Fabrizio Bert

Smartphones and Health Promotion: A Review of the Evidence

Communication via mobile phones has become an essential tool for health professionals. The latest generation of smartphones is comparable to computers, allowing the development of new applications in health field. This paper aims to describe the use of smartphones by health professionals and patients in the field of health promotion. We conducted a bibliographic search through Pubmed. Then, research results were analyzed critically in order to select the best experiences available. All searches were carried out on November 2012 and were not limited by date. Each item from the initial search was reviewed independently by members of the project team. Initial search returned 472 items with PubMed. After the removal of duplicates, 406 items were reviewed by all the members of the project team and 21 articles were identified as specifically centered on health promotion. In the nutrition field there are applications that allow to count calories and keep a food diary or more specific platforms for people with food allergies, while about physical activity many applications suggest exercises with measurement of sports statistics. Some applications deal with lifestyles suggestions and tips. Finally, some positive experiences are reported in the prevention of falls in elderly and of sexually-transmitted diseases. Smartphones are transforming the ways of communication but the lack of monitoring of contents, the digital divide, the confidentiality of data, the exclusion of the health professional from the management of patient, are the main risks related to their use.

Pregnancy e-health: a multicenter Italian cross-sectional study on internet use and decision-making among pregnant women

Background Our study aimed to estimate the prevalence of pregnancy e-health seekers in a large Italian sample; to explore the factors influencing the choices of the childbearing women regarding their lifestyles after internet consultation; and finally to investigate potential differences between primiparous and multiparous women in internet use to find information about pregnancy. Methods A multicentre survey was carried out in seven Italian cities. Data were collected through a validated questionnaire administered in waiting rooms of outpatient departments by medical doctors. Respondents were questioned about their sociodemographic status, their use of the internet to seek pregnancy information and their consequent choices to modify their lifestyles. Data were analysed using descriptive statistics and logistic regression. Results Almost all women were pregnancy e-health seekers (95%), including those who also received information from healthcare professionals. Indeed, the main reason for searching the web was the need of further knowledge on pregnancy-related topic, over and beyond other key advantages of the net such as anonymity, simplicity and rapidity. A higher likelihood of changing lifestyle after pregnancy e-health was observed among the women who searched institutional websites; declared more confidence in the information retrieved; participated into pregnancy-centred forum online; and were residents in Italy. Conclusions To reduce the likelihood for women of both finding erroneous information or misinterpreting correct ones, healthcare professionals should commit to fill the information gap and guide pregnant women in the online searches. Also, future studies are strongly needed to analyse the quality and accuracy of health information found on the web.

General population's knowledge and attitudes about antibiotics: a systematic review and meta-analysis

Nowadays, the development of antibiotic resistance represents one of the most important issues of the global public health. The incorrect use of antimicrobial drugs is recognized as one of the leading causes of antibiotic resistance. Therefore, a better understanding of the existing pieces of evidence pertaining knowledge and attitudes about antibiotic and antibiotic resistance in the general population worldwide is advisable.

Association of Histologic Regression in Primary Melanoma With Sentinel Lymph Node Status: A Systematic Review and Meta-analysis

Importance The prognostic significance of regression in primary melanoma has been debated for many years. There is no consensus regarding the need for sentinel lymph node (SLN) biopsy when regression is present within the primary tumor. Objective To review the evidence that regression may affect SLN status. Data Sources A systematic review was performed by searching in MEDLINE, Scopus, and the Cochrane Library from January 1, 1990, through June 2014. Study Selection All studies that reported an odds ratio (OR) or data on expected and observed cases of SLN positivity and histologic regression were included. Data Extraction and Synthesis Primary random-effects meta-analyses were used to summarize ORs of SLN positivity and histologic regression. Heterogeneity was assessed using the χ2 test and I2 statistic. To assess the potential bias of small studies, we used funnel plots, the Begg rank correlation test, and the Egger weighted linear regression test. The methodologic quality of the studies was assessed according to the Strengthening of Reporting of Observational studies in Epidemiology (STROBE) checklist, and 2 different meta-analyses were performed based on those criteria. Main Outcomes and Measures Summary ORs of histologic regression of primary melanoma and SLN status. Results Of the 1509 citations found in the search, 94 articles were reviewed, and 14 studies comprising 10 098 patients were included in the analysis. In the combined 14 studies, patients with regression had a lower likelihood to have SLN positivity (OR, 0.56; 95% CI, 0.41-0.77) than patients without regression. On the basis of study quality, we found that patients with regression enrolled in high-quality studies had a lower likelihood to have SLN positivity (OR, 0.48; 95% CI, 0.32-0.72) compared with results of low-quality studies (OR, 0.73; 95% CI, 0.53-1.00). Examination of the funnel plot did not provide evidence of publication bias. Conclusions and Relevance The results of this analysis showed that the risk of SLN positivity was significantly lower in patients with histologic regression compared with those without. Regression may be used in these cases to make a selection of which patients should be the most appropriate for this procedure.

