUTHOR]

Despite the recommendation of the EU environmental policies, the Italian waste management system still needs of further assessment processes. Until recently, some areas, especially in the South, have experienced serious waste management crises, mainly due to low rates of separate waste collection. This paper aims to investigate the driving factors of the landfill disposal rate. This may allow to suggest some policy recipes in order to reduce the percentage of waste disposed of at landfills and, consequently, to promote healthy environment and the citizens' health. Therefore, we propose a cluster analysis and a quantile regression technique to evaluate the magnitude of the socioeconomic and institutional factors on the landfill disposal rate. Results show that the separate collection process plays a key role to effectively reduce the waste disposed of in landfills. In this context, enhancing prevention, re-use, recycling and recovery activities becomes necessary. [ABSTRACT FROM AUTHOR]

In July 2017, twenty cattle of a free-grazing herd were found to be infested with leeches in the mouth. Main signs were bloody sialorrhea and/or a purple-red colour of the lower lip. Leeches, in a variable number (1 to 3) per animal, were found at the lingual frenulum or on the sublingual vestibular mucosa and were morphologically identified as Limnatis nilotica. To the best of our knowledge, this is the first report of cattle infestation by L. nilotica in Italy. Besides recalling the attention to leech infestation and suggesting its inclusion in the differential diagnosis of animals with suggestive signs, this short report also provides practitioners with easy-going morphological keys for proper diagnosis and discrimination among species. [ABSTRACT FROM AUTHOR]

Aim: To report on the development of an early intervention service in Modena, Italy, with information relevant to the first 4 years of implementation. Methods: The 2‐year service was offered to people aged 18‐35 with psychotic manifestations, within 2 years from psychosis onset/or naïve to antipsychotics, by teams placed within community mental health Centres, according to a "specialist within generalist" model. Treatment included pharmacological consultation, psychoeducation and social inclusion programs. Health of the Nation Outcome Scale was administered at baseline and every 6 months. Results: One hundred cases accepted the treatment from 1 March 2013 to 31 December 2016. Of these, 71% were male with a median age of 23. Ninety percent were diagnosed with non‐affective psychosis, yielding an estimated treated incidence of 19.1/105. General practitioners (GPs)represented the most frequent referrers to the program (38%), followed by referrals from acute general and psychiatric hospital units (22%) and self‐referrals (14%). Meaningful clinical improvement was observed, 6 months after enrolment. Conclusions: An early intervention service for psychosis was successfully implemented within existing community outpatient services. GPs represented the main referrals, providing some validation of the "specialist within generalist" model of care. A promising clinical improvement and trend of reduction in duration of untreated psychosis was found, supporting the variety of early detection efforts in the community. The high median age and lack of information about pathways to care underline possible barriers to access for younger patients. These findings will inform refinement of treatments and service models for the Region. [ABSTRACT FROM AUTHOR]

Featured Application: The results of this paper can support the design of nearly zero-energy single-family houses in the Italian context. The provided methodological framework can support the design of nearly zero-energy buildings and be replicated in different contexts. The effective design of nearly zero-energy buildings depends on a large set of interdependent variables, which affect both energy demand and supply. Considering them simultaneously is fundamental when searching for optimal design of nearly zero-energy buildings, as encouraged by the EU in the second recast of the Energy Performance of Building Directive (EPBD). This paper presents the application of the new energy demand and supply simultaneous optimization (EDeSSOpt) methodology to optimize the design of a single-family house in the Italian context. Both primary energy optimization and financial optimization are carried out in the context of European regulations. Robustness of the resulting optimal solution is studied through analysis of optimum neighborhoods. The resulting cost-optimized solution relies on a moderately insulated envelope, a highly efficient system, and 34% of coverage from renewables. The energy-optimized solution requires a higher level of insulation and a higher coverage from renewables, demonstrating that there is still a gap between energy and cost optimums. Beyond the results, integrated optimization by means of EDeSSOpt is demonstrated to better minimize cost functions while improving the robustness of results. [ABSTRACT FROM AUTHOR]

