Stefano Celotto

Objective: The aim of the study was to investigate knowledge, attitudes and practices (KAP) of Italian general practitioners regarding the use of food supplements. Subject and Methods: A 62-question survey, adapted from a tool used among pharmacists, was sent to Italian general practitioners. The survey contains two sections: A) KAP questions (28 true/false, 34 on a 5-point Likert scale) and B) socio-demographic questions. Results: 233 questionnaires were collected from March to July 2024. 44.6% of responders were male, 54.9% female. The majority (68.2%) came from an urban environment and 53.65% worked with other colleagues. Most of the general practitioners (69.1%) showed an adequate knowledge of the subject (> 60% of correct answers). The overall reliability of the test was rated as acceptable (alfa > 0.7). 98.7% of general practitioners agreed that they have an important role in prescribing dietary supplements, and 98.3% are involved in lifestyles counselling, but only 66.52% felt that they had adequate training on this subject. Conclusion: General practitioners recognize their pivotal role in supplement prescription, but, even if their knowledge scores were adequate, they feel a need of more specific education on the topic.

Background/Objectives: Recently, the Herpes Zoster (HZ) vaccination has been introduced, alongside influenza and pneumococcal vaccination, at age 65. Factors influencing adherence to this vaccination and its clinical benefits are not completely understood. The aim of this study was to evaluate factors influencing adherence to HZ vaccination compared to pneumococcal and influenza and to assess its clinical effect in preventing acute vascular events. Methods: A total of 1152 patients (520 males), having a birth cohort from 1952 to 1959 inclusive, was recruited, belonging to the District of Udine (N = 839) and to the ASAPs 2 and 3 of Pordenone (N = 313). For each patient, a form was compiled. Results: HZ vaccination was administered to 498 patients, influenza to 665, and pneumococcal to 742 (p < 0.0001). Among the vaccinated, 266 received the live-attenuated version, and 232 the recombinant HZ vaccine. In logistic regression, the presence of addictions, low educational level, and poor socioeconomic status were strongly associated with lower vaccine adherence. The presence of chronic diseases enhanced only pneumococcal (p < 0.001) and influenza (p < 0.001) vaccine adherence. Forty-two non-fatal acute vascular events were recorded from age 65 onwards: 14 cardiac, 20 cerebrovascular, and 8 peripheric. Only 6/493 patients experienced an event following HZ vaccination compared to 36/659 unvaccinated subjects (p = 0.0003). In Cox modeling, HZ vaccination proved to be an independent predictor in preventing subsequent acute vascular events (p < 0.001). Conclusions: The presence of pathologies does not enhance adherence to HZ vaccination while an unfavorable socio-environmental context greatly hinders it. HZ vaccination, but not influenza and pneumococcal vaccination, appears to protect against the occurrence of acute vascular events.

Background: Antimicrobial resistance (AMR) is a major challenge of the 21st century. Digital technologies are now an increasingly effective means of supporting optimal health care delivery and public health. Objective: The aim of this study was to explore the apps available to support health care professionals in the fight against AMR. Methods: A total of 4 independent researchers conducted a systematic search of the App Store and Google Play Store using the following keywords: “antimicrobial resistance,” “antibiotic resistance,” “antimicrobial stewardship,” “antibiotic stewardship,” “antibiotic guide,” “antibiotic therapy,” and “antimicrobial therapy.” The same keywords were also searched in Italian. The apps whose contents were in languages other than Italian or English, or apps which were games, or had multimedia or paid content and advertising, or apps for only specific pathologies were not considered. A set of basic information was collected for all apps found. After downloading the apps, they were evaluated using an 86-item checklist containing expert-validated criteria aggregated in the domains of pathogens and etiological agents, diagnosis and therapy support, AMR, dashboard function, antimicrobial stewardship (AMS), notes and recordings, network, and technical characteristics of the app. Results: First, 115 apps were identified: 31 apps for Android and 84 apps for iOS. By applying the exclusion criteria, 31 apps were excluded (16 for Android and 15 for iOS) for the following reasons: not available in Italian or English (6 apps), not freely available (14 apps), required registration (5 apps), and games (6 apps). The remaining 84 eligible apps (15 for Android and 69 for iOS) were downloaded, installed, and further analyzed using the same criteria, excluding 57 apps (48 for iOS and 9 for Android) for the following reasons: required further registration (16 apps), language other than Italian or English (17 apps), pathology specific (5 apps), paid content (8 apps), specific to veterinarians (4 apps), recreational apps (2 apps), referred to only scientific articles (1 app), no longer available (1 app), and not health care objectives (3 apps). The remaining 27 apps (6 for Android and 21 for iOS) were selected for in-depth analysis. Of the 27 apps that met the inclusion criteria, most apps did not fulfill the desirable aspects and only 2 of them achieved a fulfillment score of 36%. The highest scores were achieved for support for diagnosis and therapy (37%) and technical characteristics of the app (23%). Lower scores were achieved for AMS (8%), pathogens and etiological agents (4%), notes and records (3%), network (2%), AMR (1%), and dashboard function (1%). Conclusions: None of the apps examined successfully provided the desired features and functions. To better engage of prescribers in the fight against AMR, the development of an app that meets the requirements is needed.

