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Andrea Pozza,1 Richard H Osborne,2,3 Gerald R Elsworth,2 Giacomo Gualtieri,4 Fabio Ferretti,1 Anna Coluccia1 1Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy; 2Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia; 3Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 4Legal Medicine Unit, Santa Maria alle Scotte University Hospital, Siena, Siena, ItalyCorrespondence: Fabio FerrettiDepartment of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 16, Siena 53100, ItalyTel +39 0577 586409Fax +39 0577 233222Email ferrefa@unisi.itBackground: The Health Education Impact Questionnaire (heiQ) aims to evaluate eight self-management skills in people with chronic conditions. Knowledge about the relations between these self-management skills and different quality of life (QoL) outcomes has received little attention. It is also important to provide further evidence on its properties in non-English healthcare contexts, as the questionnaire is being used in cross-cultural research. Furthermore, in the Italian healthcare context, the relationship between the medical staff and the patients remains asymmetrical, with the latter having the role of passive recipients of medical prescriptions and services. The current study provided further evidence about the psychometric properties of the heiQ among Italian people with chronic conditions, specifically by assessing the factor structure, reliability, convergent/divergent and criterion validity (ie, the specific contribution of each of the self-management skills to QoL outcomes).Methods: Two hundred ninety-nine individuals with a chronic condition (mean age = 61.4 years, 50% females) completed the heiQ and the Medical Outcomes Study-Short Form (MOS SF-36). Confirmatory factor analyses, Composite Reliability Indices (CRI), bivariate correlations and linear regression analyses were computed.Results: A model with 8 correlated factors showed good fit, in a similar way to previous studies. CRI values were acceptable to good for all the subscales. Associations between some of the heiQ subscales and some of the MOS SF-36 subscales supported criterion validity. In particular, it was confirmed by the moderate associations between the constructive attitudes and approaches subscale and the MOS SF-36 vitality and perceived mental health and by the moderate correlations between the health directed activities subscale and the MOS SF-36 Vitality. In linear regressions, higher emotional distress predicted higher physical and mental QoL, while higher mental QoL was also associated with stronger constructive attitudes and approaches.Conclusion: The heiQ has robust properties across translations and it can also be used routinely in Italian healthcare contexts. The evidence that all the other self-management skills did not predict either physical or mental QoL could suggest that the self-management model of chronic diseases is still not sufficiently developed in the Italian context, where patients are passive recipients of medical instructions.Keywords: chronic diseases, self-management, health education, psychometric properties, health status, quality of life, diabetes, cardiovascular diseases

Andrea Pozza, Davide DèttoreDepartment of Health Sciences, University of Florence, Florence, ItalyBackground and objectives: In the literature there are inconsistent data regarding the role of dissociation in OCD. No study explored the association between obsessive beliefs and dissociative symptoms in OCD. It is important to understand which clinical factors are related to dissociation in OCD as more severe dissociative symptoms, particularly absorption, have been found to be predictors of treatment non-response. In the present short report we describe the results of an exploratory study aimed to investigate the role of the obsessive beliefs as predictors of the different dissociative symptoms controlling for anxiety and OCD severity in a group of OCD patients.Methods: Sixty treatment-seeking patients consecutively referred to psychiatric services were included (mean age=31.17 years, 53.30% females). The Dissociative Experiences Scale-II, the Obsessive Beliefs Questionnaire-46, the Yale-Brown Obsessive-Compulsive Scale, and the Beck Anxiety Inventory were administered.Results: Higher anxious symptoms predicted higher Dissociative Amnesia, Depersonalization/Derealization, and Absorption/Imaginative Involvement. Higher OCD severity predicted higher Dissociative Amnesia. More severe Perfectionism predicted higher Absorption/Imaginative Involvement.Conclusion: Perfectionism in OCD patients may be associated with a higher tendency to absorption and imaginative involvement. Future research should explore whether a psychotherapeutic intervention on perfectionism might improve the outcomes of the OCD patients with higher absorption tendencies.Keywords: obsessive-compulsive disorder, obsessive beliefs, dissociative symptoms, perfectionism, reality monitoring

