BACKGROUND:The distribution of mycotoxins within cereal batches is highly heterogeneous. Therefore, to obtain representative samples and accurate analytical results, sample homogenization is a critical preparatory step. OBJECTIVE:To provide reliable and standardized instructions for preparing an aggregate grain sample within official control framework, four different homogenization procedures were evaluated. The comparison considered variability in mycotoxin distribution, workload, and time constraints. METHODS:The study was conducted on four aggregate samples, each weighing 10 kg, obtained from a maize grain batch according to regulatory provisions of Regulation (EU) 2023/2782. Analytical variability of aflatoxin (B1 and B2) and fumonisin (B1 and B2) was measured. RESULTS:The contamination levels in each pooled sample and the degree of homogeneity among the procedures were assessed and compared using the relative standard deviation of repeatability (RSDr) as acceptability criterion. CONCLUSIONS:The procedures involving fine grinding (particle size <0.5 mm) and aqueous slurry preparation yielded the best results in terms of homogeneity.
Spaceflight-Associated Neuro-ocular Syndrome (SANS) has emerged as a critical neuro-ophthalmic risk for human space exploration, particularly as mission duration increases and access to space expands. Current spaceflight ocular surveillance and research protocols have prioritized structural imaging and selected neuroimaging/physiological assessments. However, accumulating evidence suggests that SANS is not confined to the posterior pole as a purely structural optic nerve head phenomenon but may also involve vascular and hemodynamic alterations. At the same time, structural changes at the optic nerve head may not fully capture the functional integrity of the afferent visual pathway. We therefore propose to define a more targeted extension of current SANS surveillance protocols incorporating ultra-widefield swept-source optical coherence tomography angiography (UWF-SS-OCTA), visual evoked potentials (VEPs) and pattern electroretinogram (ERG) into standardized pre-flight, in-flight (when feasible), and post-flight assessments. Beyond its relevance to astronaut health, this topic may also be of translational interest to the broader scientific and clinical community.
BACKGROUND:This study summarizes seven years (2018-2024) of external quality assessment (EQA) activities in cytogenomics conducted in the Lombardy Region, Italy, across four diagnostic sectors: chromosomal microarray (CGH/SNP-array), prenatal cytogenetics, postnatal cytogenetics, and oncohematology. METHODS:A descriptive analysis was performed of the regional EQA cycles, focusing on analytical concordance and on the type and evolution of non-conformities over time. RESULTS:Analytical concordance remained consistently high across all EQA cycles, with correct identification of the primary findings in CGH-array and constitutional cytogenetics. Early rounds were mainly characterized by incomplete reporting, International system for human cytogenomic nomenclature (ISCN) inaccuracies, limited interpretive content, and insufficient communication of methodological limitations, whereas more recent cycles showed progressive convergence toward national (SIGU) and international (ACMG/ClinGen, European) standards. In microarray (CGH/SNP-array) exercises, inter-laboratory variability shifted from basic interpretive and reporting deficiencies to more advanced issues of standardization in 2023-2024. Prenatal and postnatal cytogenetics showed progressive improvement in report structure, ISCN compliance, and methodological completeness. Oncohematology remained the most challenging area, with persistent variability in complex karyotype reconstruction despite improved metaphase adequacy and more complete ISCN reporting. CONCLUSIONS:These findings support the role of regionally coordinated EQA schemes in promoting harmonization of cytogenomic practice, continuous quality improvement, and public health governance.
BACKGROUND:Food and nutrition insecurity (FNI) is a major public health concern, due to its association with a variety of adverse health outcomes. OBJECTIVE:The aim of this article is to provide a description of the strategies and policies to mitigate FNI in European countries, with a particular focus on economic, agriculture and social macro-areas. METHODS:A scoping review, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA) guidelines, was performed to map any study design, reporting policies and strategies that tackle FNI through food and nutrition security (FNS), access, utilization, or stability. RESULTS:The review identified 13 documents from institutional websites and 6 scientific articles, published from 2005 to 2022. The included papers highlight a multifaceted approach to addressing food insecurity, with policies covering several dimensions. The policies identified can be categorized into several key themes: agriculture and fisheries, nutrition, environment, sustainability, economy, stakeholder's views, COVID-19 pandemic and other crisis, vulnerable populations (women, children, migrants) and information campaigns. The review describes in detail several policies, examining their effectiveness and the challenges faced in ensuring that these initiatives result in tangible improvements in food access, affordability, and nutritional quality, particularly for vulnerable populations. CONCLUSIONS:The results show a current lack of a specific and coherent policy framework on FNI at a European level. Policy fragmentation is mainly due to the multidimensional nature of FNI, which has interconnections with many different areas of the food system. The findings suggest a comprehensive approach, incorporating several policy measures and involving multiple stakeholders to ensure sustainable and equitable access to nutritious food.