Background: The objective was to capture the breadth of outcomes that have been associated with metformin use and to systematically assess the quality, strength and credibility of these associations using the umbrella review methodology.Methods: Four major databases were searched until 31 May 2020. Meta‐analyses of observational studies and meta‐analyses of randomized controlled trials (RCTs) (including active and placebo control arms) were included.Results: From 175 eligible publications, we identified 427 different meta‐analyses, including 167 meta‐analyses of observational studies, 147 meta‐analyses of RCTs for metformin vs placebo/no treatment and 113 meta‐analyses of RCTs for metformin vs active medications. There was no association classified as convincing or highly suggestive from meta‐analyses of observational studies, but some suggestive/weak associations of metformin use with a lower mortality risk of CVD and cancer. In meta‐analyses of RCTs, metformin was associated with a lower incidence of diabetes in people with prediabetes or no diabetes at baseline; lower ovarian hyperstimulation syndrome incidence (in women in controlled ovarian stimulation); higher success for clinical pregnancy rate in poly‐cystic ovary syndrome (PCOS); and significant reduction in body mass index in people with type 1 diabetes mellitus, in women who have obesity/overweight with PCOS and in obese/overweight women. Of 175 publications, 166 scored as low or critically low quality per AMSTAR 2 criteria.Conclusions: Observational evidence on metformin seems largely unreliable. Randomized evidence shows benefits for preventing diabetes and in some gynaecological and obstetrical settings. However, almost all meta‐analyses are of low or critically low quality according to AMSTAR 2 criteria.

Few studies assessed the associations between dietary vitamin K and depressive symptoms. We aimed to investigate the association between dietary vitamin K and depressive symptoms in a large cohort of North American People. In this cross-sectional analysis, 4,375 participants that were aged 45–79 years from the Osteoarthritis Initiative were included. Dietary vitamin K intake was collected through a semi-quantitative food frequency questionnaire and categorized in quartiles. Depressive symptoms were diagnosed using the 20-item Center for Epidemiologic Studies-Depression (CES-D) ≥ 16. To investigate the associations between vitamin K intake and depressive symptoms, logistic regression analysis were run, which adjusted for potential confounders. Overall, 437 (=10%) subjects had depressive symptoms. After adjusting for 11 confounders, people with the highest dietary vitamin K intake had lower odds of having depressive symptoms (OR = 0.58; 95%CI: 0.43–0.80). This effect was only present in people not taking vitamin D supplementation. In conclusion, higher dietary vitamin K intake was significantly associated with a lower presence of depressive symptoms, also after accounting for potential confounders. Future longitudinal research is required to explore the directionality of the association.

Introduction Angiotensin-converting enzyme inhibitors (ACEI) may have several pleiotropic effects, but the literature regarding a possible relationship between ACEI use and frailty is limited. We investigated whether ACEI use is associated with lower risk of frailty in a cohort of North American individuals. Methods Data from the Osteoarthritis Initiative, a cohort study with 8 years of follow-up including community-dwelling adults with knee osteoarthritis or at high risk for this condition, were analyzed. ACEI use was defined through self-reported information and confirmed by a trained interviewer. Frailty was defined using the Study of Osteoporotic Fracture (SOF) index as the presence of at least two of the following criteria: (1) weight loss ≥ 5% between baseline and any subsequent follow-up visit; (2) inability to do five chair stands; and (3) low energy level according to the SOF definition. A multivariable Poisson regression analysis was used to assess the association between ACEI use at baseline and incident frailty. The data were reported as relative risks (RRs) with their 95% confidence intervals (CIs). Results The final sample consisted of 4295 adults (mean age 61.2 years, females 58.1%). At baseline, 551 participants (12.8%) used ACEI. After adjusting for 15 potential confounders, the use of ACEI was associated with a lower risk of frailty (RR 0.72; 95% CI 0.53–0.99). The adjustment for the propensity score substantially confirmed these findings (RR 0.75; 95% CI 0.54–0.996). Conclusion ACEI use may be associated with a reduced risk of frailty in individuals with/at risk of knee osteoarthritis, suggesting a potential role for ACI in the prevention of frailty.

Purpose To map and grade all health outcomes associated with magnesium (Mg) intake and supplementation using an umbrella review. Methods Umbrella review of systematic reviews with meta-analyses of observational studies and randomized controlled trials (RCTs) using placebo/no intervention as control group. We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values, 95% prediction intervals, heterogeneity, small-study effects and excess significance. For meta-analyses of RCTs, outcomes with a random-effect p value < 0.005 and a high-GRADE assessment were classified as strong evidence. Results From 2048 abstracts, 16 meta-analyses and 55 independent outcomes were included (36 in RCTs and 19 in observational studies). In RCTs of Mg versus placebo/no active treatment, 12 over 36 outcomes reported significant results (p < 0.05). A strong evidence for decreased need for hospitalization in pregnancy and for decreased risk of frequency and intensity of migraine relapses in people with migraine was observed using the GRADE assessment. In observational studies, 9/19 outcomes were significant (p < 0.05). However, only one outcome presented highly suggestive evidence (lower incidence of type 2 diabetes in people with higher Mg intake at baseline) and one suggestive (lower incidence of stroke associated with higher Mg intake at baseline). Conclusion Strong evidence according to the GRADE suggests that Mg supplementation can decrease the risk of hospitalization in pregnant women and reduce the intensity/frequency of migraine. Higher Mg intake is associated with a decreased risk of type 2 diabetes and stroke with highly suggestive and suggestive evidence, respectively, in observational studies.