Andrea PozzaDepartment of Health Sciences, University of Florence, 50135 Florence, ItalyIntroduction and objectives: Immigration in Europe is a challenge for health care systems. Psychotic experiences are not uncommon in the community. Meta-analyses showed that immigrants are at higher risk of psychotic symptoms and experiences than natives. In the international literature, there is little knowledge about the psychological processes explaining the relationship between immigrant status and psychotic experiences. Aberrant salience, the biased assignment of significance to otherwise innocuous stimuli, and alexithymia (difficulty identifying/verbalizing feelings and concrete speech/thinking) have been found to be vulnerability/maintenance factors of psychotic symptoms. This report presents a study investigating whether: 1) adolescent immigrants in Italy report more intense psychotic experiences than natives; 2) aberrant salience and alexithymia predict more intense psychotic experiences; and 3) these psychological processes moderate the effect of immigrant status on psychotic experiences. Knowledge about the role of these processes in psychotic experiences may suggest early detection or prevention strategies.Methods: One hundred and forty-eight community adolescents were recruited (mean age =17.57 years, 47.30% females); of these, 75 were born in Italy (natives) and 73 were immigrants (born in countries other than Italy). The Aberrant Salience Inventory, the Toronto Alexithymia Scale-20, and the Screening for Psychotic Experiences were administered in classrooms.Results: Immigrants had higher aberrant salience (F=4.38, p

Andrea Pozza,1 Christine Lochner,2 Fabio Ferretti,1 Alessandro Cuomo,3 Anna Coluccia1 1Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy; 2SU/UCT MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa; 3Department of Molecular Medicine, University of Siena School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy Background: Obsessive–compulsive disorder (OCD) is one of the leading causes of disability and reduced quality of life (QOL), with impairment in a number of domains. However, there is a paucity of literature on the association between severity of OCD symptoms and QOL, and the data that do exist are inconsistent. In addition, the role of severity in QOL has not been summarized as yet from a cross-generational perspective (ie, across childhood/adolescence and adulthood). Through meta-regression techniques, the current study summarized evidence about the moderator role of severity of OCD symptoms on differences in global QOL between individuals with OCD and controls. Methods: Online databases were searched, and cross-sectional case–control studies comparing participants of all ages with OCD with controls on self-report QOL measures were included. Random-effect meta-regression techniques were used to comment on the role of illness severity in global QOL in individuals with OCD. Results: Thirteen studies were included. A positive significant association emerged between OCD severity and effect sizes on global QOL: in samples with higher severity, there were narrower differences in QOL between patients with OCD and controls than in samples with lower severity. Such positive association was confirmed by a sensitivity analysis conducted on studies including only adults, where the difference in QOL ratings between patients and controls was significantly narrower when OCD severity was higher. Conversely, a negative association between severity and QOL was found in those studies including only children/adolescents, where the difference in QOL was significantly larger between patients and controls when OCD severity was higher. Conclusion: QOL remains an important issue to address in the management of OCD in all age groups, irrespective of illness severity. Even in those with lower severity ratings, QOL may be considered as an important marker of treatment response. Keywords: obsessive–compulsive disorder, quality of life, systematic review, symptoms severity, well-being, meta-regression

Anna Coluccia,1 Fabio Ferretti,1 Andrea Fagiolini,2,3 Andrea Pozza1 1Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, 2Department of Molecular Medicine, School of Medicine, University of Siena, 3Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy Abstract: Obsessive–compulsive disorder (OCD) is a seriously impairing psychiatric condition that affects 1%–3% of youth. Investigating the quality of life (QOL) is an important issue for treatment planning of this disorder, as targeting symptoms without taking it into account may bias assessment and prognosis when the patient presents with reduced symptoms that do not correspond to improved QOL. However, QOL in young individuals with OCD has been under-studied. This meta-analysis summarized current evidence that assessed differences in global, social and school QOL dimensions, between children/adolescents with OCD and screened controls. Age, sex and OCD severity were examined as moderators. Case–control studies were included if children/adolescents with primary OCD were compared with screened controls on validated self-reported QOL outcomes. Online databases (January 1966–January 2016) were searched. Five case–control studies were included (n=543, 17 effect sizes overall). On global QOL, a large effect size emerged (d=-1.16, P

