Blood Stream Infections in Allogeneic Hematopoietic Stem Cell Transplant Recipients: Reemergence of Gram-Negative Rods and Increasing Antibiotic Resistance

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Musculoskeletal pain in women from DAMA Trial: role of a physical activity intervention

Epidemiological studies showed that prevalence of musculoskeletal pain is higher in women than in men (Bracci et al. 2007; Salaffi et al. 2005) and low back pain is the most commonly reported whereas conflicting evidence exists for the association between physical activity and low back pain symptoms (Heneweer et al. 2011; Sitthipornvorakul et al. 2011). In this study, we investigated the prevalence of musculoskeletal pain and the role of a non-specific physical activity (PA) intervention in prevention/reduction of pain in the frame of the DAMA Trial. DAMA (n° ISRCTN28492718, funded by Istituto Toscano Tumori and Ministry of Health ) is a 24-month factorial randomized trial in post-menopausal women with high-Mammographic Breast Density (MBD), a risk factor for breast cancer (Masala et al. 2006), aimed to evaluate the ability of a structured intervention based on a moderate-intensity physical exercise and/or specific dietary modification, to reduce MBD. Participants were post-menopausal women, 50-69 yrs, with MBD>50%. Exclusion criteria were: current/recent HRT; current smokers; diabetes and/or other co-morbidities contraindicating dietary and PA intervention. After the baseline visit in which blood and urine samples, anthropometry, dietary and lifestyle information were collected, participants (234 women) were randomized by age- and BMI-stratified blocks, to one of the four arms: dietary intervention, PA intervention, dietary+PA intervention or control. The PA intervention included one hour/week exercise program carried out by exercise specialist, individual and group sessions to explain PA benefits, group walks and at least 1 hour/day of individual moderate PA (i.e. walking, biking, home exercise). The control arm received general advice on healthy diet and PA. To evaluate physical fitness of all participants, at baseline and follow-up (FU), specific visits were performed and a specific questionnaire on pain was self-administered to investigate body site of pain, pain intensity and duration. Baseline and FU pain questionnaires were completed by 210 women (102 randomised to PA intervention*, 108 to control arm§). At baseline pain was reported by 154 women (73%), among them 75% reported back, 29% shoulder and 29% leg pain. After the 24-month intervention a significant effect emerged for low back pain in women randomised to PA intervention, in term of reduced prevalence of women with pain and prevention of new cases (p=0.02 in PA arm, 0.30 in control arm) suggesting also a beneficial effect of non-specific PA

Up to one-third of breast cancer cases in post-menopausal Mediterranean women might be avoided by modifying lifestyle habits: the EPIC Italy study

Breast cancer (BC) is the most frequent cancer among women in developed countries. Physical activity (PA), body mass index (BMI), and alcohol intake have been identified as relevant lifestyle modifiable risk factors for post-menopausal BC. We aimed to evaluate the role of these factors in modulating post-menopausal BC risk and to estimate the proportion of BC cases attributable to low PA, high BMI, and alcohol taking into account non-modifiable factors

Glycemic Index, Glycemic Load and Mammographic Breast Density: The EPIC Florence Longitudinal Study

<div><p>A few studies have evaluated the association between diet and mammographic breast density (MBD) and results are inconsistent. MBD, a well-recognized risk factor for breast cancer, has been proposed as a marker of cumulative exposure to hormones and growth factors. Diets with a high glycemic index (GI) or glycemic load (GL) may increase breast cancer risk, via an effect on the insulin-like growth factor axis. We have investigated the association between carbohydrate intake, GI, GL and MBD in a prospective study. We identified a large series of women, in the frame of the EPIC-Florence cohort, with a mammogram taken five years after enrolment, when detailed information on dietary and lifestyle habits and anthropometric measurements had been collected. Mammograms have been retrieved (1,668, 83%) and MBD assessed according to Wolfe’s classification. We compared women with high MBD (P2+DY Wolfe’s categories) with those with low MBD (N1+P1) through logistic models adjusted for age, education, body mass index, menopause, number of children, breast feeding, physical activity, non-alcohol energy, fibers, saturated fat and alcohol. A direct association between GL and high MBD emerged in the highest quintile of intake in comparison with the lowest quintile (OR = 1.73, 95%CI 1.13–2.67, p for trend = 0.048) while no association with glycemic index was evident. These results were confirmed after exclusion of women reporting to be on a diet or affected with diabetes, and when Hormone Replacement Therapy at the date of mammographic examination used to assess MBD was considered. The effect was particularly evident among leaner women, although no interaction was found. A positive association was suggested for increasing simple sugar and total carbohydrates intakes limited to the highest quintiles. In this Italian population we observed an association between glycemic load, total and rapidly absorbed carbohydrates and high MBD. These novel results warrant further investigations.</p></div

Association between energy-adjusted GI and GL and high MBD by menopausal status and BMI (1,628 EPIC-Florence women).

