Italian General Population Research Articles

Are smartphones and tablets influencing the quality of sleep? An Italian answer


 Background: Electronic media use may affect sleep health. The present study aimed to estimate the association between technological devices usage, especially mobile phone, during the evening/night and self-reported sleep disorders. 
 Methods: The survey was conducted between June and September 2016. Anonymous self-reported questionnaire was distributed to the Italian general population and investigated demographic data, presence of sleep disorders and the use of electronic devices. 
 Results: The analysis was based on 597 questionnaires. Mobile phone exposure has been associated with increased difficulty falling to sleep (p= 0.018). 
 The use of mobile phones at bedtime was significantly related to self-reported sleep disturbance (p <0.001). 
 Using mobile phone more than 60 minutes before going to sleep, the use of these devices in bed, surfing internet remained statistically significant in the multivariate analysis. 
 Conclusion: Our results suggest that the use of a mobile phone before going to sleep is associated with reporting sleep disturbances. Public health prevention strategies could comprise promotion of optimum sleep habits and information regarding the effects of an intensive electronic devices use on the sleep status.

Influenza Vaccination Uptake in the General Italian Population during the 2020-2021 Flu Season: Data from the EPICOVID-19 Online Web-Based Survey.

To assess influenza vaccine uptake during the 2020/2021 flu season and compare it with that of the 2019/2020 flu season among respondents to the second phase of the web-based EPICOVID-19 survey, we performed an observational web-based nationwide online survey (January–February 2021) in which respondents to the first survey (April–June 2020) were contacted and asked to complete a second questionnaire. Factors associated with vaccine uptake in the 2020/2021 flu season were assessed by applying a multivariable multinomial logistic regression model. Out of the 198,822 respondents to the first survey, 41,473 (20.9%) agreed to fill out the follow-up questionnaire; of these, 8339 (20.1%) were vaccinated only during the 2020/2021 season, 8828 (21.3%) were vaccinated during both seasons and 22,710 (54.8%) were vaccinated in neither season. Educational level (medium (aOR 1.33 95%CI 1.13–1.56) and high (aOR 1.69 95%CI 1.44–1.97) vs. low) and socio-economic deprivation according to SES scoring (1 point aOR 0.83 (95%CI 0.78–0.89), 2 aOR 0.68 (95%CI 0.60–0.77) points or ≥3 points aOR 0.42 (95%CI 0.28–0.45) vs. 0 points) were found to be associated with flu vaccine uptake. Our study shows that social determinants seemed to affect flu vaccination uptake and identifies specific categories of the population to target during future influenza vaccination campaigns.

COVID-19 lockdown: The relationship between trait impulsivity and addictive behaviors in a large representative sample of Italian adults

BackgroundThe importance of trait impulsivity in development, continuation and escalation of addictive behaviors has long been recognized. MethodsA cross-sectional population-based survey was conducted during the COVID-19 lockdown on 6003 Italian adults aged 18–74 years, representative of the Italian general population, to investigate the relationship between impulsivity (Barratt Impulsiveness Scale – BIS) and selected addictive behaviors (gambling habits, smoking status, cannabis use, average alcohol daily use). ResultsA statistically significant relationship was found between motor impulsivity and starting/increasing drinking and increasing gambling (high vs. low motor impulsivity: multivariate odds ratio, OR=3.12; 95% confidence interval, CI: 1.45–6.74; p for trend=0.004 for start and OR=1.53; 95% CI: 1.26–1.86; p for trend<0.001 for increase drinking, respectively; OR=2.09; 95% CI: 1.41–3.12; p for trend<0.001 for increasing gambling). LimitationsPotential information and recall bias. The necessity to limit the length of the questionnaire not to reduce the quality of the answers of study participants. ConclusionsThe multifaceted nature of impulsivity, potentially either cause or effect, hampers the understanding of its proper role in addictive behaviors. If confirmed by future longitudinal studies, our findings might support the planning, implementation and monitoring of evidence-based preventive interventions, to reduce addictive behaviors during public health emergencies.

