Background Alcohol consumption is a potentially modifiable risk factor for breast cancer (BC). Reducing alcohol consumption within the daily amount at low-risk for alcohol-related consequences (daily alcohol threshold) may contribute to preventing BC new cases. However, most women are unaware of risk factors for BC, the daily alcohol threshold, and how to measure alcohol use. We aimed at investigating the efficacy of accessing an interactive website in increasing the knowledge that alcohol is a BC risk factor. Methods We conducted a randomized controlled trial among women waiting for mammography. Women completed a questionnaire to investigate their knowledge before and after accessing an interactive (intervention group) and non-interactive (control group) website. Results We recruited 671 women, randomized 329 (49.0%) and 342 (51.0%) to the intervention and control groups, respectively. At baseline, most women were not aware of most modifiable BC risk factors. Accessing either website significantly increased the percentage of women who acquired the knowledge on BC risk factors, with the interactive website achieving better results: 82% and 69% of women acquired the knowledge that alcohol is a risk factor for BC in the intervention and control groups, respectively (p<0.001). Among women with lower levels of education, the probability of acquiring this knowledge was higher in the intervention group than control group. Conclusion Our results show that accessing an interactive website may increase the percentage of women who acquire the knowledge that alcohol is a BC risk factor especially among women of lower levels of education.

BACKGROUND: Ten years after the launch of the Okanagan Charter, which called on universities to embed health promotion principles and values into their core strategies, this study investigates how Italian state universities have responded. By analyzing updated strategic plans, we assessed the integration of health and wellbeing principles into their policies, mission, vision, and programming, and identified good practices to be offered to the stakeholders. METHODS: A deductive content analysis was conducted on the strategic plans of 45 out of 61 Italian state universities. A multidisciplinary team developed a coding framework based on key health promotion themes: participation, wellbeing-centered mission and vision, psycho-physical, social, and organizational wellbeing, sustainability, and equity. Each plan was independently reviewed by three researchers randomly selected out of 12, and findings were synthesized narratively. RESULTS: 45 Italian state universities had updated strategic plans, most developed through top-down processes. Only 40% explicitly referenced wellbeing in their mission and vision. While 90% addressed sustainability, mainly energy-related, other aspects like mobility, waste, and food received less attention. Equity was widely considered: 89% promoted inclusion and gender equality, 58% offered tax relief, and 40% provided inmate education. Mental wellbeing was addressed in 64% of plans, social wellbeing in 60%, and healthy lifestyles in 42%. Collaboration with health services was rare, and preventive strategies were limited. The study identified a set of good practices, low-cost, actionable, and community-oriented, that can serve as practical tools to support the implementation of health promotion strategies in universities. CONCLUSIONS: Italian universities showed a growing but uneven commitment to health promotion. Despite frequent references to wellbeing, its integration remains partial and sectoral. This study identified key areas for improvement, such as participation, and highlighted a selection of good practices. These practices offer actionable and replicable models that, through advocacy, can support the development of healthier, more inclusive, supportive university environments.

Background:The widespread use of the internet and social media has transformed how people access health information impacting health literacy. Health literacy, the ability to access, understand, and use health information, is crucial to promote and maintain good health. This study is the first exploring with network analysis the correlation and distribution of the items of the Health Literacy Survey Questionnaire (HLS-Q) 12 short form to verify their correspondence to the principal domains of the health literacy conceptual model proposed by Sorensen et al. in 2013. Materials and Methods:A digital version of the Italian HLS19-Q12 questionnaire was distributed online through social media and informal channels in May 2024. The sample consisted of 352 participants from the metropolitan area of Cagliari, Italy. Network analysis was employed to examine the clustering and relationships between the questionnaire items, via JASP using the Ising Fit method. Results:Key findings include significant difficulties in accessing professional help and understanding medical emergencies. Network centrality measures highlighted the prominence of items related to understanding medical emergencies and making health decisions. Three clusters corresponding to healthcare, disease prevention, and health promotion, were visually identified with the last two closely interconnected. The item "making decisions to improve health" is crucial, acting as a bridge between clusters. Some items traditionally belonging to one domain shifted to another. Conclusions:The network analysis provided a clear depiction of health literacy as complex system, emphasizing interactions. Health literacy involves accessing, evaluating, and applying information, with empowerment playing a key role according to our findings. By addressing identified needs and focusing on prominent items, healthcare professionals and policymakers can enhance health literacy and improve health outcomes for individuals and communities. This pilot study's findings could benefit future research and interventions to improve health literacy.