Suicide attempts and emergency room psychiatric consultation

BackgroundSuicidal behaviours are major public health concerns worldwide. They are associated with risk factors that vary with age and gender, occur in combination, and may change over time. The aim of our study was to investigate how frequently patients visiting a hospital emergency room (ER) require a psychiatric consultation for attempted suicide, and to outline the characteristics of this population.MethodsDeterminants of emergency room visits for psychiatric reasons were studied prospectively from 2008 to 2011 at the “Maggiore” Hospital in Novara.Results280 out of 1888 patients requiring psychiatric consultation were referred to the ER because of suicide attempt. Suicide attempters were more often female. The rate of suicide attempters among Italian people was 14.2%, compared to 19.5% in foreigners. Subjects living with parents or own family and those having a permanent job had a higher frequency of suicide attempt. Suicide attempts were more frequent among patients with a history of psychiatric disorders; nonetheless, suicide attempts were more common among those who had not previously been hospitalized in a psychiatric ward or were not under the care of a psychiatrist. The multivariate analysis found that female gender was a risk factor for suicide attempt, while being in the colder months of the year and, surprisingly, unemployment were protective factors.ConclusionsA better understanding of patients referring to the ER due to attempted suicide may allow the identification of at-risk subjects and the implementation of targeted treatment approaches.

Depression symptoms and the progression of carotid intima-media thickness: a 5-year follow-up study.

OBJECTIVE Only a few studies have investigated the changes in carotid intima-media thickness (IMT) over time, and uncertainties remain on the underlying mechanisms linking depression and subclinical atherosclerosis. We carried out a prospective cohort study to evaluate whether depression is associated with changes in carotid IMT in subjects with cardiac risk factors but free from coronary heart disease (CHD), and to what extent the atherogenicity of depression can be explained by inflammatory markers and autonomic nervous system dysfunction. METHODS During baseline and follow-up visits: all participants were asked to provide blood samples and compile a structured questionnaire; trained physicians assessed depression symptoms using Beck Depression Inventory (BDI); altered cardiac autonomic tone was measured using time-domain components of heart rate variability in 24 h Holter recordings; measurements of carotid IMT were carried out using B-mode ultrasound image acquisition. Logistic and linear regression analyses were used to adjust for potential confounders and explore potential mediators. RESULTS A total of 381 subjects completed the 5-year follow-up. The mean carotid IMT significantly increased in all subjects but the amount of increase was significantly larger among subjects with depression symptoms: mean IMT increased by 0.16±0.14 mm; 0.31±0.28 mm and 0.61±0.54 mm among the subjects with no, mild and moderate/severe depression, respectively (all p<0.01). The association between moderate/severe depression and IMT increase remained highly significant even after controlling for all the variables considered, however when both IL-6 and CRP were included in multivariate models the regression coefficient decreased by 42.3%. Some of the inflammation markers and autonomic nervous system dysfunction were also independently correlated with carotid IMT increase. CONCLUSION Depression symptoms are independently associated with an accelerated progression of carotid IMT in subjects with CHD risk factors, and inflammation may substantially modulate the association between depression and carotid IMT progression.

Antibiotic Use: A Cross-Sectional Survey Assessing the Knowledge, Attitudes and Practices amongst Students of a School of Medicine in Italy

Background Since antibiotic resistance has become a worldwide public health concern and is in part related to physicians’ lack of knowledge, it is essential to focus our attention on healthcare profession students. The present study aims at evaluating the knowledge and attitudes of the School of Medicine’s students towards antibiotic usage and antibiotic resistance. Methods In December 2013, a cross sectional study was conducted amongst medical, dental, nursing and other health care profession students of the School of Medicine at the University of Torino. Students of all the academic years took part in this study. Questionnaires were submitted during regular lectures (only students who attended courses on one specific day were surveyed) and the data collected was analyzed using StataMP11 statistical software. Results Overall, 1,050 students were interviewed. The response rate was 100%. Around 20% of the sample stated that antibiotics are appropriate for viral infections and 15% of the students that they stop taking those drugs when symptoms decrease. Results of the multivariate analyses showed that females were more likely than males to take antibiotics only when prescribed (OR 1.43, 95% CI 1.04–1.98). Interestingly, students with a relative working in a health-related field, as well as those who took at least one course of antibiotics in the last year, had a lower probability of taking those drugs only under prescription (OR = 0.69 95% CI: 0.49–0.97 and OR = 0.38 95% CI: 0.27–0.53, respectively). Conclusion The present paper shows how healthcare profession students do not practice what they know. Since those students will be a behavioral model for citizens and patients, it is important to generate more awareness around this issue throughout their studies. It would be advisable to introduce a specific course and training on antibiotics in the core curriculum of the School of Medicine.