The role of mtDNA haplogroups on metabolic features in narcolepsy type 1

Narcolepsy type 1 (NT1) is due to selective loss of hypocretin (hcrt)-producing-neurons. Hcrt is a neuropeptide regulating the sleep/wake cycle, as well as feeding behavior. A subset of NT1 patients become overweight/obese, with a dysmetabolic phenotype. We hypothesized that mitochondrial DNA (mtDNA) sequence variation might contribute to the metabolic features in NT1 and we undertook an exploratory survey of mtDNA haplogroups in a cohort of well-characterized patients.We studied 246 NT1 Italian patients, fully defined for their metabolic features, including obesity, hypertension, low HDL, hypertriglyceridemia and hyperglycemia. For haplogroup assignment, the mtDNA control region was sequenced in combination with an assessment of diagnostic markers in the coding region.NT1 patients displayed the same mtDNA haplogroups (H, HV, J, K, T, U) frequency as those reported in the general Italian population. The majority of NT1 patients (64%) were overweight: amongst these, 35% were obese, 48% had low HDL cholesterol levels, and 31% had hypertriglyceridemia.We identified an association between haplogroups J, K and hypertriglyceridemia (P = 0.03, 61.5% and 61.5%, respectively vs. 31.3% of the whole sample) and after correction for age and sex, we observed a reduction of these associations (OR = 3.65, 95%CI = 0.76–17.5, p = 0.106 and 1.73, 0.52–5.69, p = 0.368, respectively). The low HDL level showed a trend for association with haplogroup J (P = 0.09, 83.3% vs. 47.4% of the whole sample) and after correction we observed an OR = 6.73, 95%CI = 0.65–69.9, p = 0.110.Our study provides the first indication that mtDNA haplogroups J and K can modulate metabolic features of NT1 patients, linking mtDNA variation to the dysmetabolic phenotype in NT1.

Sexuality in breast cancer survivors: sexual experiences, emotions, and cognitions in a group of women under hormonal therapy.

Earlier diagnosis and improved treatments have led to better outcomes in breast cancer, making quality of life a key issue. Sexuality represents a pillar of quality of life, although it is often neglected by both healthcare providers and patients when it comes to cancer. This study aims to explore the differences in sexual functioning, distress, psychopathology, emotions, and cognitions between breast cancer patients under hormonal treatment and controls. Seventy-nine women (age range between 24 and 69years) in hormonal therapy for breast cancer completed a self-reported protocol. A matched control group of 103 women was randomly extracted from an Italian general population database. Eight self-report questionnaires exploring biopsychosocial factors were administered. The current study showed an impaired sexuality in breast cancer patients compared to controls. Breast cancer women under hormonal treatment were characterized by diminished or absent sexual activity (chi2 = 36.16; p < 0.001), lower level of sexual functioning in all areas except for pain (F(1,180) = 8.1; p < 0.01), higher sexual (F(1,180) = 10.08; p < 0.001) and psychological distress (F(1,180) = 6.23; p < 0.05), higher scores in Difficulties in Identifying Feelings (F(1,180) = 7.31; p < 0.01) and Externally Oriented Thinking (F(1,180) = 6.64; p < 0.05), higher level of negative emotions related to sexuality (F(1,180) = 11.13; p < 0.001), and more rigid cognition towards peculiar aspects of sexuality, such as Failure Disengagement Thoughts (F(1,180) = 22.01; p < 0.001) and Age related Beliefs (F(1,180) = 5.7; p < 0.05). Health care providers do not usually assess those issues in their routine practice, so that sexuality remains an unmet need with remarkable effects on general health and quality of life.

COVID-19: opinions and behavior of Italian general population during the first epidemic phase.

Background and aim:On January 9, 2020, the World Health Organization (WHO) declared that Chinese health authorities had identified a new coronavirus strain never before isolated in humans, the 2019-nCoV later redefined SARS-CoV-2, that still today represent a public health problem. The present survey started on 10 February 2020 with the aim of a) assessing the risk perception in healthcare workers and young students, following the evolution of attitudes, perception and knowledge over time, b) provide useful information to the general population during survey.Results:A study sample consisting of 4116 Italian individuals of both sexes was enrolled. High levels of risk perception, low perception of self-efficacy and low levels of knowledge scores (24.55 ± 5.76 SD) were obtained indicating the need for continuous population monitoring as well as further communication strategies carried out at institution levels.Conclusion:The results of the present study could help public health authorities in carrying out informative campaigns for general population and could be an important tool in evaluating public knowledge and misperceptions during the management of the COVID-19. (www.actabiomedica.it)

Exploring the Protective Function of Positivity and Regulatory Emotional Self-Efficacy in Time of Pandemic COVID-19.

