Search Results (1,958)

Background/Objectives: Eco-anxiety is emerging as a response to worsening environmental conditions. However, several gaps hinder the estimation of this phenomenon worldwide. This review aims to provide a measure of eco-anxiety control by those factors that may affect its prevalence assessment. Methods: The review was conducted in accordance with the PRISMA guidelines, and the protocol was registered on PROSPERO (CRD42024556132). PubMed, Scopus, Web of Science, and PsycINFO databases were interrogated. Cross-sectional studies in English and Italian languages assessing eco-anxiety through validated questionnaires were considered. The quality assessment was conducted using the adapted Newcastle–Ottawa Quality Assessment Scale. Results: Sixty-nine articles published between 2020 and 2025 were included. Of these, 60 studies were meta-analyzed, for a total sample size exceeding 65,000 participants across different countries and cultural contexts. The overall pooled mean eco-anxiety level was approximately 34.8/100 (95% CI: 29.6–39.9), corresponding to a moderate level of eco-anxiety, with women scoring higher than men (p < 0.05). Assessment tool and country were also shown as significant predictors of eco-anxiety, while age did not seem to play a significant role. Conclusions: Though further rigorous research is needed in this field, focusing on these variables could help to design targeted strategies that address environmental concerns and support mental well-being and resilience towards environmental challenges. Full article

Background/Objectives: The identification of a decedent through skeletal analysis is dependent on accurate estimation of demographic characteristics, including biological sex. The most well-known sex estimation technique using the pubic bone is the Phenice method. In 2012, it was revised by Klales and colleagues and a logistic regression equation to predict sex was applied. Later, a program that estimates sex from Klales’ scoring with a random forest model, MorphoPASSE, was developed by Klales. Methods: Here we compare the accuracy of the original and revised methods, along with MorphoPASSE, using a contemporary sample of Northern Italians with documented sex. We further test the assertions by Phenice that his method is easy to employ for new observers and that ambiguity can be applied when characteristics do not morphologically fit into the categories of the method. Accuracy, error, bias, sensitivity, and specificity were calculated for each approach, along with McNemar’s tests for paired data, which compared documented sex and estimated sex. A linear weighted Cohen’s Kappa measured the differences in scoring between a new observer and an experienced observer. Results: Phenice’s method achieved higher accuracy (97%) than the Klales method and MorphoPASSE (86% each), as well as higher sensitivity and specificity, and lower error and bias. All McNemar’s tests conducted were not significant. The new observer demonstrated a similar accuracy (93%) to the experienced observer (97%). Furthermore, comparisons of Phenice’s scoring with ambiguity indicate its superior performance for capturing variation over the Klales method and MorphoPASSE. Conclusions: Phenice’s method is recommended in forensic anthropology and bioarchaeological contexts, particularly in Milan. Full article

Background and Objectives: Evaluating osteoarthritis (OA) care quality is increasingly relevant for service improvement and benchmarking purposes. The Osteoarthritis Quality Indicator questionnaire (OA-QI) measures patient-reported guideline-concordant care; however, no version has been tested in Italian primary care or bilingual contexts. This study aimed to introduce the OA-QI version 3 (OA-QI v3) in German and Italian, assess its applicability in practice, and examine its acceptability and reliability. Materials and Methods: A cross-sectional survey was conducted using the South Tyrolean General Practice Research Network. Thirty-eight general practitioners recruited 266 patients with hip or knee OA. Patients completed the OA-QI v3 in German or Italian, with subsamples for comprehensibility testing (n = 38) and retest reliability after 14 days (n = 36). Test–retest reliability was analyzed using percent agreement, Cohen’s κ, intraclass correlation coefficients (ICC), and standard error of measurement. The smallest detectable change was analyzed to estimate factual change. Results: Response rate reached 95% of the targeted patients. Patient feedback showed good comprehensibility and ease of use in both languages. Adherence to recommended quality indicators varied, with strengths in physical activity advice, NSAID prescription, and pain assessment, but gaps in weight management, occupational counseling, and assistive devices. Test–retest reliability ranged from fair to substantial at the item level (κ = 0.33–0.69) and was moderate for the total score (ICC = 0.55, 95% CI 0.28–0.74). While measurement error restricted individual-level interpretation, reliability at the practice or institutional level supports application for benchmarking and quality monitoring. Conclusions: The OA-QI v3 was feasible, acceptable, and reliable for group-level assessments in South Tyrol. These findings position OA-QI v3 as a practical tool for identifying care gaps and guiding quality improvement, while providing important lessons for the full validation of the German and Italian versions in larger cross-national samples. Full article