Introduction:Healthcare reorientation aims for health services focused not exclusively on diseases but also on prevention and health promotion. The implementation depends strongly on professionals' willingness to actively participate in the reorientation. An effective strategy to boost reorientation is to reorient education and role definition of future professionals. This paper examines whether photovoice can be a suitable method to i) increase future health professionals' awareness of users' needs and expectations; and ii) enable a process of critical reflection on role definition and health services organisation.Methods:One hundred and seventy-two medical students participated in the photovoice project. Participants were asked to produce one photo combined with a caption, responding to a pre-identified question: "What is, in your opinion, the main aspect affecting users' satisfaction/dissatisfaction in a healthcare facility?". Participants discussed their photos in group discussions (n = 16) and participated in data analysis sessions (n = 4).Results:Participants' contributions revolved around how services were delivered (e.g., kindness, accessibility, attention to additional needs) rather than the service provided. The students showed their empathic side and proposed smart and inclusive solutions to improve overall users' experience.Conclusions:This study demonstrated the value of using photovoice to reach medical students and to integrate health promotion into their professional identities. The photovoice process, teamwork, and discussions opened a breach into traditional thinking regarding aspects of healthcare services that are taken for granted or are overlooked. Furthermore, participants' proposals often implied a change in the behaviour of professionals - their future selves - towards patients and low-cost improvements of organisational practices.

The measurement of sense of coherence (SOC) has received attention for more than three decades. Despite the extensive use of SOC-13, there is still a long debate regarding its dimensionality structure. Recently, there has been an increasing use of network modeling as a valid alternative to latent-variable modeling. This study proposes an exploratory approach to the structure of SOC-13 by adopting a network perspective. The network structure was estimated with a Gaussian Graphical Model, and Exploratory Graph Analysis (EGA) was used to inspect network dimensionality. We fit and compared the unidimensional, first- and second-order confirmatory factor analysis (CFA), bifactor-CFA, and structure derived from EGA. Our results showed unacceptable fit values for the CFA models, suggesting that SOC-13 is not unidimensional. Inspection of the estimated network suggested that the SOC-13 items emerged as a dynamic system of mutually interacting nodes that formed three distinct clusters of items (communities) that are not those defined in the literature. EGA identified three communities of items: the first community was characterized by comprehensibility and manageability items, the second community was characterized by comprehensibility and manageability items, and the third dimension was characterized by all meaningfulness items and one comprehensibility item. Our study presented a novel perspective in investigating the structure of SOC-13 that strengthens the assumption that SOC should be conceptualized as a complex system of cognitive (comprehensibility), behavioral (manageability), and motivational dimensions (meaningfulness) that are deeply linked and not necessarily distinct.

Background:The COVID-19 outbreak played a significant psychological impact on nurses, as they coped with intense emotional and cognitive demands, in a context in which the Health System was not prepared to face the emergency. Literature showed that pandemics influenced the nurses' stress and psychosocial health due to poor rest, high work overloads, a lack of control over the patient flows, and a frequent isolation from family. Under these circumstances, nurses experienced severe psychological and mental stressors that generated mental health problems. Recent literature showed that coping strategies, especially those that were positive, promoted mental health in workers and helped them to face stressors. Objective:The study aimed to investigate the relationship between vicarious traumas and the impact of traumatic events on nurses' mental health. In addition, we analyzed the role of coping strategies in moderating the effect of vicarious traumas on mental health. Methods:The study was performed in November 2020, during the first wave of the COVID-19 pandemic. A self-reported structured questionnaire was administered via an online method to reduce face-to-face contact. Logistic regressions were conducted to analyze the relationship between both vicarious traumas and the impact of traumatic events impact and mental health. An interaction analysis with the PROCESS macro was performed to analyze the role of coping strategies in moderating the relationship between vicarious traumas and mental health. Results:A total of 183 nurses answered to the questionnaire. A moderation analysis showed that positive coping strategies such as physical activity, reading/music, and yoga/meditation showed to be protective in reducing the effect of vicarious traumas on the nurses' mental health problems. Conversely, negative coping strategies strengthened that relationship and may compromise their quality of working life. Conclusion:These findings provide further support for considering positive coping strategies as an important resource to alleviate psychological distress, thus helping the professional to reduce the negative effects of stress.