Andrea Pozza,1,2 Gerhad Andersson,3 Davide Dèttore2,41Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; 2Miller Institute of Behavioural and Cognitive Psychotherapy, Genoa, Italy; 3Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; 4Department of Health Sciences, University of Florence, Florence, Italy Abstract: Group cognitive–behavioral therapy (GCBT) may be a cost-effective alternative modality for the treatment of obsessive–compulsive disorder (OCD). In the last decade, a great deal of research has been conducted to evaluate the efficacy of GCBT for OCD. Despite promising results, studies have produced inconclusive evidence. The current paper will present a protocol for a systematic review and meta-analysis of randomized controlled trials assessing the efficacy of GCBT compared with control conditions or individual CBT at post-treatment and follow-up on OCD symptoms, anxiety, depression, obsessive beliefs, quality of life, and functioning. Another aim will be to compare the levels of early drop out from GCBT relative to control conditions or individual CBT. Finally, the study will investigate potential outcome moderators (age, sex, OCD severity, severity of concurrent depression, comorbid personality disorders, duration of OCD symptom onset, duration of treatment, intensity of treatment, generation cohort, methodological quality, and publication date). A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be conducted using random-effects meta-analyses. Online databases and trial registries will be searched, the corresponding authors will be contacted, and conference proceedings and relevant journals will be hand-searched to locate published and unpublished studies. Risk of bias will be assessed using the Cochrane Collaboration’s tool. Keywords: obsessive–compulsive disorder, cognitive–behavioral therapy, meta-analysis, group therapy

Anna Coluccia, Fabio Ferretti, Andrea PozzaDepartment of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, University of Siena, Siena, ItalyPurpose: The patient-centered approach to health care does not seem to be sufficiently developed in the Italian context, and is still characterized by the biomedical model. In addition, there is a lack of validated outcome measures to assess outpatient experience as an aspect common to a variety of settings. The current study aimed to evaluate the factorial validity, reliability, and invariance across sex of the Health Services OutPatient Experience (HSOPE) questionnaire, a short ten-item measure of patient-centeredness for Italian adult outpatients. The rationale for unidimensionality of the measure was that it could cover global patient experience as a process common to patients with a variety of diseases and irrespective of the phase of treatment course.Patients and methods: The HSOPE was compiled by 1,532 adult outpatients (51% females, mean age 59.22 years, standard deviation 16.26) receiving care in ten facilities at the Santa Maria alle Scotte University Hospital of Siena, Italy. The sample represented all the age cohorts. Twelve percent were young adults, 57% were adults, and 32% were older adults. Exploratory and confirmatory factor analyses were conducted to evaluate factor structure. Reliability was evaluated as internal consistency using Cronbach’s α. Factor invariance was assessed through multigroup analyses.Results: Both exploratory and confirmatory analyses suggested a clearly defined unidimensional structure of the measure, with all the ten items having salient loadings on a single factor. Internal consistency was excellent (α=0.95). Indices of model fit supported a single-factor structure for both male and female outpatient groups. Young adult outpatients had significantly lower scores on perceived patient-centeredness relative to older adults. No significant difference emerged on patient-centeredness between male and female outpatients.Conclusion: The HSOPE questionnaire seemed to be a tool with high acceptability and excellent psychometric properties to measure patient-centeredness as a unidimensional construct. Limitations and implications for future research are discussed.Keywords: patient-centered care, health care services, psychometric properties, patient-reported outcomes