Despite several empirical studies on the 2019 coronavirus disease (COVID-19) pandemic that have highlighted its detrimental effect on individuals’ mental health, the identification of psychological factors that may moderate its impact on individuals’ behavior and well-being remains partly unexplored. The present study was conceived to examine the mediation role of regulatory emotional self-efficacy in the relationship between positivity and anxiety, depression, and perceived self-efficacy in complying with the containment measures to contrast the COVID-19 spread. Furthermore, the moderation role of age was tested. A sample of 1258 participants (64.2% women; Mage = 42.09, SD = 13.62) enrolled from the Italian general population answered an online survey aimed at investigating the role of individual differences in facing the COVID-19 pandemic. We opted for a snowball recruiting procedure to find participants. The online survey was disseminated through email invitation and using social media platforms (i.e., Facebook, Instagram). A multi-group path analysis model was performed using Mplus 8.4 to explore the hypothesized relations among variables. The following criteria were employed to evaluate the goodness of fit: χ2 likelihood ratio statistic, CFI and TLI > 0.95, RMSEA < 0.06 and SRMR < 0.08. The findings corroborated the protective role of both positivity and regulatory emotional self-efficacy in reducing individuals’ anxiety and depressive symptoms, as well as in fostering individuals’ capabilities in complying with the containment measures imposed by the government to reduce the risk of illness and to contain the spread of the virus COVID-19. Specifically, regulatory emotional self-efficacy beliefs partially mediated the relations between positivity and anxiety and depressive symptoms and fully mediated the effect of positivity on perceived self-efficacy beliefs in complying with the containment measures. These paths were equal across ages. The results of the present study appear relevant to implementing psychological interventions aimed to reduce the deleterious effects of the COVID-19 pandemic on mental health through the promotion of individuals’ optimistic orientation and emotion regulation.

Italians Do It … Less. COVID-19 Lockdown Impact on Sexual Activity: Evidence From a Large Representative Sample of Italian Adults

BackgroundTo explore how sexual activity was impacted by coronavirus disease 2019 (COVID-19) lockdown measures in the general adult population.MethodsA cross-sectional survey was conducted among 6,003 Italian adults aged 18–74 years who were representative of the Italian general population. Study subjects were recruited at the time of the nationwide stay-at-home order (from April 27 to May 3, 2020). We identified characteristics associated with decreased frequency of sex during lockdown, differentiating between cohabiting and non-cohabiting subjects.ResultsOver one-third (35.3%) of Italians reported to have changed their sexual activity during lockdown (8.4% increased and 26.9% decreased). When focusing on cohabitants (N = 3,949, 65.8%), decreased sexual activity (20.7%) was more frequently reported by men (22.3%; compared to women, multivariable odds ratio 1.23; 95% confidence interval, 1.05–1.44), younger subjects (P for trend <0.001), more educated subjects (P for trend = 0.004), subjects living in smaller houses (P for trend = 0.003), and those reporting longer time spent outdoors before the lockdown (P for trend <0.001).ConclusionsCOVID-19 lockdown drastically altered people’s day-to-day life and is likely to have impacted lifestyle habits and behavioral risk factors, including sexual attitudes and practice. This is the first national population-level study exploring changes in sexual life in this COVID-19 era. As we report sexual practice to have been affected by lockdown restrictions, we suggest that the mental health, social, and other determinants of these changes are to be explored beyond imposed social distancing.