Dementia is an increasing challenge for health care and social system in developed countries. Interventions with a cognitive focus, also using assistive technology, are leading to promising results in improving cognitive and behavior symptoms in individuals with dementia. Aim of our study was to evaluate the combined effects of the standard cognitive training in addition to web-based rehabilitation in dementia people living in a nursing home. We have studied twenty dementia people (10 females and 10 males) with a mild to moderate cognitive decline (MMSE 25 ± 3.4) associated to moderate behavioral alterations, and mainly due to vascular causes. These patients were randomly assigned to one of two groups (experimental or standard treatment-namely the control group). All participants in the experimental group completed the specific training, consisting of 24 sessions of web-based cognitive training, for 8 weeks, in addition to standard rehabilitation. Each participant was evaluated by a skilled neuropsychologist before and after each treatment. The experimental group had a statistically significant change of the Geriatric Depression Scale (p = 0.03), Constructive Apraxia (p < 0.001), Matrices Attentive (p = 0.01), and Mini Mental State Examination (p = 0.04). Web-based cognitive rehabilitation can be useful in improving cognitive performance, besides psychological well-being, in demented individuals living in home care. [ABSTRACT FROM AUTHOR]

In Italy, poverty and disability are two strictly related issues. Households with disabled members continuously face a poverty risk. We simulate a simple Real Business Cycle model to investigate the macroeconomic effects of a permanent increase of civilian disability pensions. We stress the effectiveness of such a policy to stimulate private consumptions. The exercise is implemented via the reduction-both temporary and permanent-of public spending. Results show both the long- and short-run trade-off the policy maker has to deal with when the disability-poverty dualism becomes a relevant issue. In the long-run, a minimum increase of civilian disability pensions allows households with a disabled member to consume more and to exit from poverty condition. However, while temporary decline of public consumption entails a larger decrease of income inequality between the two groups of households, permanent reduction dampens the unavoidable recessionary effect. In the short-run, a temporary reduction of public spending causes an immediate surge of the consumption of households with a disabled member at a cost of a deep recession. By the opposite, a permanent public spending reduction softens the unavoidable output slump but private consumptions only gradually increase. [ABSTRACT FROM AUTHOR]

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Aim: The aim of the study is to evaluate changes in opinions and behaviors of university students about sexual attitudes, use and effectiveness of contraceptive methods and sexually transmitted diseases (STDs). Subjects and methods: The study was carried out through three surveys in 1998, 2003 and 2008. A self-completion questionnaire, divided into three major sections, was administered. The groups were analyzed with the Chi-square test and the multiple logistic regression analysis; the significance level was set at p < 0.05. Results: Contraceptive methods were not used by 12.0, 12.5, and 16.2 % of the sample in 1998, in 2003 and 2008 respectively. The condom was the most common method used by responders, followed by the pill; both methods of birth control are also considered the most effective. In 2008, students demonstrated to have a good knowledge about STDs transmission through sexual intercourse and contraceptive use was higher among responders with multiple partners ( p = 0.028), lower in smokers ( p= 0.003) and female gender ( p = 0.001). Conclusion: The results highlight the necessity to activate programs on sex education, on the use of contraceptives and STD prevention. Peer education should also be considered. [ABSTRACT FROM AUTHOR]

PURPOSE: To analyze physical restraint use in an Italian acute psychiatric ward, where mechanical restraint by belt is highly discouraged but allowed. DESIGN AND METHODS: Data were retrospectively collected from medical and nursing charts, from January 1, 2005, to December 31, 2008. Physical restraint rate and relationships between restraints and selected variables were statistically analyzed. FINDINGS: Restraints were statistically significantly more frequent in compulsory or voluntary admissions of patients with an altered state of consciousness, at night, to control aggressive behavior, and in patients with 'Schizophrenia and other Psychotic Disorders' during the first 72 hr of hospitalization. PRACTICAL IMPLICATIONS: Analysis of clinical and organizational factors conditioning restraints may limit its use. [ABSTRACT FROM AUTHOR]