Abstract Kawasaki Disease (KD) is a multisystemic vasculitis of medium- and small-sized arteries. Abnormal intimal thickening may develop in the involved arterial area after regression of coronary artery aneurysm (CAA). Intimal dysfunction may induce local stenosis or arteriosclerosis in the future. In this case–control study, we investigated 29 consecutive KD patients [20 male, median current age, 7.9 years; median follow-up duration, 5.7 years] and a group of 29 healthy matched controls (CON) [19 male, median current age, 10.8 years]. They were assesed and compared for CAA, LVFS, GCS, GLS, coronary artery (CA) Z scores, carotid intima-media thickness (IMT) and coronary artery IMT by high-resolution transthoracic echocardiography (hrTTE). Coronary artery IMT (caIMT) was significantly higher in patients with a maximal CA Z score > 2.5 in acute KD than in CON: KD caIMT: 0.62 mm [IQR, 0.57–0.72 mm] vs. 0.53 mm [0.51–0.60 mm], p = 0.043. CAAs were found in 15 (51.7%) patients with acute KD. The maximal median LCA Z score in acute KD was 2.57z [IQR, 1.93—3.2z] and in follow-up −0.39z [IQR, −1.25 to −0.36z]. There was no significant difference in carotid IMT between KD patients and CON. Signs of CA intima-media thickening were detected by hrTTE in patients with a maximal CA Z score > 2.5 in acute KD. These data indicate that these patients may be at risk for cardiovascular sequale even in the absence of permanent CA luminal abnormalities. Therefore long-term follow-up of this group of KD patients may be required.

ABSTRACT: Moving from conventional (CMS) to automatic (AMS) milking systems could affect milk quality. Moreover, the type and preservation methods of the forages used in the TMR, such as alfalfa hay (HTMR) or corn silage (STMR) have been demonstrated to modify milk composition. Thus, this study investigated the effect of implementing AMS and different diet forage types on the quality of Italian Holstein-Friesian bulk milk. Milk samples (n = 168) were collected monthly from 21 commercial farms in northern Italy during a period of 8 mo. Farms were categorized into 4 groups according to their milking system (CMS vs. AMS) and diet forage type (HTMR vs. STMR). Milk quality data were analyzed through the mixed procedure for repeated measurement of SAS with the milking system, diet forage type, and sampling day as fixed effects. Milking through the AMS led to lower milk fat, freezing point, and β-LG A; longer coagulation time; and higher K content, pH, and β-LG B than CMS. Cows fed STMR produced milk with greater fat, protein, casein, Mg content, titratable acidity, and β-LG A, but with reduced curd firming time, freezing point, and β-LG B than those fed HTMR. In conclusion, milk quality is not only altered by the diet's forage type and characteristics but also by the milking system.

Abstract Sonic hedgehog subgroup of medulloblastoma (SHH-MB) is characterized by aberrant activation of the SHH signaling pathway. An inhibition of the positive SHH regulator Smoothened (SMO) has demonstrated promising clinical efficacy. Yet, primary and acquired resistance to SMO inhibitors limit their efficacy. An understanding of underlying molecular mechanisms of resistance to therapy is warranted to bridge this unmet need. Here, we make use of genome-wide CRISPR-Cas9 knockout screens in murine SMB21 and human DAOY cells, in order to unravel genetic dependencies and drug-related genetic interactors that could serve as alternative therapeutic targets for SHH-MB. Our screens reinforce SMB21 cells as a faithful model system for SHH-MB, as opposed to DAOY cells, and identify members of the epigenetic machinery including DNA methyltransferase 1 (DNMT1) as druggable targets in SHH-dependent tumors. We show that Dnmt1 plays a crucial role in normal murine cerebellar development and is required for SHH-MB growth in vivo. Additionally, DNMT1 pharmacological inhibition alone and in combination with SMO inhibition effectively inhibits tumor growth in murine and human SHH-MB cell models and prolongs survival of SHH-MB mouse models by inhibiting SHH signaling output downstream of SMO. In conclusion, our data highlight the potential of inhibiting epigenetic regulators as a novel therapeutic avenue in SMO-inhibitor sensitive as well as resistant SHH-MBs.