Background: Metabolic dysfunction-associated fatty liver disease (MASLD) affects nearly 20% of the Italian population, with an annual economic burden of € 7.94 billion on the National Health Service, largely due to advanced liver disease and metabolic comorbidities. Progressive liver fibrosis remains the strongest predictor of adverse outcomes. Early diagnosis is crucial, as fibrosis is potentially reversible in its early stages. Sedentary behavior (SB) is one of many modifiable risk factors for several chronic diseases; however, most evidence is based on self-reported data. This study investigates the association between objectively measured daily energy expenditure and liver stiffness in adults with MASLD. Methods: We conducted a cross-sectional analysis of 104 adults (18–65 years) with obesity and moderate-to-severe steatosis (CAP ≥ 248 dB/m) from the Obesity-AF study. Daily energy expenditure (METs/day) was assessed via 7-day wrist-worn actigraphy. Liver stiffness (LSM, kPa) was measured non-invasively using transient elastography (FibroScan^®). Results: Lower daily energy expenditure was independently associated with higher liver stiffness. Each 1-MET increase correlated with a −1.239 kPa reduction in LSM (95% CI: −2.012, −0.466; p = 0.002). Sedentary individuals (≤1.5 METs) exhibited significantly higher LSM (+0.73 kPa, p = 0.03) versus non-sedentary peers, even after full adjustment. Findings were robust across sensitivity analyses. Conclusions: Our study shows that SB, objectively measured by actigraphy, is independently associated with increased liver stiffness in patients with MASLD and obesity. Reducing sedentary time may represent a simple, low-cost, and scalable strategy to mitigate fibrosis progression. However, given the cross-sectional design and the specificity of our sample, longitudinal studies are needed to confirm the causal role of SB and to evaluate the effectiveness of targeted interventions in broader MASLD populations. Full article

This study investigates the mineralogical and physical properties of serpentinite from the Monteferrato area (Tuscany, Italy) to evaluate its potential use in Tuscany architectural restoration. The research addresses the need to identify replacement materials compatible with historic stones while preserving their original features. Representative specimens from the Bagnolo quarry were analysed through physical testing and a wide range of mineralogical and geochemical techniques, including polarised light microscopy, X-ray diffraction, electron probe micro-analysis, whole-rock chemistry, and fibre quantification. The results show a mineralogical composition dominated by serpentine-group minerals and magnetite, with physical properties generally consistent across samples. Measured capillary water absorption ranges from 3.27 to 5.27 g/m²·s^0.5, open porosity from 5.25% to 8.93%, apparent densities range from 2.49 to 2.56 g/cm³, and imbibition coefficient from 2.16% to 3.71%. Comparative analysis with serpentinite from historic sources (Figline di Prato quarry, Tuscany) and from monuments (Baptistery of San Giovanni, Florence) demonstrates close compositional and textural affinities, supporting the suitability of the rock from the studied quarry for restoration purposes in Tuscany monuments. However, chrysotile concentrations up to 14,153 mg/kg, exceeding Italian regulatory thresholds, represent a critical limitation. This not only requires the implementation of strict safety measures but also raises serious concerns regarding the practical feasibility of using this stone in conservation projects. More broadly, the presence of asbestiform minerals in serpentinites highlights a significant and often underestimated health risk associated with their extraction, processing, and use. Despite its importance, detailed fibre count data are rarely published or made publicly accessible, hindering both transparent risk assessment and informed decision-making. By integrating petrographic, mineralogical, and physical–mechanical characterisation with fibre quantification, this study not only assesses the technical suitability of Monteferrato serpentinites for restoration of Tuscan monuments but also contributes to a more responsible and evidence-based approach to their use, emphasising the urgent need for transparency and health protection in conservation practices. Full article