Aim: To define food safety and risk perception of foodborne diseases in the private home setting and identify specific behaviours during food purchase, storage and preparation in a large survey study. Subject and methods: A large sample of individuals ( n = 1,000) living in the area of Cassino, Italy, volunteered to participate in the study. All participants were randomly recruited and underwent a questionnaire-based interview at their home regarding food-safety measures. Logistic regression analyses were used to test for correlations between demographic characteristics and knowledge/behaviours of food diseases. Risks of hazardous practices in the home were calculated according to educational, physical, occupational and marital status. All analyses were performed using the EPIINFO 3.5 statistical program. Results: Our data showed that there was an insufficient amount of knowledge regarding foodborne diseases and pathogens. In most families, we found that there was a lack of correct adherence to food hygiene, mainly due to errors during both food preparation and storage. There was a higher risk for food safety errors in families with children, older persons and pregnant women. Conclusion: Our findings confirm that the home environment represents an important site for the spread of pathogens responsible for foodborne diseases. In order to adopt good hygiene practices in the home setting, consumers need to be informed about safety procedures of domestic food handling, storage and preparation. [ABSTRACT FROM AUTHOR]

im: A randomised field trial was conducted to evaluate a school-based programme to prevent tobacco use in children and adolescents. Subject and methods: The trial included 534 children and 308 adolescents who were randomly selected to receive or not to receive the prevention programme. The prevention programme included: (a) health facts and the effect of smoking, (b) analysis of the mechanisms underlying intiation of smoking and (c) refusal skills training to deal with the social pressures to smoke. A questionnaire was administered before the intervention programme and 2 years later. Results: The prevalence rates of smoking in both groups of children and adolescents were increased at the end of the study. Anyway, the difference of smoking prevalence between the intervention and control groups was statistically significant only for the children's group (from 18.3 to 18.8% for the intervention group and from 17.8 to 26.9% in the control group) ( p = 0.035). As regards reasons that induced the start of smoking, there was a significant increase of the issue ' because smokers are fools' ( p = 0.004 for children; p < 0.001 for adolescents) and ' because smokers are irresponsible' ( p ≤ 0.001 for both children and adolescents) in the experimental groups. Conclusion: The results suggest that a school-based intervention programme addressing tobacco use among children and adolescents, based on the development of cognitive and behavioural aspects, can be effective. After 1 year of intervention, smoking prevalence was significantly lower in children belonging to the intervention group than in children not randomised to intervention. Targeting young children before they begin to smoke can be a successful way of prevention. [ABSTRACT FROM AUTHOR]

ims: A survey was conducted amongst university students to assess their level of susceptibility to and knowledge about measles, mumps and rubella (MMR) and their prevention, and to find factors associated to their seropositivity for MMR viruses. Subjects, and methods: A cross-sectional study was conducted involving 961 students from the University of Cassino (Italy). The enzyme immunoassay method was used to assess seropositivity for MMR, while knowledge and previous vaccination information were acquired through a self-administered questionnaire. Results: The prevalence of IgG antibodies was 93.2% for measles, 91.4 % for mumps and 81.3% for rubella. The susceptibility for measles was higher in the 21–25 and over 31 age groups. The seroprevalence profile of mumps was similar to that of measles, while the level of immunity to rubella was very low in students aged under 20 years (76.7%) and 21–25 years (81.2%). Only 111 students said they had been vaccinated against measles, 46 against mumps and 103 against rubella. Most students demonstrated poor knowledge concerning MMR and were not practicing preventive behaviours. Conclusions: The susceptibility was particularly high for rubella. Concerted efforts are needed to educate young adults about the benefits of vaccination and to raise their level of consciousness so as to motivate them to request vaccination. [ABSTRACT FROM AUTHOR]