BACKGROUND:Membrane sweeping is a common but still invasive procedure offered to hasten labour in prolonged pregnancy. Rising labour induction rates have increased the use of interventions like membrane sweeping, though its impact on women's experiences remains unclear. AIM:To explore women lived experiences of membrane sweeping in a tertiary Italian maternity unit and identify their informational needs. METHODS:Twenty women ≥40+0 to 41+6 weeks' gestation who underwent membrane sweeping were interviewed in-hospital 24-48 h postpartum. Semi-structured interviews (mean 18 min) were analysed with combined inductive-deductive content analysis. FINDINGS:Three themes emerged i) clarity and timing of information ii) baseline knowledge and information-seeking behaviour iii) physical and emotional experience of the procedure in relation to the onset of labour. In addition, some women reported the procedure as painful or required further pharmacological induction of labour, adding a layer of dissatisfaction in their narrations. However, most women stated that they would undergo membrane sweeping again in a future pregnancy. CONCLUSIONS:When embedded in shared decision-making, membrane sweeping can be a well-accepted initial induction option. Moreover, structured antenatal education could be recommended.
BACKGROUND:Pain is highly prevalent among hospitalised adults, and in Italy Law 38/2010 mandates its assessment and relief. We aimed to estimate pain prevalence and severity among adult inpatients and identify factors associated with moderate-to-severe pain and satisfaction with pain management in a university hospital. METHODS:We conducted a cross-sectional survey in May 2023 at IRCCS Policlinico San Donato using a structured questionnaire in adult inpatients hospitalised for at least 24 hours. Multivariable logistic regression explored factors associated with pain severity and satisfaction. RESULTS:Among the 229 patients interviewed, 84% reported pain at the time of the interview, with 52.4% experiencing moderate pain and 9.6% severe pain. Pain in the previous 24 hours was associated with moderate-to-severe pain at the time of the interview and lower satisfaction with care. Thirty-two percent were aware of Law 38/2010, and awareness was associated with lower pain severity and higher satisfaction. CONCLUSIONS:Pain remains highly prevalent among adult inpatients. Experiencing pain in the previous 24 hours was associated with greater severity and lower satisfaction, suggesting the importance of timely and consistent pain assessment and relief throughout hospitalisation.
BACKGROUND:Evidence for spontaneous seizure detection by dogs remains limited. This study examined whether ictal odor cues elicit behavioral responses in untrained companion dogs. OBJECTIVE:To test whether dogs naïve to human epilepsy show spontaneous discrimination of ictal versus interictal odor. METHODS:Thirty dogs, without prior seizure exposure, freely investigated three odor stations (ictal, interictal, blank) using sweat samples from a single unfamiliar donor in controlled, non-social conditions. RESULTS:Dogs were more likely to investigate the ictal odor first than expected by chance (Monte Carlo p=0.029), indicating an early orienting bias. No differences emerged in sustained engagement. Structured exploratory patterns occurred only in odor conditions (ictal p=0.001; interictal p=0.002), not in the control (p=0.715). CONCLUSIONS:Ictal odor may carry salience sufficient to influence initial attention in naïve dogs. However, findings are based on a single donor and require replication with multiple individuals to assess generalizability.
INTRODUCTION:Although notable efforts have been made to harmonise regulatory processes for the approval of new therapeutic drugs by the competent authorities, some discrepancies concerning risk-benefit assessments and regulatory actions remain. METHODS:This analysis compared the approaches of the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) in the approval of new active substances and identified potential clinical implications associated with these differences in "Indication", "Contraindications" and "Posology and administration of drugs" sections of drug summary of products characteristics (SmPC). RESULTS:The overall analysis showed major differences in 63.9% for the indications, in 75% for contraindications and in 13.9% for posology. Considering the more represented therapeutic areas (cancer and haematology/haemostaseology drugs), the percentage of major differences for the indications was 70% in cancer area and 50% in haematology/haemostaseology area. For contraindications major differences were observed in 90% of cancer drugs, and 60% in haematology/haemostaseology drugs. DISCUSSION:Our findings highlight the need of further efforts on harmonizing decision making driven by scientific data between regulatory authorities in the interest of patients in a public health perspective.