Pattern of sensitization to Juniperus oxycedrus 4EF-hand polcalcin, Jun o 4, compared with the 2EF-hand grass homolog Phl p 7 in a general Italian population of subjects suffering from pollinosis

Cupressaceae pollen causes allergic reactions worldwide with long-lasting symptomatic periods. Currently, no cypress polcalcin is available for diagnostic purposes. With the aim to investigate the pattern of sensitization to a cypress polcalcin, a synthetic gene of Jun o 4, the Juniperus oxycedrus 4EF-hand polcalcin, was cloned and expressed in Escherichia coli. Its features were investigated in comparison with the grass 2EF-hand Phl p 7. Rhinitis was the symptom most frequently reported in a cohort of Italian patients sensitized to rJun o 4 and/or rPhl p 7. The detection of many pollen allergic patients sensitized to the cypress polcalcin, but negative to Phl p 7, indicates that Phl p 7 cannot be further considered a marker of sensitization towards all the polcalcins. A 4EF-hand cypress polcalcin claims the inclusion in allergy diagnostic tests. In addition, the sensitivity of polcalcins to gastrointestinal digestion is reported and discussed for the first time.

Hemoglobinopathies and Cancer: Preliminary Results of an Italian Multicenter Experience

Hemoglobinopathies and Cancer: Preliminary Results of an Italian Multicenter Experience

An EQ-5D-5L value set for Italy using videoconferencing interviews and feasibility of a new mode of administration

ObjectivesTo test the feasibility of using videoconferencing (VC) administered interviews and to derive an EQ-5D-5L value set for Italy. MethodsPreferences were collected using the EuroQol standardized valuation protocol (EQ-VT) administered via VC. Two valuation methods were employed, composite time trade-off (cTTO) and discrete choice experiment (DCE). Technical, organizational and protocol feasibility were tested in a pilot of 198 interviews. Upon positive assessment, data collection continued with a target sample of 1000–1200 participants including the pilot. Quality control (QC) procedures were employed to monitor interviewers’ performance during the pilot and the data collection. Data were modelled using GLS, Tobit, Logit and Hybrid models with different error specifications. Monotonicity of coefficients, statistical significance, and theoretical considerations informed the model choice. ResultsDropouts and technical problems occurred in less than 5% of the 198 pilot interviews. Protocol compliance was demonstrated with significant improvements in QC parameters and limited interviewers’ effects, for all interviewers. Overall, interviewers were satisfied with this mode of administration, highlighting it allows flexibility and efficient scheduling. Based on these results, VC was deemed as a feasible mode of administration. The study collected preferences for 1182 responders, including the pilot interviews. The demographic characteristics of the sample were representative of the Italian general population for age, gender and geographical macro-areas. The hybrid Tobit heteroscedastic model without constant estimated on the full sample (including pilot) was selected for the derivation of the value set. Values ranged from −0.571 for the worst health state (55555) to 1 for the best health state (11111). Pain/discomfort registered the largest decrement, followed by mobility, anxiety/depression, self-care, and usual activities. 523 health states were worse than dead. ConclusionsVC is viable for the conduct of valuation interviews. The Italian value set for the EQ-5D-5L can be used for value determinations of health technologies.

Stuck between a rock and a hard place: The clinical conundrum of managing cardiac surgical patients during the SARS-CoV-2 pandemic.

Deferring nonemergent cardiac surgery became the strategy of choice for several international healthcare systems afflicted by high case burdens of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2/COVID‐19) to both conserve valuable healthcare resources and protect patients from possible exposure. Missing from the available dataset to help guide policy development has been a clear understanding of the extent to which COVID‐19 infection modulates cardiac surgery outcomes. In their investigation, Bonalumi et al. uncovered an inpatient COVID‐19 positivity rate of almost 10 times higher than that of the general Italian population, as well as a mortality rate over 20 times higher amongst cardiac surgery patients with perioperative COVID‐19 infection compared to those COVID‐negative. While the summation of available evidence points to the serious consideration cardiac surgeons must give to delaying surgeries during the COVID‐19 pandemic, recognition must be given to the risks that postponing cardiac surgery may have on patient outcomes. Emerging data is beginning to demonstrate the efficacy of vaccination in preventing postoperative COVID‐19 infection and morbidity.