Context: Pasture is widely used in rural Mediterranean areas as a local resource for animal feeding in a sustainable food system. Aims: The present study aimed at evaluating the effects of pasture from a Mediterranean environment on milk fatty acid profile and organoleptic characteristics in grazing Cilentana goats bred in Cilento (Salerno province, southern Italy). Methods: Twelve Cilentana dairy goats, grazing on local feeding resources were studied for 5 months (from May to September), starting from 60 days after kidding. Bodyweight and milk yield were recorded, whereas milk samples were collected and analysed for milk chemical composition and fatty acid profile. Milk organoleptic characteristics were analysed using an instrumental sensory platform. Key results: Season significantly (P < 0.01) affected the pasture fatty acid profile, with the highest polyunsaturated fatty acid (PUFA) content (64.83%) occurring in May. Results of the milk fatty acid composition, permitted to classify as 'High quality' the goat milks sampled in May and June, with the significantly (P < 0.01) highest monounsaturated fatty acid (MUFA; 23.98% and 25.37%) and PUFA (4.74% and 4.43%) contents and lowest saturated fatty acid:unsaturated fatty acid (SFA:UFA) ratio (2.50 and 2.36), and as 'Low quality' those sampled in August and September with the significantly (P < 0.01) highest SFA (75.79% and 75.84%) content. Milk n -6: n -3 polyunsaturated fatty acid ratio was always lower than 4. Some sensory differences in milk organoleptic characteristics were detected by the artificial senses platform, which would be almost impossible to detect by a human panel. Conclusions: Milk samples obtained from grazing goats were influenced by the quality of local feeding resources in terms of nutraceutical value and sensory profile. Implications: Pasture influenced the composition of milk functional compounds, improving the UFAs and conjugated linoleic acid isomers, widely recognised as having beneficial effects on human health. The n -6: n -3 PUFA ratio, lower than 4, confirms the positive effects of pasture on nutritional characteristics of goat milk and underlines the important role of pasture of marginal areas for the quality of livestock products in the frame of a sustainable agro-food system. Some differences were detected by the artificial senses platform among milk samples, which were almost impossible to detect by a human panel, highlighting the potentiality of the artificial senses to link animal-sourced foods to a territory. Pasture is widely used in Mediterranean areas as local resource for animal feeding, guaranteeing favourable chemical and sensory characteristics of products. The aim of the study was to assess milk chemical and sensory characteristics of 12 Cilentana goats grazing in a mountainous area of Cilento (southern Italy). Positive effects of pasture on nutritional characteristics of goat milk underline the important role of pasture of marginal areas for the quality of livestock products in the frame of a sustainable agro-food system. [ABSTRACT FROM AUTHOR]

Mental health issues are common among university students. Nevertheless, few studies focused on Italian students. This study aimed to assess prevalence and associated factors of perceived stress (PS), depressive symptoms (DS) and suicidal ideation (SI) in an Italian sample. A cross-sectional study was conducted amongst a convenience sample of students in humanities field (2018). Questionnaires were self-administered. Outcomes were assessed through Beck Depression Inventory-II (DS, SI) and Perceived Stress Scale (PS). Multivariable regressions were performed (p-value < 0.05 significant; sample size = 203). DS and SI prevalence was 30.6% and 8.8%. PS median score was 20 (IQR = 11), 87.7% reported moderate/severe PS. DS likelihood was increased by psychiatric disorders family history and not attending first year of course and decreased by not thinking that university hinders personal activities. Chronic disease and higher stress score increased SI probability; good/excellent family cohesion reduced it. Being female, thinking that university hinders resting/relaxing, seeing a psychologist/psychiatrist were positively associated with PS; having no worries about future was negatively associated. A high prevalence of mental health issues was reported, with miscellaneous associated factors that were linked to both private and social aspects. Universities must be aware of this to provide efficient preventive measures.