Objectives: An analysis based on epidemiological material to show whether the term Metabolic Syndrome (MS) should be adopted when aiming at predicting coronary heart disease (CHD) and major cardiovascular disease (CVD) fatal events. Material and Methods: MS was defined according to the International Diabetes Federation (IDF) and risk factors were identified in the Italian Risk Factors and Life Expectancy (RIFLE) population study covering over 25,000 adult men from a pool of 19 Italian population samples. The original MS definition and the plain original units of measured risk factors were challenged in Cox proportional hazard models predicting 196 CHD and 412 major CVD fatal events in a seven-year follow-up. Parallel models were run including also total serum cholesterol as a covariate, an unfortunately excluded covariate in the MS definition. The performance of the various models was tested by the log-likelihood statistics treated with the Akaike Information Criterium (AIC). Results: Models using the plain measurements of the risk factors involved were systematically and significantly outperforming any other categorized score based on the IDF-MS classification. An intermediate role was played by a model where the predictive variable was a factor score (derived from a Factor Analysis) where the MS risk factors were linearly combined. The same models also including serum cholesterol provided a significantly better prediction when compared with those without serum cholesterol, based on AIC. Conclusions: The use of a subset of classical CVD risk factors classified according to the IDF-MS criteria adds nothing better than the exclusive use of the risk factors treated by traditional procedures. The addition of serum cholesterol definitely helps in the prediction of the CHD component of major CVD events. Its omission is erroneous. Full article

Background: Access to and use of health services represent crucial issues/challenges for older people experiencing frailty with functional limitations and chronic diseases, especially when they age in place alone. Both access to and use of health services are also characterised by gender differences. The present study analysed these factors in three Italian regions (Lombardy, North; Marche, Centre; and Calabria, South), where in 2019, the “Inclusive Ageing in Place” (IN-AGE) project was carried out, involving 120 senior people aged 65 years and of both genders. Methods: In this mixed-methods study, both qualitative (predominant section) and some quantitative data (e.g., socio-demographic aspects and functional limitations) were collected through semi-structured interviews. In addition to basic quantitative analyses, content analysis and the quantification of statements were performed to process the qualitative data. The results for both men and women are presented. Possible barriers to accessing health services were also considered. Results: Women reported more cases of chronic diseases than men, especially arthritis/osteoporosis, and a greater use of drugs than men. Both genders used services provided by the general practitioner (GP) and medical specialist (MS), the latter being mostly private. More women than men used rehabilitation, especially in the private sector, and reported the issue of cost for private healthcare and the travel distance to reach medical units as barriers to access. The long waiting lists/times were complained about by both males and females. Conclusions: This study, despite its simple/descriptive qualitative approach with a limited sample, could provide, however, some insights for policymakers and healthcare professionals to plan prevention policies and deliver appropriate and timely health services to older people experiencing frailty and ageing in place alone, devoting attention to gender-related issues in the design and provision of such services. Full article

Acinetobacter baumannii is a multidrug-resistant opportunistic pathogen that poses critical challenges in hospital settings due to its environmental resilience and high resistance to antibiotics. Genomic surveillance has become essential for identifying transmission patterns, guiding antimicrobial stewardship, and informing infection control policies. We conducted whole-genome sequencing on 44 A. baumannii isolates collected between 2022 and 2023 from diverse wards in an Italian hospital. Illumina-based sequencing was followed by a comprehensive bioinformatics pipeline, including genome assembly, taxonomic validation, MLST, SNP-based phylogeny, pan-genome analysis, antimicrobial resistance (AMR) gene profiling, and virulence factor prediction. Most isolates were classified as ST2; SAMPLE-34 was ST1 and genetically distinct. Phylogenetic analysis revealed four clonal clusters with cluster-specific AMR and accessory gene content. The pan-genome included 5050 genes, with notable variation linked to hospital ward origin. ICU and internal medicine strains carried higher loads of AMR genes, especially against aminoglycosides, β-lactams, and quinolones. Virulence profiling highlighted widespread immune evasion mechanisms; “Acenovactin” was predominant, while some isolates lacked key adhesion or toxin factors. Our findings underscore the clinical relevance of integrating genomic epidemiology into routine hospital surveillance. Identifying clonal clusters and resistance signatures supports real-time outbreak detection, risk stratification, and targeted infection prevention strategies. Full article