Ultra-processed food consumption modifies the association of Nutri-Score with all-cause mortality

Abstract Background The Nutri-Score front-of-pack label rates foods according to their nutritional quality while the NOVA classification is focused on degree of processing; both systems separately predicted mortality in epidemiological contexts. We evaluated whether ultra-processed food (UPF) modifies the association of the Nutri-Score with mortality. Methods Longitudinal analysis on 22,549 Italian men and women (mean age 54±12 y) from the Moli-sani Study (2005-2010) followed for 11.2 y. Food intake was assessed by a food frequency questionnaire. The Food Standards Agency nutrient profiling system (FSAm-NPS) score, used to derive the Nutri-Score, was calculated for each food based on its amount of energy, saturated fat, sugar, sodium, fibre, protein, fruits, vegetables, legumes and nuts per 100 g of product. The FSAm-NPS dietary index was calculated for each participant as an energy weighted mean of the FSAm-NPS score of all foods consumed, and increased values indicate lower nutritional quality. UPF intake was the proportion (%) of UPF in the total weight of food consumed (g/d) and categorized as low/high (below/above the population median, respectively). Results In a multivariable analysis, 1-SD increase in the FSAm-NPS index led to increased risk of all-cause (HR = 1.07; 95%CI 1.02-1.13) and CVD mortality (HR = 1.08; 1.00-1.18). UPF intake was an effect modifier since the association of FSAm-NPS index with mortality was confined to individuals with high UPF intake (HR = 1.14; 1.05-1.25) but not in those with low UPF (HR = 1.00; 0.93-1.07; p for interaction=0.034). Similar findings were reported for CVD mortality (HR = 1.14;0.99-1.31 and HR = 1.01;0.90-1.13 for high and low UPF consumers, respectively; p for interaction=0.18). Conclusions Higher mortality risk associated with a NutriScore revealing nutrient-poor food intake is limited to individuals also reporting high UPF intake. Food labelling systems should account for food processing in addition to nutritional content. Key messages Ultra-processed food modifies the association between the 5-color Nutri-Score front-of-pack label with all-cause mortality in an Italian general population. Food labelling systems, that are conceived to help consumers make healthier food choices, should also account for food processing in addition to nutritional content.

Iodine Intake from Food and Iodized Salt as Related to Dietary Salt Consumption in the Italian Adult General Population.

Since the Italian iodoprophylaxis strategy is based on the use of iodized salt, we assessed the relationship between dietary salt consumption and iodine intake in the Italian adult population. We estimated the relative contribution given by the use of iodized salt and by the iodine introduced by foods to the total iodine intake. The study population included 2219 adults aged 25–79 years (1138 men and 1081 women) from all Italian regions, participating to the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 2008–2012 (OEC/HES), and examined for sodium and iodine intake in the framework of the MINISAL-GIRCSI Programme. Dietary sodium and total iodine intake were assessed by the measurement of 24 h urinary excretion, while the EPIC questionnaire was used to evaluate the iodine intake from food. Sodium and iodine intake were significantly and directly associated, upon accounting for age, sex, and BMI (Spearman rho = 0.298; p < 0.001). The iodine intake increased gradually across quintiles of salt consumption in both men and women (p < 0.001). The European Food Safety Authority (EFSA) adequacy level for iodine intake was met by men, but not women, only in the highest quintile of salt consumption. We estimated that approximately 57% of the iodine intake is derived from food and 43% from salt. Iodized salt contributed 24% of the total salt intake, including both discretionary and non-discretionary salt consumption. In conclusion, in this random sample of the Italian general adult population examined in 2008–2012, the total iodine intake secured by iodized salt and the iodine provision by food was insufficient to meet the EFSA adequate iodine intake.

Fear of COVID-19 in Patients with Acute Myocardial Infarction.

A marked decline in myocardial infarction (AMI) hospitalizations was observed worldwide during the COVID-19 outbreak. The pandemic may have generated fear and adverse psychological consequences in these patients, delaying hospital access. The main objective of the study was to assess COVID fear through the FCV-19S questionnaire (a self-report measure of seven items) in 69 AMI patients (65 ± 11 years, mean ± SD; 59 males). Females presented higher values of each FCV-19S item than males. Older subjects (>57 years, 25th percentile) showed a higher total score with respect to those in the first quartile. The percentage of patients who responded “agree” and “strongly agree” in item 4 (“I am afraid of losing my life because of the coronavirus”) and 3 (“My hands become clammy when I think about the coronavirus”) was significantly greater in the elderly than in younger patients. When cardiovascular (CV) patients were compared to a previously published general Italian population, patients with CV disease exhibited higher values for items 3 and 4. Measures should be put in place to assist vulnerable and high CV risk patients, possibly adding psychologists to the cardiology team.