Background: Ergonomics programmes addressed to children fit the health-promoting schools (HPS) framework. Beyond the integration of ergonomics in curricula, an important aspect is the effectiveness of the programme. This pilot study aims to evaluate the effectiveness of the programme proposed to a sample of middle-school children (aged 10–13 years) of the metropolitan city of Cagliari. Methods: The programme was designed along the lines of the INAIL (Italian National Institute for Insurance against Accidents at Work) scheme and proposed to 260 children. It consisted of three phases: 1) assessment of students’ background with a pre-intervention questionnaire (completed by 142 students); 2) teaching of the ergonomics training modules and evaluation of the weight of a sample of 160 backpacks, and of students’ perception to be able to sit by putting their feet on the ground; 3) evaluation of conceptual understanding of ergonomics concepts with a post-intervention questionnaire (completed by 107 students out of the 142 students who completed phase 1). Results: There was a substantial improvement in the percentage of correct responses post-intervention, confirmed by the chi-square test, regarding concepts about ergonomics, backpack weight and handling. Most of the backpacks exceeded the maximum allowed value, and 20% of students were perceived to be unable to sit putting their feet on the ground. Conclusions: The practical application of ergonomics pedagogy proved effective in the school setting and should be integrated into school curricula. The prevention technicians can offer a holistic approach, while the teachers are essential to implement the programme on a large scale. Effectiveness evaluation is necessary to guide resource allocation and implement and sustain the HPS approach. A tailored programme has a greater chance of reaching its target audience and maximizing effectiveness.

BackgroundViolence against healthcare workers in psychiatric settings is a concern in the literature. Violence effects for healthcare professionals and organizations include an absence from work due to injury or illness, a decreased job satisfaction, and a lower quality of work. The aim of this study is to identify the consequences of violence on the health, work habits, and performance of nurses working with psychiatric patients.MethodsThe study was conducted using semi-structured interviews with 18 nurses from different hospitals and territorial psychiatric settings in Southern Italy. The interviews were conducted from July to December 2020 by telephone and were recorded with the consent of the participants. The collected data were transcribed and analyzed.ResultsThe narratives revealed five main themes: (1) Feelings about the violence experienced; (2) the effects of violent incidents on nurses; (3) features of the mental health setting related to the phenomenon of the assault; (4) the care and organizational aspects to prevent the assault; and (5) the care in psychiatric settings during the COVID-19 pandemic. The aggressions resulted in a change in the nurses' work habits and performances; they were more careful after the aggression and modified their approach to the patient. Additionally, the nurses discussed developing skills and strategies to protect themselves and avoid aggression.ConclusionsAggression has a negative impact on the health and work performance of nurses. Adopting personal and nursing strategies in place to prevent aggression allows them to improve the patient care and to protect themselves from such incidents. The creation of a safer work environment by healthcare organizations in which professionals work can improve their health, job performance, and the effectiveness of psychiatric nursing care.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

AbstractIn this chapter, the authors, representing The Netherlands, Spain, Germany, Italy, Norway, the United Kingdom and Poland, trace the development of higher education in salutogenesis in Europe, spanning 30 years. At this time, the annual summer schools of the European Training Consortium in Public Health and Health Promotion (ETC-PHHP) have trained more than 700 participants from 60 countries. Perhaps the most distinguished member of the summer school’s faculty – at least from the perspective of advancing salutogenesis as a theory for health promotion – is Aaron Antonovsky, who participated in the 1992 edition of the course in Gothenburg, Sweden.