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) represents the gold standard technique for the diagnosis and staging of lung carcinoma. However, its diagnostic yield may be limited for granulomatous pathologies or rare tumors requiring comprehensive histological and molecular analysis. Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) is an emerging technique that allows for the acquisition of larger histological samples with preserved tissue architecture. The primary objective of this prospective multicenter study was to evaluate the potential increase in diagnostic yield afforded by the addition of EBUS-TMC to EBUS-TBNA in patients selected by pre-test clinical–radiological criteria presenting with hilar–mediastinal lymphadenopathies without an obvious primary neoplastic lung lesion. Methods: The study prospectively enrolled 91 patients across two Italian interventional pulmonology units. Patients were selected based on a pre-defined clinical–radiological criterion aimed at excluding primary lung cancer suspects. For each patient, both EBUS-TBNA and EBUS-TMC were performed. Results: The overall diagnostic yield for the combined procedure was 84.6% (77/91 patients). EBUS-TMC achieved a diagnostic yield of 78.0%, which was significantly higher than EBUS-TBNA alone of 60.4%. The addition of EBUS-TMC resulted in a statistically significant increase in diagnostic yield of 17.6%. This increase was particularly pronounced for lymphoproliferative diseases. The safety profile of EBUS-TMC was favorable without major complications. The clinical–radiological criterion used to select patients for EBUS-TMC in addition to the standard of care of EBUS-TBNA, aiming at excluding primary lung cancer, was correct in 89.0% of the study population (81 out of 91 patients). Conclusions: EBUS-TMC is a safe and feasible technique that significantly enhances the diagnostic yield (17.6% absolute increase in diagnostic yield) in patients with hilar–mediastinal lymphadenopathies. The clinical–radiological criterion employed proved effective in pre-selecting patients who benefit most from cryobiopsy, thereby enabling a more rational allocation of healthcare resources. Full article

Background: High-dose methotrexate (HDMTX) is widely used for acute lymphoblastic leukaemia (ALL), but its pharmacokinetic (PK) variability and toxicity require therapeutic drug monitoring (TDM). Our 10-year retrospective study investigated HDMTX PK parameters and their associations with renal and hepatic biomarkers in an Italian cohort of adult patients with ALL. Methods: Plasma MTX concentrations [MTX C(p)] were measured at 24-, 48-, and 72 h post-infusion. PK modelling was performed to calculate area under the curve (AUC_{0 → 72 h}) and half-life (t½). Creatinine, total bilirubin, and sample quality indices were retrieved from routine clinical laboratory analyses. Results: Mean (±SEM) MTX plasma concentrations were 36.09 ± 15.53 μmol/L, 0.93 ± 0.43 μmol/L, and 0.30 ± 0.07 μmol/L at 24, 48, and 72 h, respectively, with marked inter-patient variability. PK analysis showed a mean AUC_{0 → 72 h} of 112.85 ± 34.09 h·μmol/L and a t½ of 17.15 ± 2.40 h. MTX C(p) and AUC_{0 → 72 h} showed significant positive correlations with serum creatinine at all time points, confirming renal function as a major MTX clearance determinant. Age moderated the relationship at 72 h, with younger patients showing stronger correlations. Hepatic function measured by total bilirubin also correlated with MTX C(p) and AUC_{0 → 72 h} at 48 and 72 h, especially in younger patients, suggesting a hepatic contribution to MTX variability. No associations were found between the PK parameters and lipemic, icterus, or haemolysis indices. Conclusions: These findings highlight the value of integrating renal and hepatic biomarkers into HDMTX drug monitoring protocols. Such biomarker-informed TDM may improve the safety and efficacy by identifying patients at risk of delayed clearance and toxicity, especially younger individuals or those with renal insufficiency. Full article