Objective: To examine cancer-related mortality in patients with severe mental disorders (SMI) in the Emilia Romagna (ER) Region, Northern Italy, during the period 2008-2017 and compare it with the regional population., Methods: We used the ER Regional Mental Health Registry identifying all patients aged ≥18 years who had received an ICD-9CM system diagnosis of SMI (i.e., schizophrenia or other functional psychosis, mania, or bipolar affective disorders) during a 10-year period (2008-2017). Information on deaths (date and causes of death) were retrieved through the Regional Cause of Death Registry. Comparisons were made with the deaths and cause of deaths of the regional population over the same period., Results: Amongst 12,385 patients suffering from SMI (64.1% schizophrenia spectrum and 36.9% bipolar spectrum disorders), 24% (range 21%-29%) died of cancer. In comparison with the general regional population, the mortality for cancer was about 50% higher among patients with SMI, irrespective if affected by schizophrenia or bipolar disorders. As for the site-specific cancers, significant excesses were reported for stomach, central nervous system, respiratory, and pancreas cancer with a variability according to psychiatric diagnosis and gender., Conclusions: Patients suffering from SMI had higher mortality risk than the regional population with some differences according to cancer type, gender, and psychiatric diagnosis. Proper cancer preventive and treatment interventions, including more effective risk modification strategies (e.g., smoking cessation, dietary habits) and screening for cancer, should be part of the agenda of all mental health departments in conjunction with other health care organizations, including psycho-oncology., (© 2021 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.)

Background: The aim of the study was to assess the perceived quality of life and the psychosocial impact of the various restrictive measures due to COVID-19 pandemic on cancer patients in Italy, as well as their perception of the relationship with doctors and caregivers., Methods: This study compares three population-based observational studies of patients with cancer carried out in three consecutive time periods characterized by different restrictive measures using a self-administered online questionnaire., Results: Among the basic needs, psychological and medical support appeared to be prevalent; so did the need for safe transportation to reach the treatment facilities. Internet was the main source of information on the coronavirus. Although 74.6% of the total number of patients did not give up hospital therapies, 34.8% complained about variations in the continuity of treatment, with different percentages in the three samples. The majority of the sample (73.8%) was worried of being infected, but 21.9% did not share their anxieties and worries with others. The multivariate regression analysis showed that a pessimistic perception of quality of life was influenced by living in extra-urban areas and alone (OR = 1.4; OR = 2.1); while a perception of a reduced physical function result affected by the state of anxiety and stress (OR = 1.9) and the difficulties in continuity of medical assistance (OR = 2.2). The scoring of the SF-12 in the Physical Component Summary and Mental Component Summary scores showed a fluctuating trend throughout the three periods investigated., Conclusions: It is important for health professionals, caregivers and social workers to identify the new needs in order to enhance home care interventions, personalize and optimize care, ensure continuity of care and guarantee a high quality of life even in a health emergency situation.

Background: The aim of the study was to evaluate in the Italian smokers, the effects of implementation of the law about Pictorial Health Warnings (PHWs) on tobacco products., Methods: A quasi-experimental longitudinal design was conducted between 2016 and 2017. The data were collected before (pre-PHW/Wave 1) and after (post-PHW/Wave 2) the implementation of the law. The adopted questionnaire included impact of advertisement (Label Impact Index, LII), quitting behavior and knowledge of tobacco related diseases., Results: 455 respondents completed both the Waves. 7.7% of smokers declared to have stopped smoking in Wave 2 and 29% of these declared the PHWs as one of the reasons to quit. The knowledge of tobacco related diseases was significantly (p <0.001) increased from Wave 1 to Wave 2 (58% versus 72%), similarly the LII (mean = 26.9, SD = 16.7 and mean = 40.4, SD = 16.2)., Conclusion: Tobacco addiction is a problem that needs to be addressed from different angles. PHWs confirm their complementary role as a support for smokers along with other strategies such as text warnings and the tobacco quit line of the Istituto Superiore di Sanità (Italian National Institute of Health) reported on the packages. Nonetheless, over the years these measures have been not enough and policy makers should consider more strategies synergistically acting in the fight against tabagism.