BACKGROUND:Establishing healthy eating habits during early childhood is essential for long-term health and prevention of non-communicable diseases. The Mediterranean Diet (MD) is recognized as one of the healthiest dietary patterns worldwide. This study aimed to evaluate dietary habits and adherence to the MD among preschool children using the Mediterranean Diet Quality Index (KIDMED) and to explore the influence of parental sociodemographic and anthropometric factors on children's dietary adherence. METHODS:This cross-sectional study included 114 preschool children (24-60 months) from Sarajevo and Orašje, Bosnia and Herzegovina. Data were collected using a modified KIDMED questionnaire, assessing dietary habits and general sociodemographic information. Children's anthropometric parameters were obtained from medical records, and Body Mass Index (BMI) z-scores were calculated using WHO AnthroPlus. Descriptive statistics, group comparisons, and multiple linear regression were performed in RStudio (version 2024.12.0+467), with statistical significance set at p<0.05. RESULTS:The mean KIDMED score was 5.17±2.98 (median 6, interquartile range IQR 3-8), indicating moderate adherence to the MD. Thirty-four percent of children had a poor-quality diet, 36.8% required improvement, and 28.9% showed optimal adherence. Fruit and vegetable consumption was high, but intake of fish, whole grains, nuts, and olive oil was low. Parental education, employment, economic status, and BMI were not significantly associated with children's KIDMED scores (Regression correlation coefficient=0.249, p=0.433). CONCLUSIONS:Preschool children demonstrated moderate adherence to the MD, with clear signs of dietary westernization. Early, family-centered nutritional education is essential to promote and maintain healthy eating habits from early childhood.
PURPOSE:The aim of this study is to describe data on occupational exposure to formaldehyde in the context of Italian economic activities. METHODS:Measurement data of airborne concentrations (n=26,216) of formaldehyde in the period 1996-2024 were selected from the national register of occupational exposure to carcinogens (Sistema Informativo Registri di Esposizione Professionale, SIREP). Descriptive statistics were calculated for main exposure-related variables. The number of potentially exposed workers was estimated for the best-characterized sectors. RESULTS:The overall geometric mean was 0.028 mg/m3. Most of the exposure was found in the wood (n=4,912), chemical (n=4,090), and plastic industries (n=3,925). A different distribution of exposure was found according to gender, as women exposures were more common in the healthcare sector. The estimated number of potentially exposed workers in the selected sectors was approximately 100,000. CONCLUSIONS:The implementation of the new European Union (EU) regulation has enhanced the surveillance system, resulting in noteworthy improvements in the monitoring of occupational exposure to formaldehyde.
INTRODUCTION:The rapid proliferation of new psychoactive substances (NPS) presents a major challenge to drug control systems. Unlike traditional controlled substances, NPS are synthetic compounds engineered to bypass existing regulations, raising serious public health concerns due to their high potency and unpredictable toxicity. To support a coordinated European response, the REITOX (Réseau européen d'information sur les drogues et les toxicomanies) network brings together national focal points from EU Member States, Norway, Türkiye and the European Commission. OBJECTIVE:To provide a comparative overview of legislative frameworks and regulatory responses to NPS across REITOX Member Countries within the European Union. METHODS:We conducted a cross-national analysis of legal texts, procedures for scheduling new substances, and alignment with international and EU legislation. The role of the Early Warning System (EWS), coordinated by the European Union Drugs Agency (EUDA) and supported by the REITOX network, was also examined. RESULTS:The analysis revealed substantial variation among REITOX member states in legal approaches, timelines, and integration with EU-level mechanisms. REITOX focal points play a central role in information exchange and in supporting the EWS for early detection and coordinated responses to NPS-related threats.