CWD surveillance and diagnosis are important issues in Europe since its detection in Norway, as some of its strains, like that of classical scrapie, are contagious. In addition, there are concerns as several matters about CWD are not yet known. Although diagnostic methods for the active surveillance in bovine and small ruminants have been able to detect the European CWD strains, a retrospective study on Italian wild red deer (Cervus elaphus) samples was performed to compare the results obtained from rapid screening tests, authorized according to EU Regulation 999/2001, and the RT-QuIC, a highly sensitive method in the detection of prion disease infection. A total of one hundred brainstems and medial retropharyngeal lymph nodes were selected out of those received from the CWD Italian surveillance system. Confirmed CWD-positive and -negative samples were included in the study as controls. All of the samples were first tested with the HerdChek BSE–Scrapie Antigen Test and then using the RT-QuIC. The rapid test was negative in all brainstem and lymph node samples. RT-QuIC analyses showed only one red deer brainstem sample positive for seeding activity, while all lymph nodes were negative, including the one from this case. This positive brainstem sample was then re-extracted and retested using two different recombinant prion protein substrates (Ha90-231; BV23-231) and their different batches from the first analyses. Seeding activity was consistently confirmed across both substrates and extractions, with positive signals detected down to dilutions of 10⁻⁴ using rPrP Ha90-231 and as low as 10⁻⁶ with rPrP BV23-231. The additional diagnostic investigations performed on this red deer using the alternative rapid test (TeSeE SAP Combi), Western blot, and immunohistochemistry showed negative results both in the brainstem and lymph nodes. This study showed that overall, the results obtained with the HerdChek BSE–Scrapie Antigen Test and RT-QuIC agree except in one case. Our findings highlight the potential of the RT-QuIC method to detect very low levels of PrP^Sc-associated seeding activity that may escape detection using classical methods. While seeding activity does not always equate to infectivity, only a bioassay will confirm the real disease status of this Italian case. These findings support the integration of RT-QuIC as a powerful complementary tool within existing surveillance frameworks to strengthen early detection and diagnostic accuracy. Full article

Background: Perfectionism is a multidimensional personality trait encompassing both adaptive and maladaptive aspects that strongly influence students’ psychological health. Spiritual well-being, defined by existential and religious components, has been suggested as a protective factor, yet its relationship with perfectionism remains underexplored in university populations. This study aimed to investigate these associations in a large nationwide sample of Italian undergraduates. Methods: A total of 2103 students from public and private universities across Northern, Central, and Southern Italy participated in an online cross-sectional survey. Validated instruments were used to assess multidimensional perfectionism and spiritual well-being. Results: Self-oriented perfectionism emerged as the most prevalent dimension, followed by other-oriented and socially prescribed perfectionism. Scores for existential well-being were higher than those for religious well-being. Existential well-being was negatively associated with socially prescribed perfectionism, suggesting a buffering role against maladaptive forms of striving. Religious well-being showed only a small positive association with perfectionism. Gender and age differences were also observed, with women and younger students reporting higher levels of perfectionism. Conclusions: Findings highlight existential well-being as a potential protective factor in academic contexts, supporting meaning-centered strategies to mitigate maladaptive perfectionism. Longitudinal and cross-cultural studies are warranted to clarify causal mechanisms and inform culturally sensitive educational and clinical practices. Full article