Vaccinations in Italy show a downward trend since 2013 due to an evergrowing mistrust of the population with regard to vaccination that has resulted in lesser adherence to vaccination programs. The main cause of the reduction is due to a tendency observed in recent years, even at the international level, known as 'vaccine hesitancy'. A growing number of studies on vaccine hesitancy show that causes vary by country, population, vaccine, and context influences, but in all cases emerges the importance of health care professionals in patients decision about vaccine. The new Piano Nazionale della Prevenzione Vaccinale 2017-2019 (PNPV - Italian National Plan on Vaccine Prevention) underlines the need to invest for healthcare professionals in technical and scientific training not only about vaccination and vaccination strategies, but also on communication skills. Training interventions are also considered important for achieving another PNPV goal that is to "support, at all levels, the sense of responsibility of healthcare workers […..].". The training of health care staff is therefore recognized as a key aspect for the consolidation of national vaccination policies. It is intended to improve and standardize SSN's performance, skills and quality and to provide the essential tools to be able to respond adequately the growing demand for correct and exhaustive information from patients. Therefore, it is important to invest in strategies to improve technical, scientific and communication knowledges on vaccinations, adapting them to specific political, social and cultural contexts, in order to reinforce the sense of trust with citizens and to pursue the success of public health strategies to increase vaccine coverage.

Aim: This study evaluated the knowledge and attitudes of Italian mothers - whose daughters had been vaccinated in 2012 - towards primary (anti-HPV vaccination) and secondary (Pap test screening) cervical cancer prevention, as well as sources of information and mother-daughter communication on health issues., Methods: The survey - part of a multicenter study carried out in 4 Italian cities (Ferrara, Rome, Cassino and Palermo) - was conducted through self-administered questionnaires. The first univariate analysis evaluated differences between mothers of under-18s and over-18s relative to knowledge and attitudes on HPV vaccination and Pap test. The second univariate analysis evaluated differences between the 2 groups of mothers and possible geographical variations regarding the sources of information on HPV and Pap test., Results: The sample proved knowledgeable about the correlation between HPV and cervical cancer (&gt;85%) but less aware of other HPV-related diseases. HPV vaccination should be administered before first sexual intercourse according to mothers of over-18s, and to 14- to 17-year-olds according to mothers of under-18s. Up to 88% of mothers of under-18s and 80% of mothers of over-18s declared that the vaccine should be given free of charge. More mothers of under-18s consulted a general practitioner (GP) or gynecologist before deciding to vaccinate their daughters. Mothers of under-18s received information on HPV vaccination mainly from GPs and gynecologists, while mothers of over-18s were informed through TV and books/journals. Over 80% of the sample declared satisfaction with the information received from their gynecologist during the Pap test., Conclusions: The findings provide useful information for the development of effective public health interventions that may help improve acceptance of HPV vaccination among mothers.

In recent years there has been a constant increase in the number of elderly people being admitted to nursing homes. Elderly nursing home residents seem to have a higher risk of malnutrition with respect to the community dwelling elderly population. A study was therefore performed to evaluate the nutritional status of elderly subjects living in 8 nursing homes in the "D" health district in Frosinone (Italy). Subjects aged over 65 years living in one of the selected nursing homes since at least two months were invited to participate. Nutritional status was evaluated by anthropometric measurements to calculate the Body Mass Index and by data collected through the Mini Nutritional Assessment. Additional data regarding the subject's educational level, social life, family ties, length of stay in the facility, physical activity, medical conditions, frequency of diarrhoeal episodes and eating habits, were collected through a questionnaire. Statistical analysis of data was performed with Epi Info software version 3.3 One hundred eighty four subjects participated in the study, 69.4% of which had been admitted to the nursing home following a request by their family, mainly for health reasons or because the family could no longer take care of them. Approximately 38% of subjects admitted having a moderate decrease in functional independence. The mean BMI was found to be 27.3 while the mean MNA was 20.6, with no sex- or age-related differences. The prevalence of underweight based on BMI threshold values was 6.3%; 30.8% of subjects were normal weight. On the other hand, MNA results revealed that 13% of study subjects were malnourished and 66.1% were at risk for malnutrition. These results indicate that assessment of nutritional status in elderly subjects should not be based on BMI alone and that MNA is a more appropriate tool in the elderly as it allows for a dynamic evaluation of the risk of malnutrition in this population. The results of this study also show a high risk of malnutrition in the study sample, and confirm the need for increased surveillance of nutritional status among residents of nursing homes.