*<p>Adjusted ORs obtained by multivariate logistic models including terms for age (years), education (university and secondary school yes/no), number of children (0; 1–2; ≥3), duration of breast feeding (≤8 months/>8 months), non -alcohol energy intake (kcal/day, continuous), leisure time physical activity (MET/week in continuous), alcohol (g/day), fiber (g/day) and saturated fat (g/day) intakes in quintiles and, alternatively, body mass index (normal weight/overweight/obese) and menopausal status (pre-/post-menopausal).</p

Mean and median values of selected lifestyle and dietary variables of 1,668 participants by low and high MBD (EPIC-Florence).

*<p>Metabolic equivalents (METs) for non occupational physical activity (including recreational and household activities).</p>**<p><i>P</i>-values were calculated from GLM.</p

Association between energy-adjusted total carbohydrate, simple sugars and starches and high MBD (1,628 EPIC-Florence women).

*<p>Crude ORs obtained by models including only the variable of interest (classified in quintiles).</p>**<p>Adjusted ORs obtained by multivariate logistic models including terms for age (years), education (university and secondary school yes/no), body mass index (normal weight/overweight/obese), menopausal status (pre−/post-menopausal), number of children (0; 1–2; ≥3), duration of breast feeding (≤8 months/>8 months), non-alcohol energy intake (kcal/day, continuous), leisure time physical activity (MET/week in continuous), alcohol (g/day), fiber (g/day) and saturated fat (g/day) intakes in quintiles.</p>∧<p>Included simultaneously in the crude and adjusted models.</p

Association between energy-adjusted GI, GL and high MBD (1,628 EPIC-Florence women).

*<p>Crude ORs obtained by models including only the variable of interest (classified in quintiles).</p>**<p>Adjusted ORs obtained by multivariate logistic models including terms for age (years), education (university and secondary school yes/no), body mass index (normal weight/overweight/obese), menopausal status (pre−/post-menopausal), number of children (0; 1–2; ≥3), duration of breast feeding (≤8 months/>8 months), non-alcohol energy intake (kcal/day, continuous), leisure time physical activity (MET/week in continuous), alcohol (g/day), fiber (g/day) and saturated fat (g/day) intakes in quintiles.</p

A multinational consensus on dysphagia in Parkinson's disease:screening, diagnosis and prognostic value

Background: Parkinson\u2019s disease (PD) is a neurodegenerative disorder characterized by a combination of motor and non-motor dysfunction. Dysphagia is a common symptom in PD, though it is still too frequently underdiagnosed. Consensus is lacking on screening, diagnosis, and prognosis of dysphagia in PD. Objective: To systematically review the literature and to define consensus statements on the screening and the diagnosis of dysphagia in PD, as well as on the impact of dysphagia on the prognosis and quality of life (QoL) of PD patients. Methods: A multinational group of experts in the field of neurogenic dysphagia and/or PD conducted a systematic revision of the literature published since January 1990 to February 2021 and reported the results according to PRISMA guidelines. The output of the research was then analyzed and discussed in a consensus conference convened in Pavia, Italy, where the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. Results: Eighty-five papers were used to inform the Panel\u2019s statements even though most of them were of Class IV quality. The statements tackled four main areas: (1) screening of dysphagia: timing and tools; (2) diagnosis of dysphagia: clinical and instrumental detection, severity assessment; (3) dysphagia and QoL: impact and assessment; (4) prognostic value of dysphagia; impact on the outcome and role of associated conditions. Conclusions: The statements elaborated by the Consensus Panel provide a framework to guide the neurologist in the timely detection and accurate diagnosis of dysphagia in PD

Consensus on the treatment of dysphagia in Parkinson's disease

Background: Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but there is no consensus on their efficacy in PD. Objective: To conduct a systematic review of the literature and to define consensus statements on the treatment of dysphagia in PD and related nutritional management. Methods: A multinational group of experts in the field of neurogenic dysphagia and/or Parkinson's disease conducted a systematic evaluation of the literature and reported the results according to PRISMA guidelines. The evidence from the retrieved studies was analyzed and discussed in a consensus conference organized in Pavia, Italy, and the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. Results: The literature review retrieved 64 papers on treatment and nutrition of patients with PD and dysphagia, mainly of Class IV quality. Based on the literature and expert opinion in cases where the evidence was limited or lacking, 26 statements were developed. Conclusions: The statements developed by the Consensus panel provide a guidance for a multi-disciplinary treatment of dysphagia in patients with PD, involving neurologists, otorhinolaryngologists, gastroenterologists, phoniatricians, speech-language pathologists, dieticians, and clinical nutritionists