What Is the Role of Resilience and Coping Strategies on the Mental Health of the General Population during the COVID-19 Pandemic? Results from the Italian Multicentric COMET Study.

The effects of the COVID-19 pandemic on mental health are now well documented, however, few studies have been focused on the role of coping strategies and resilience in counterbalancing these detrimental effects. Data are derived from the COvid Mental hEalth Trial (COMET), a national multicentric trial carried out in the Italian general population. The final sample consisted of 20,720 participants, 53.1% (n = 11,000) of the sample reported low levels of resilience. Adaptive coping strategies and resilience levels did not have any significant protective impact on the levels of depressive, anxiety, and stress symptoms. Only self-distraction was a risk factor for poor mental health (Beta Coefficient, B = 0.1, 95% Confidence Interval, CI: 0.003 to 0.267 for stress symptoms; B = 0.2; 95% CI: 0.077 to 0.324 for anxiety symptoms and B = 0.2, 95% CI: 0.105 to 0.382 for depressive symptoms). High levels of resilience were predicted by adaptive coping strategies, such as acceptance (B = 1.8, CI 95% = 1.4–2.7). Exposure to the different weeks of lockdown, being infected by COVID-19, and being a healthcare professional did not influence the levels of resilience. Our findings should be carefully considered, since the low levels of resilience may represent the missing link between the pandemic and the current increase in mental health problems.

Characterization of epidemiological distribution and outcome of COVID-19 in patients with hereditary hemorrhagic telangiectasia: a nationwide retrospective multi-centre study during first wave in Italy

BackgroundCoronavirus Disease 2019 (COVID-19) continues to have a devastating impact across the world. A number of pre-existing common clinical conditions were reported to represent risk factors for more severe COVID-19 outcomes. Hereditary Hemorrhagic Telangiectasia (HHT) is a rare vascular heritable disorders, characterized by complications secondary to visceral Arterio-Venous Malformations. The impact of HHT, as well as for many Rare Diseases (RDs) on infection susceptibility profile and clinical adverse outcome risk is an unresolved issue.ObjectivesThe main objectives were: to assess the clinical features and outcomes of HHT patients infected with COVID-19; to compare the relative infection risk in these patients with the Italian general population throughout the first pandemic wave; to investigate the factors potentially associated with severe COVID-19 outcome in HHT patients, and the possible impact of COVID-19 infection on HHT-related symptoms/complications. Finally, we aimed to estimate how the lockdown-associated wearing of personal protective equipment/individual protection devices could affect HHT-related telangiectasia bleeding frequency.MethodsThe study is a nation-wide questionnaire-based survey, with a multi-Center retrospective cross-sectional design, addressed to the whole Italian HHT population. COVID-19 cases, occurring throughout the first pandemic wave, were collected by a questionnaire-based semi-structured interview. Only the cases ascertained by laboratory confirmation (molecular/serological) were included for epidemiological estimates. Information concerning eventual SarS-Cov-2 infection, as well as regarding HHT-related manifestations and HHT-unrelated co-morbidities were collected by the questionnaire. Prevalence data were compared to Italian general population in the same period.ResultsThe survey disclosed 9/296 (3.04%) COVID-19 cases, 8/9 of them being resident in Lombardy, the main epidemic epicenter. Pneumonia was reported by 4/9 patients, which prompted hospital admission and intensive care management in 2 cases. No fatal outcome was recorded. After careful refinement of epidemiological analysis, the survey evidenced overlapping infection risk in HHT compared to general population.ConclusionsCOVID-19 infection profile parallels geographical distribution of epidemic foci. COVID-19 in HHT patients can lead to highly variable clinical profile, likely overlapping with that of general population. The HHT disease does not seem to involve a different approach in terms of hospital admission and access to intensive care with respect to general population.