Background: Alzheimer's disease presents a social and public health problem affecting millions of Italians. Those affected receive home care from caregivers, subjected to risk of stress.The present investigation focuses on stress, anxiety and depression in caregivers., Methods: Data on 200 caregivers and their patients were collected using a specific form to assess cognitive, behavioural, functional patient (MMSE, and ADL-IAD) and caregiver stress (CBI). The relationship between stress, depression and disease has been assessed by means of a linear regression, logistic analysis which reveals the relationship between anxiety, stress and depression and cognitive problems, age, the patient's income., Results: The caregivers are usually female (64%), mean age of 56.1 years, daughters (70.5%), pensioners and housewives (30%), who care for the sick at home (79%). Of these, 53% had little time for themselves, 55% observed worsening of health, 56% are tired, 51% are not getting enough sleep. Overall, 55% have problems with the patient's family and/or their own family, 57% at work. Furthermore, 29% feel they are failing to cope with the situation as they wish to move away from home. The increase in the degree of anxiety and depression is directly proportional to the severity of the illness, affecting the patient (r = 0.3 stress and depression r = 0.4 related to CBI score). The memory disorders (OR = 8.4), engine problems (OR = 2.6), perception disorders (OR = 1.9) sick of the patient with Alzheimer's disease are predictive of caregiver stress, depression is associated with the presence of other disorders, mainly behavioural (OR = 5.2), low income (OR = 3.4), patients < 65 years of age (OR = 2.9)., Conclusion: The quality of life of caregivers is correlated with the severity of behavioural disorders and duration of the Alzheimer's disease. The severity of the disease plays an important role in reorganization of the family environment in families caring for patients not institutionalised. It is important to promote measures to soften the impact that the patient has on the caregiver, and that, at the same time, improves the quality of life of the patient.

This study evaluated the indoor air quality of 26 classrooms of secondary schools in the city of Cassino (Italy). Two types of school buildings were assessed: buildings specifically designed as schools, and former dwellings converted to schools. Measurements were taken in both winter and spring months, before students entered the classrooms and while the classrooms were occupied. Lower thermal comfort levels were observed during the winter months; in fact, during the winter, ideal temperature, humidity and air speed parameters were found in only a small percentage of classrooms and students were found to experience thermal discomfort as a result. Air velocity was often found to be inadequate both in winter and spring months and in both types of school buildings evaluated. Illumination levels measured during the winter months with both natural daylight and mixed illumination, were found to be below 200 lux, the minimum recommended level recommended by the ministerial decree 18.12.1975. Noise levels above the maximum level recommended by the ministerial decree 01.03.1991 were also frequently observed. The symptoms most frequently reported by students were headache, difficulties in concentrating, cough, and unusual tiredness. The various discomfort situations observed in both types of school buildings point toward a need for greater attention toward indoor air quality of schools as this can have affect students' attention, concentration, productivity and comfort.

This study was designed to assess toxic and genotoxic compounds in the urban air of Caserta, South Italy using cuttings from the plant Tradescantia #4430. In situ monitoring of gaseous pollutans was made at 17 sampling points in two seasons of the year. Genotoxicity was evaluated by recording the micronuclei in meiotic pollen mother cells (Trad-MCN assay). In addition, the passive sampler semipermeable membrane devices (SPMDs) were deployed at the sampling points with a significant increase in micronuclei frequency. SPMDs concentrated priority organic pollutants were identified by high performance liquid chromatography and gas chromatography, while toxicity and mutagenesis were assessed on the bacterium Vibrio fischeri using the Microtox and Mutatox systems respectively. Significant toxic and mutagenic effects were observed at different points on the town grid and SPMDs effectively concentrated trace contaminants. The relationship between what was present in the air sampled by SPMDs and the micronuclei frequency was also explored.