Correlation between driving-related skill and alcohol use in young-adults from six European countries: the TEN-D by Night Project

BackgroundOnly few studies with small experimental samples investigated the impact of psychoactive substances on driving performance. We conducted a multicenter international cross-sectional study to evaluate the correlation between alcohol use and driving-related skill as measured by brake reaction time (RT).MethodsBefore and after the entrance into randomly selected recreational sites from six European countries, all subjects aged 16-35 years, owning a driver license, were asked to compile a structured socio-demographic questionnaire and measure RT (SimuNomad3 driving simulator), breath alcohol concentration (BAC; Drager Alcoltest), and drug use (Oratect III saliva test, only at the exit). Mixed regression modeling was used to evaluate the independent association between RT and alcohol concentration or drug use.ResultsBefore the entrance into the recreational site, 4534 subjects completed all assessments and composed the final sample. Their mean age was 23.1 ± 4.2y; 68.3% were males; 54.7% had BAC > 0 g/L (assumed alcoholics); 7.5% declared illegal drug assumption (mostly cannabis). After the exit, 3019 also completed the second assessment: 71.7% showed BAC > 0 g/L. Controlling for age, gender, educational level, occupation, driver license years, and drug use, BAC was positively associated with RT, achieving significance, however, only when BAC was higher than 0.49 g/L. Significant interaction terms were found between BAC and female gender or drug use, with highest RTs (> 1 sec.) recorded among drug users with BAC > = 1 g/L.ConclusionsThis field study confirms previous experimental data on the negative impact of alcohol use on driving-related skill, supporting regulations and educational campaigns aimed at discouraging driving after consumption of psychoactive substances.

Consumption of Antidepressants in Italy: Recent Trends and Their Significance for Public Health

OBJECTIVES The study assessed the consumption of antidepressants in Italy between 2000 and 2011 and identified trends in use. METHODS Data on use of antidepressant drugs between 2000 and 2011 were collected from the Italian Medicines Agency database. Data were expressed as the daily defined dose (DDD) per 1,000 inhabitants. Trends in drug consumption were ascertained by logarithmic transformation of incidence rates by using the formula ln(y)=b × x, where y is the incidence rate, b is the regression coefficient, and x represents the calendar years. Time trends were expressed as expected annual percentage change (EAPC). A significance level of .05 was chosen. RESULTS Antidepressant consumption increased drastically between 2000 and 2011, from 8.18 to 36.12 DDD per 1,000 inhabitants per day. A single joinpoint (time point with a significant trend change) occurred in 2002 (EAPC=56.4%, 2000-2002, and 6.2%, 2002-2011). The trend analysis stratified by type of drug showed a huge increase in consumption of selective serotonin reuptake inhibitors and other antidepressants and a decrease in consumption of tricyclic antidepressants. CONCLUSIONS Mental disorders are less stigmatized now than in the past. In Italy and elsewhere, antidepressant use is growing, and it would be important to monitor this trend, especially considering the possible effects of the current economic crisis on mental health. In this scenario, the role of public health in mental health promotion has become fundamental.

There comes a baby! What should I do? Smartphones’ pregnancy-related applications: A web-based overview

Our article aims to give an overview of the most mentioned smartphones’ pregnancy-related applications (Apps). A keywords string with selected keywords was entered both in a general search engine (Google®) and PubMed. While PubMed returned no pertinent results, a total of 370 web pages were found on Google®, and 146 of them were selected. All the pregnancy-related Apps cited at least eight times were included. Information about App’s producer, price, contents, privacy policy, and presence of a scientific board was collected. Finally, nine apps were considered. The majority of them were free and available in the two main online markets (Apple® App Store and Android® Google Play). Five apps presented a privacy policy statement, while a scientific board was mentioned in only three. Further studies are needed in order to deepen the knowledge regarding the main risks of these devices, such as privacy loss, contents control concerns, the digital divide and a potential humanization reduction.