The integration of artificial intelligence (AI) is rapidly transforming healthcare, enhancing accuracy, personalizing care, and streamlining administrative tasks. The report published in May 2025 by the OECD (Organization for Economic Co-operation and Development) offers a taxonomy of health roles based on their susceptibility to automation through GenAI and robotics, ranging from low risk (e.g., physicians) to high risk (e.g., orderlies, transcriptionists). While AI augments many routine clinical tasks, roles requiring complex judgment and empathy remain largely human-driven. Key concerns arise from the potential uncritical adoption of these evaluations, which fragment healthcare roles and risk overlooking their integrative, relational nature. Additionally, industry-led implementation of AI may undervalue frontline clinical expertise and ethical considerations. To ensure responsible integration, multi-stakeholder strategies such as the European Pact for Skills and targeted upskilling initiatives are essential. Policymakers must guide AI adoption to redesign roles and education in ways that empower the workforce without sacrificing the core values of care.
The enhanced games, a new sports event scheduled to take place in the United States in the spring of 2026, propose a competition model in which the use of performance-enhancing drugs (PEDs) is openly permitted and encouraged. This initiative represents a radical departure from long-established sporting norms and is strongly criticised by major international institutions, due to its potential public health consequences and ethical implications. PEDs use poses significant risks, ranging from severe physical damage to long-term mental health effects. The enhanced games risk normalising these substances, particularly among vulnerable populations such as youth, who are highly influenced by elite athletes and media narratives. This commentary examines the conceptual frameworks underpinning sport, performance enhancement, and doping as well as the main issues that may arise in relation to these games. Particular emphasis is placed on the possible implications for public health, from both an ethical and a health perspective.
INTRODUCTION:This paper summarizes the conclusions of the Expert Consensus (EC) on the use of platelet-rich plasma (PRP) in regenerative medicine. The initiative aimed to promote appropriate and effective clinical use of PRP based on current scientific evidence and expert experience. The main objectives are: to define a flexible operative range for PRP, allowing for personalized application; to establish principles for standardized clinical practice. METHODS:The methods used to develop this EC involved the scientific literature review, the data quality assessment, the evaluation of practical experiences, the critical summary of reviewed literature, the development of questions for expert panel and the drafting of consensus statements. RESULTS:Recommendations emphasize compliance with legislation, proper device use and operator training. Adequate platelet load is essential for therapeutic efficacy; platelet recovery should be considered as quality standard. PRP has demonstrated effectiveness in managing diabetic and venous ulcers, osteoarthritis, and tendinopathies, although variability in protocols and inconsistent reporting limit the strength of evidence. Emerging applications include vasculitis, mucositis, and urogenital conditions, although further research is needed. CONCLUSIONS:The EC encourages multicentre research, strict publication standards, and international collaboration to strengthen scientific foundations for PRP use in regenerative medicine.
INTRODUCTION:The COVID-19 pandemic had a profound impact on global health, notably affecting patients with non-COVID-19 conditions, who faced substantial disruptions in their treatment and care. The aim of this narrative review was to identify the main indicators used in literature to evaluate the indirect impact of COVID-19 on health and wellbeing. METHOD:A literature search was conducted using PubMed from January 2021 to November 2022. The indicators were categorized into five main groups: burden of disease (BoD), life expectancy (LE), health-related quality of life (HRQoL), cost of illness and mental health status and were retrieved from 20 scientific articles. RESULTS:Disability-adjusted life years (DALYs) revealed substantial health losses; a decrease in LE was observed, with inequalities across population subgroups; HRQoL showed impairments in physical functioning, daily activities and emotional well-being; productivity losses were economically relevant and varied by context and elevated symptoms of anxiety and depression were reported. DISCUSSION:The compiled indicators may contribute to the development of sustainable pandemic mitigation policies.
INTRODUCTION:Vaccine hesitancy remains a major public health challenge in Europe, with declining confidence in vaccine safety and efficacy despite high overall acceptance. Evidence on its determinants and effective interventions is fragmented, underscoring the need for a comprehensive synthesis. This overview of systematic reviews aimed to describe the most recent determinants of vaccine acceptance, barriers to vaccination, and effective interventions to reduce hesitancy or increase uptake in Europe. METHODS:The search was conducted in PubMed, Embase, Epistemonikos. Reviews were eligible if they included European data. RESULTS:Of 3,363 papers, 88 reviews were included, classified into children, adolescents, and parents (n=29); pregnant women (n=11); healthcare workers (HCWs) (n=12); and the general population (n=36) reviews. Determinants of vaccine acceptance included high education, socioeconomic status, gender, trust in government/health authorities, and HCW recommendations, with associations that varied across populations, vaccines, and contexts. Emerging determinants such as health engagement and social media were reported. Main barriers included fear of side effects, safety concerns, preference for natural immunity, and logistical challenges. Interventions included educational campaigns, reminders, organizational changes, school-based programs, and digital tools. Active reminders, school-based programs, and organizational changes showed the most consistent effectiveness. CONCLUSIONS:Vaccine hesitancy is multifaceted, requiring tailored, evidence-based strategies. Future research should prioritize rigorous study designs and underexamined factors.