Recently there has been a growing interest in non-pharmacological treatments for ADHD. We evaluated the efficacy of a specific Omega-3/6 dietary supplement (two capsules containing 279 mg eicosapentaenoic acid [EPA], 87 mg Docosahexaenoic Acid [DHA], 30 mg gamma linolenic acid [GLA] each) in ameliorating inattentive symptoms in inattentive-ADHD children (6–12 years) with a baseline ADHD-RS-Inattention score ≥ 12. Secondary objectives included changes in global functioning, severity of illness, depression, and anxiety symptoms, learning disorders and in the fatty acids blood levels. The study was a randomised, double-blind, placebo-controlled efficacy and safety trial with a 6-month double-blind evaluation of Omega-3/6 vs placebo (Phase-I) and a further 6-month-open-label treatment with Omega-3/6 on all patients (Phase-II). In total 160 subjects were enrolled. No superiority of Omega-3/6 supplement to placebo was observed on the primary outcome (ADHD-RS-inattention score) after the first 6-months, with 46.3

Introduction:Increasing people's knowledge of transmission, prevention, early diagnosis, and available treatments is a key step toward HIV control; it means setting the conditions for empowerment and enabling individuals to make aware choices about the prevention strategy best suited to their needs. This study aims to identify unmet needs on HIV knowledge among freshman students.Methods:A cross sectional study was carried out at the University of Cagliari, which is an Italian public state university. Data were collected by means of an anonymous questionnaire; the final sample included 801 students.Results:Results offer a detailed picture of students' knowledge and perceptions of HIV. Several topics deserve to be better understood by students, but the main gaps relate to the pre-exposure prophylaxis and the decreased likelihood of sexually transmitting HIV due to early treatments. Students' vision of the quality of life of people living with HIV was negatively affected by perceiving as relevant the effects of HIV on physical health or on sexual/affective domains, while conversely, it seemed positively affected by knowing that current treatments are useful for counteracting physical symptoms and decreasing the possibility of transmitting HIV.Conclusion:Being aware of the potential benefits of current therapies could favour a less negative view, in line with the current state of the beneficial effects of HIV treatment. Universities are a valuable setting to bridge the HIV knowledge gap and thus also contribute to tackling stigma and actively promoting HIV testing.

Sense of coherence (SOC) is a psycho-social trait formed in childhood or adolescence, allowing individuals to be more resilient to daily life stressors, stay well, and improve their personal health. Although SOC remains stable after the age of thirty, only a few studies investigated its stability in adulthood. The aim was to investigate the development of SOC over time in 489 participants and its association with age, gender, educational level, or negative life events. The study was performed as part of the Healthy Ageing project of the Academic Collaborative Centre AGORA, a longitudinal study involving four municipalities of Eastern Netherlands. A self-administrated questionnaire was used to monitor the SOC of the elderly in 2008, 2010, and 2013, using the Orientation to Life Questionnaire (SOC-13). The analysis included repeated-measures ANOVA analysis and bivariate analysis using Pearson's chi square test. We found no statistically significant variation in SOC over time (F (2, 282) = 2.99, p = 0.052) and no significant association with age (F (2, 282) = 2.851, p = 0.06), gender (F (2, 282) = 0.845, p = 0.43), or educational level (F (2, 282) = 0.708, p = 0.49). SOC remained stable in the elderly population, even if they experienced negative events over their lifespan.

AbstractIn this chapter, measurement issues are addressed concerning Aaron Antonovsky’s original sense of coherence (SOC) questionnaires of 29 items and of 13 items, as well as several modified translations applicable to the individual, the family, the organization, and the community levels. Validity (face, construct, consensual, criterion, predictive) and reliability issues (test–retest, internal consistency) of the scales are discussed. Criticism of the original scales is deliberated.

BackgroundCOVID-19 pandemic, with its dramatic impact on society, poses a challenge to Health Pro-motion and to its principles of empowerment, social cohesion and citizens' democratic participation in health policies. In this pressing emergency, public health strategies aimed at preventing the spread of the pandemic have been primarily oriented towards restrictive measures (travel restrictions, use of PPE) in absence of an adequate educational communication, aimed at increasing citizens' knowledge and skills in regard to the emergency context.AimTo offer a perspective on the Italian situation, in terms of health literacy and life skills in the context of COVID-19 pandemic, aimed not only at identifying deficits, but particularly at determining opportuni-ties and resources (assets) - offered by the peculiar context of crisis - useful to provide citizens with the necessary tools to comprehend the criticalities linked with the emergency and to shape their behaviour to new requirements, in absence of external obligations, as well as to promote future participation of the population - both effective and informed - in a social and political context.MethodsA non-systematic review of literature on the subject of health literacy and social cohesion in emergency contexts has been supported by a qualitative assessment, based on the model of assets and on the Italian condition in the last trimester of 2020.ResultsThe scarce ability of the population to independently adequate habits and behaviour to new criti-calities required by the risk of infection - as well as the necessity to suspend their empowerment and capa-bility from government authorities to protect public health - has been firstly traced back to a widespread lack of literacy and life skills at a general population level. The current situation of crisis offers a peculiar opportunity of tools, circumstances and receptiveness to highlight such deficits, as well as an intervention on multiple fronts, in order to increase literacy and capability, both on an individual and on a community level, through inclusive and sustainable initiatives.ConclusionA prevention strategy based on the critical understanding of risk and risk-related criticalities is the only one which can aspire to last over time, while offering an effective tool for the safeguarding of public health, along with an opportunity of being prepared to contrast future emergencies more effectively. The development of such strategies represents one of the most significant contributions Health Promotion can offer in the time of Coronavirus.