Objective Studies suggest that men who undergo assisted reproductive technologies (ART) may have a higher risk of cardiovascular disease; however, limited data on this matter is available. This observational pilot study aimed to investigate the overall vascular health of fathers with history of intracytoplasmic sperm injection (ICSI) compared to fathers whose partners conceived spontaneously.Methods Diet quality, physical activity, sedentary behavior as well as overall vascular function including the assessment of pulse wave analysis, intima-media thickness (cIMT), arterial stiffness of the common carotid artery (CCA) and blood lipids, were evaluated.Results A total of 34 fathers with history of ICSI and 29 controls (48.49 [46.32 − 57.09] years vs. 47.19 [40.62 − 55.18] years, p = 0.061) were included. After adjusting for age, no significantly increased cardiovascular risk was detected regarding vascular function.Conclusions The results suggest an unaltered cardiovascular risk profile in fathers with history of ICSI. In the future, prospective multicenter studies are required to validate these preliminary results.

ABSTRACT: Myiasis is a worsening parasitic condition in newborn sheep, requiring effective medications for healing. This article demonstrates the development of a phytotherapeutic emulgel (phytogel) composed of copaiba oil (Copaifera martii) and “barbatimão” (Stryphnodendron adstringens (Mart.) Coville) incorporated into a polymeric blend composed of Pluronic® F127 and Carbopol® 934P. The formulation demonstrated antimicrobial potential by inactivating the bacteria Staphylococcus aureus. Administering the phytotherapeutic to the umbilicus of newborn lambs for five days effectively promoted healing and prevented inflammation and myiasis. The erythrogram and leukogram of the animals showed statistical equivalence between the animals treated with the phytotherapeutic and iodine. Furthermore, the human intervention index of the phytogel was lower when compared to iodine. The results underscore the medication’s potential, warranting further studies in veterinary medicine.

(1) Background: The aim of this review was to identify and summarize adverse cardiovascular health events associated with the simultaneous consumption of energy drinks (ED) and alcohol. Potential prevention strategies and the implementation of research toward the underlying mechanisms for these pathologies were highlighted to emphasize the need for further investigation and to encourage more attention to this field. (2) Methods: The PubMed database was searched for case reports linked with adverse cardiovascular events after simultaneous ED and alcohol consumption. Inclusion criteria were: the reported age of the patient is between 16 and 35 years and confirmed co-consumption of EDs and alcohol. All relevant articles that met the inclusion criteria were fully read and all relevant data was extracted. The extracted data was summarized and presented in this review of cases. (3) Results: In total, 10 cases were identified. The analysis showed that mainly young adults (median age = 24.5 years), in particular men (80%) were affected. The three parts of the cardiovascular system affected were heart rhythm (42%), myocardial function (33%), and coronary arteries (25%). In 3 cases the outcome was fatal. Moreover, preexisting health conditions and/or potential trigger factors were present in 60% of selected cases. (4) Conclusions: This review of case reports suggests that the simultaneous consumption of EDs and alcohol can lead to adverse cardiovascular health events and even incidents with fatal outcomes were reported. Potential trigger factors and preexisting health conditions seem to increase the probability of adverse cardiovascular health events. Consumers should be informed about the potential risks and follow responsible consumption behavior to prevent future health events. More systematic studies are needed to determine the acute effects on the cardiovascular system in young adults.

Objective This study aims to investigate the interactive effect of a glycine equivalent (Glyequi) and standardized ileal digestible threonine (SID Thr) levels in low crude protein diets on performance, blood biochemistry, pectoral muscular creatine content and oxidative stability of meat in broiler chickens from 21 to 42 days. Methods A total of 1,500, twenty-one-day-old Cobb-Vantress male broiler chickens were distributed in a completely randomized 5×3 factorial arrangement of Glyequi×SID Thr with five replicates of 20 birds each. Fifteen dietary treatments of 16.5% CP were formulated to contain five levels of total Glyequi (1.16%, 1.26%, 1.36%, 1.46%, and 1.56%) and three levels of SID Thr (0.58%; 0.68% and 0.78%). Results Interaction effects (p