Background: Anchovies (Engraulis encrasicolus L.) are a component of the Mediterranean diet and among the most fished species. Despite Italian consumers showing a strong preference and willingness to pay more for locally caught anchovies, cases of mislabeling with non-local or different species have been documented. Molecular techniques like DNA barcoding offer reliable species identification, even in processed products, where morphological traits are no longer detectable. This pilot study applied a DNA barcoding technique targeting the mitochondrial cytochrome b gene to authenticate anchovies caught in the Italian Southern Adriatic Sea. Objectives: The study evaluated seasonal variations in the chemical and nutritional composition of anchovies, particularly the fatty acid profiles, highlighting their health benefits. Methods: During 2021, two fish samplings of anchovies were conducted per season from two fishing areas in Southern Adriatic Sea, one sample was used for mitochondrial DNA analyses, the other was used for morphometric measurements, physical, bromatological and chemical analyses. Results: Fish collected in summer showed higher total weight and edible yield relative to those fished in winter (p < 0.05). Anchovies fished in summer contained the highest concentration of proteins (p < 0.05) as compared to those caught during winter and autumn, while, in turn, they showed the highest amount of fat (p < 0.01). Fillets from anchovies fished during spring and summer contained a greater (p < 0.05) concentration of polyunsaturated fatty acids, and n-3 fatty acids than samples collected in autumn and winter. Conclusions: This study paves the way for further investigation to refine and validate the genetic identification and nutritional features of anchovies caught in the Italian Southern Adriatic Sea and marketed to consumers. Full article

Background/Objectives: Fibromyalgia (FM) is a chronic pain syndrome frequently associated with severe pain, sleep disturbances, worry, and depressive rumination. Although previous studies have shown links among these factors, no study has specifically examined the mediating role of sleep disturbances in the relationship between forms of Repetitive Negative Thinking (i.e., worry and rumination) and pain intensity. This study aimed to investigate whether sleep disturbances mediate the relationship between: (1) worry and pain intensity and (2) depressive rumination and pain intensity. Methods: An online cross-sectional survey was conducted with a sample of 867 Italian adults who reported having received an FM diagnosis from a rheumatologist or pain physician. After screening, 733 participants (97.3% female; mean age = 51.0 ± 9.95 years) were included in the analyses. Participants completed the Penn State Worry Questionnaire, the Ruminative Response Scale, the Brief Pain Inventory, and the Pittsburgh Sleep Quality Index. Mediation analyses were performed using Hayes’ PROCESS macro (Model 4). Results: Depressive rumination was associated with pain intensity both directly (B = 0.021, 95% Confidence Intervals [CIs] 0.012, 0.030) and indirectly through sleep disturbances (B = 0.014, 95% CIs 0.010, 0.020), indicating partial mediation. In contrast, worry showed no direct effect on pain intensity (B = 0.011, 95% CIs −0.003, 0.025) but demonstrated a significant indirect effect via sleep disturbances (B = 0.018, 95% CIs 0.012, 0.025), consistent with full mediation. Conclusions: Pain intensity, sleep quality, worry, and depressive rumination are interrelated in FM. Depressive rumination plays a particularly strong role in pain perception, independent of sleep quality. Interventions that integrate cognitive–behavioral and metacognitive strategies with sleep-focused treatments may help improve both sleep and pain outcomes in individuals with FM. Full article

Background: Molecular techniques for microbial identification have highlighted the relevance of polymicrobial infections in humans, such as those affecting the urinary tract. Although in vitro investigations have demonstrated connections between co-infections and microbial interaction, their role is unclear in clinics, given the overlap with host conditions. Objective: We aimed to separate the roles of organisms and patient conditions in human polymicrobial urinary samples by performing a relevant epidemiological analysis. Methods: We analyzed retrospective results from urine cultures performed during one year in a 1200 beds Italian hospital. Patients were grouped as uncompromised and compromised and positive urine cultures were grouped as monomicrobial and polymicrobial. We assessed associations between single microorganisms and the groups of positive samples and between single microorganisms and the group of patients through a multivariate logistic regression model, adjusting by the confounding effect of seven variables. Results: We enrolled 24,067 urine samples, among which 7208 were positive, 75% monomicrobial and 25% polymicrobial. We found that the polymicrobial samples had a microbial scenario wider than the monomicrobial ones and the organisms most sampled had the highest number of different pairwise associations. Certain organisms shown having absolute numerical advantages in the polymicrobial urine cultures with respect to the monomicrobial ones, independently of host’s conditions. Conclusions: The numerical advantage shown by certain organisms in polymicrobial urine samples over monomicrobial samples supports the hypothesis of microbial synergies favouring the occurrence of certain co-infections. Full article