Investigating the Link between Alpha-1 Antitrypsin Deficiency and Abdominal Aortic Aneurysms

Alpha-1-Antitrypsin (AAT) is one of the major plasmatic protease inhibitors. In the last decade, an association between Alpha-1-Antitrypsin Deficiency (AATD) and Abdominal Aortic Aneurysms (AAA) has been hypothesized. Multiple factors may be involved in AAA's etiopathogenesis, and an underlying structural defect of the extracellular matrix (ECM) is always present. AATD could be a reasonable risk factor for AAA because it is related to protease/antiprotease imbalance and enhanced ECM degradation of the vessel wall. We performed genotyping of 138 patients hospitalized in the Vascular Surgery Division of the ASST-Spedali Civili di Brescia, Italy, for nontraumatic rupture of AAA. The second purpose was to observe the distribution of main nongenetic risk factors for AAA between patients with and without AATD. Out of 138 patients, 22 were found with AATD: 16 MS, 1 SS, 3 MZ, and 2 with a new rare AAT variant. When compared to the general Italian population, our cohort's frequency of deficient S allele was significantly higher (7.8 vs. 2.2% respectively, P < 0.01), whereas the deficient Z allele was similar (1.1 vs. 1.3% respectively, P > 0.05). Although we found no differences in age, gender, hypertension, diabetes, and smoke habits between AAA patients with and without AATD, hyperlipidemia was significantly less frequent in patients with AATD (46.4 vs. 12.5% respectively, P < 0.05). In our AAA patients' cohort, the S allele frequency was higher than in the general Italian population. Our results support the hypothesis that AATD might be a risk factor for AAA.

Factors impacting resilience as a result of exposure to COVID-19: The ecological resilience model.

Despite the severe psychological impact of the COVID-19 pandemic, some individuals do not develop high levels of psychological distress and can be termed resilient. Using the ecological resilience model, we examined factors promoting or hindering resilience in the COVID-19 pandemic. Of the 1034 participants (49.9±16.2 years; females 51.2%) from Italian general population, 70% displayed resilient outcomes and 30% reported moderate-severe anxiety and/or depression. A binary regression model revealed that factors promoting resilience were mostly psychological (e.g., trait resilience, conscientiousness) together with social distancing. Conversely, factors hindering resilience included COVID-19-anxiety, COVID-19-related PTSD symptoms, intolerance of uncertainty, loneliness, living with children, higher education, and living in regions where the virus was starting to spread. In conclusion, the ecological resilience model in the COVID-19 pandemic explained 64% of the variance and identified factors promoting or hindering resilient outcomes. Critically, these findings can inform psychological interventions supporting individuals by strengthening factors associated with resilience.

Prevalence of HPV genital infection in patients with moderate-to-severe psoriasis undergoing systemic treatment with immunosuppressive agents or biologics.

Psoriasis is an immune-mediated inflammatory disease and its relationship with infection has been extensively investigated. Concern for the increased prevalence of human papilloma virus (HPV) infection in patients undergoing systemic immunomodulatory or immunosuppressive therapies for psoriasis has been gradually growing among clinicians. To evaluate the prevalence of HPV in a cohort of patients with psoriasis treated with currently available systemic, conventional and biotechnological drugs. A multi-centric prospective study was conducted in the main dermatological clinical centres of central and southern Italy. Data from 588 patients (366 males and 222 females) with moderate-to-severe psoriasis, aged ≥18 years and treated with conventional and biological drugs, were collected based on a documented history of HPV infection, a positive Papanicolaou test (Pap-test) when available, and clinical evidence of genital warts reported during consultation. Overall, 18 of 588 patients (3.6% [95%CI: 1.8-4.5]) were positive for HPV or had a history of cervical cancer. Considering anamnestic and demographic data, such as gender, age, smoking, weight and body mass index, no statistically significant differences between HPV+ and HPV- patients were found. Moreover, the eradication of HPV infection was successfully achieved using conventional treatments. The prevalence of HPV infection in patients with moderate-to-severe psoriasis, undergoing systemic treatment with immunosuppressive agents or biologics, appears to be the same as that in the general Italian population, indicating that the level of infection among such patients is acceptable.