Background Aging is marked by a progressive rise in chronic diseases with an impact on social and healthcare costs. Physical activity (PA) may soothe the inconveniences related to chronic diseases, has positive effects on the quality of life and biological rhythms, and can prevent the decline in motor functions and the consequent falls, which are associated with early death and disability in older adults. Methods We randomized 120 over-65 males and females into groups of similar size and timing and will give each either moderate physical activity or cultural and recreational activities. Being younger than 65 years, inability to participate in physical activity for any medical reason, and involvement in a massive program of physical exercise are the exclusion criteria. The primary outcome measures are: quality of life, walking speed, and postural sway. Participants are tested at baseline, post-treatment, and 6-month (24 weeks) and 12-month (48 weeks) follow-ups. Discussion This study aims at improving the quality of life, wellness, and cognitive functioning in the elderly through a low-cost affordable program of moderate physical activity. Given the growing aging of the world population and the social and economic burden of disability in the elderly, our results might have a major impact on future practices. Trial registration ClinicalTrials.gov NCT03858114 . Registered on 28 February 2019.

Background: Physical activity in the elderly is recommended by international guidelines to protect against cognitive decline and functional impairment. Objective: This Randomized Controlled Trial (RCT) was set up to verify whether medium-intensity physical activity in elderly people living in the community is effective in improving cognitive performance. Design: RCT with parallel and balanced large groups. Setting: Academic university hospital and Olympic gyms. Subjects: People aged 65 years old and older of both genders living at home holding a medical certificate for suitability in non-competitive physical activity. Methods: Participants were randomized to a 12-week, 3 sessions per week moderate physical activity program or to a control condition focused on cultural and recreational activities in groups of the same size and timing as the active intervention group. The active phase integrated a mixture of aerobic and anaerobic exercises, including drills of “life movements”, strength and balance. The primary outcome was: any change in Addenbrooke's Cognitive Examination Revised (ACE-R) and its subscales. Results: At the end of the trial, 52 people completed the active intervention, and 53 people completed the control condition. People in the active intervention improved on the ACE-R (ANOVA: F(1;102)=4.32, p=0.040), and also showed better performances on the memory (F(1;102)=5.40 p=0.022) and visual-space skills subscales of the ACE-R (F(1;102)=4.09 p=0.046). Conclusion: A moderate-intensity exercise administered for a relatively short period of 12 weeks is capable of improving cognitive performance in a sample of elderly people who live independently in their homes. Clinical Trials Registration No: NCT03858114

This study aims to provide a picture of University of Cagliari students' alcohol-related behaviour and to explore factors associated with it. Data were collected by administering a questionnaire to 992 freshmen university students from different programs consisting of twelve closed questions, including three questions from the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C short form). Three subgroups of alcohol-related behaviour were distinguished (risky drinkers, social drinkers and abstainers). In order to explore factors associated with patterns of alcohol consumption, a multivariate logistic regression was performed. The prevalence of risky drinkers was 35%. A binge-drinking behaviour at least once in the last twelve months was declared by 65% (more widespread in men and in students living away from their parents). Risky consumption is significantly associated with age of onset of alcohol use, living away from parents' home, drinking outside meals and attending health courses. Regarding the levels of daily alcohol consumption perceived as a health risk, 66% of men and 88% of women indicate values higher than those recommended. The results underline the need for tailored prevention measures. University could be a promising setting to implement actions according to a health promotion perspective, to empower students to control their alcohol consumption.