Well-designed population-based seroepidemiological studies can be useful to refine estimates of infectious agent transmission and disease severity, thus representing an important component of epidemiological surveillance. However, the interpretation of results may be hampered by heterogeneous data quality and the lack of standardized methodology in some cases. The development and use of highly sensitive and accurate tools, refined over the past decades, have facilitated the study of current and past exposure to infectious agents in target populations. In particular, seroepidemiological studies provide a detailed overview of past and current infection burdens (i.e., respiratory infectious diseases), helping to identify high-risk groups and biomarkers of disease severity. They also help to understand the evolutionary dynamics of the disease over time, providing crucial information on its spread and community impact. Investing time and resources in seroepidemiological studies is essential, not only for monitoring the population's immunological status, but also for implementing strategies that promote public health and predict future infectious diseases scenarios.
INTRODUCTION:Ochratoxin A (OTA) and citrinin (CIT) are toxic compounds produced by fungi that may contaminate a variety of food, posing significant health risks, particularly following chronic exposure. OTA, a potent nephrotoxin, is widely present in cereals, dried fruits, coffee and animal-derived products; CIT, which often co-occurs with OTA, also exhibits nephrotoxic effects. METHODOLOGY:This project aims to evaluate the exposure to OTA and CIT in adults and children of both sexes, and in breastfeeding women, and to investigate OTA toxicological effects using a juvenile animal model. The biomonitoring study analyzed OTA and CIT in urine, and OTA in breast milk. It also involved the evaluation of biomarkers of effect and the administration of food frequency questionnaires to assess dietary intake. The toxicological study employed an innovative animal model to identify early biomarkers of renal and endocrine effects and to elucidate OTA's mechanisms of action. RESULTS:The findings contribute to a deeper understanding of risk characterization and support the development of public health strategies aimed at minimizing OTA and CIT exposure.
The OECD Report "Digital and AI skills in health occupations: What do we know about new demand?" published in 2025 analyses the impact of digital technologies, AI, and advanced robotics on health occupations across OECD (Organisation for Economic Co-operation and Development) countries, with a particular focus on Canada, United Kingdom, and United States. Drawing on the analysis of more than 55 million online job postings (2018-2023), the study examines trends in the demand for digital skills and classifies health occupations according to their susceptibility to automation or augmentation. Conclusions indicate that, while a limited share of roles faces automation risks, a variety of health professions are expected to benefit from forms of task augmentation. The report highlights the need for tailored policies on lifelong training, data governance, and human-centred bioethical approaches to ensure the sustainable integration of AI into healthcare systems.
OBJECTIVES:To present the strategy developed by the Local Health Authority AULSS6, Padua Province, Italy, for implementing artificial intelligence (AI) in healthcare systems. METHODS:Between December 2024 and December 2025, a series of structured meetings of a multidisciplinary Steering Committee were conducted. Ideas, priorities and initiatives were systematically collected, categorized, and refined through consensus. RESULTS:The strategy produced several outcomes: an AI ethics and readiness checklist ensuring compliance with the EU AI Act, GDPR, (EU General Data Protection Regulation) and cybersecurity requirements; multi-level education programs for staff; systematic technology evaluation guidelines and HTA (Health Technology Assessment) evaluation studies planning; active participation in projects on AI for public health and clinical outcomes prediction and resource optimization; communication strategies designed to enhance transparency and trust. Collectively, these initiatives enabled AULSS6 to build institutional capacity for responsible AI adoption at the local level. CONCLUSIONS:AULSS6 shows that local health authorities can lead responsible AI implementation in healthcare. Its multidimensional approach close to the population offers a replicable, scalable model for health systems across Italy and Europe, advancing digital transformation through a bottom-up strategy close to the communities served.
