Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The eHealth Literacy Scale (eHEALS) is a tool for the self-assessment of perceived comfort and skills in using the Internet as a source for health-related information. Although evidence exists of reliability, construct and structural validity of the scale, there is a lack of evidence for criterion validity in relation to what is proposed by Norman and Skinner in their theoretical model of eHealth literacy (lily model), in particular it is not clear whether having more health literacy can positively influence eHealth literacy as measured by the eHEALS. Objective: Our study aim was to assess whether real-life experiences in the area of health, as a proxy of higher health literacy, could influence eHealth literacy as measured using the eHEALS and proposed in the lily model of e-health literacy, while also validating the scale in the adult Italian population by exploring its internal consistency and component structure. Methods: Two web-based surveys were conducted among adults living in Northeast Italy. In order to be able to measure the impact of a real-life experience in the health field, we divided our sample into two groups, respectively characterized by experience in studying or working in the health sector and by lack thereof. Results: We recruited a total of 1135 subjects, of which 326 were included in the group with studying and working experiences in the health field. After removing subjects who didn’t complete the whole eHEALS, a total of 868 eHEALS respondents were included for further analysis. Mean eHEALS total score was 28.2±6.2 for the whole sample, with statistically significant differences (P<.001) between the two groups, with the higher health literate group scoring significantly better (31.9±5.9 vs 26.7±5.6). Cronbach alpha was high for all groups (.90 for the whole sample of eHEALS respondents, and .91 and .87 for the two groups separately), and Principal Factor Component analysis showed good factor loadings for all items ranging from 0.68 to 0.83 in the whole sample, with an eigenvalue of 4.90 explaining 61% of the total variability. Analysis of convergent validity showed results in line with current literature, with a significant, yet moderate, correlation of eHEALS score with frequency of Internet use for health-related purposes. Conclusions: The study demonstrated health literacy positive influence on eHEALS results and its complex relation with eHealth literacy, corroborating what was initially proposed by Norman and Skinner in the lily model. Also, we have been able to test an alternative Italian translation of the eHEALS (IT-eHEALS), which can be used as a valid tool to measure eHealth literacy in the adult Italian population.

Previous research has examined several parental, child-related, and contextual factors associated with parental quality of life (QoL) among parents with a child or an adolescent with autism spectrum disorders (ASD); however, no systematic review has examined the relationship between parental QoL and parental involvement in intervention. To fill this gap, a systematic review was conducted using four electronic databases and checked reference lists of retrieved studies. Records were included in the systematic review if they presented original data, assessed parental QoL, and involvement in intervention for children or adolescents with ASD, were published in peer-reviewed journals between 2000 and 2020, and were written in English. Among the 96 screened full-texts, 17 articles met the eligibility criteria. The selected studies included over 2000 parents of children or adolescents with ASD. Three categories of parental involvement (i.e., none, indirect, direct) were identified, which varied across studies, although most had direct parental involvement. The results from this review show that increased parental involvement in the intervention for children or adolescents with ASD may be one way to promote their QoL. However, further research specifically focused on parental involvement during the intervention for children and adolescents with ASD is warranted.

The approach for treating high-risk prostate cancer still presents different unresolved issues. We report the safety and efficacy of a radiation therapy strategy based on the combination of moderate hypofractioned simultaneous integrated boost (SIB) and Image Guidance. In this phase II trial of patients with high-risk prostate cancer, Image Guided SIB-IMRT plans (Simultaneous Intensity Modulated - Intensity Modulated Radiotherapy) were delivered between 2009 and 2012. All patients enrolled (41) received in 25 fractions a total dose of 67.5 Gy (2.7 Gy/fraction) to the prostatic volume, 56.25 Gy (2.25 Gy/fraction) to the seminal vescicles, and 50 Gy (2.0 Gy/fraction) to the pelvic lymph nodes (LN) chains with concurrent androgen deprivation therapy (ADT). The image-guided radiotherapy (IGRT) procedure was performed using three gold seeds. RTOG late gastrointestinal and genitourinary toxicities and 6-year biochemical relapse-free survival (BRFS) were assessed in combination of their statistical correlation with clinical factors and dosimetric parameters. Rate of late genitourinary toxicity grade 2 was 9.8%, while rates of late gastrointestinal toxicity were 14.6% and 2.4%, for grade 1 and 2, respectively. Diabetes and maximum doses to rectum appeared to be statistically relevant risk factors for late rectal toxicity. Five-year BRFS was 95.1%. In our study, we observed positive results in terms of toxicity and good efficacy in a cohort of high-risk prostate cancer patients treated with a multimodality therapy approach comprising hypofractionation, irradiation of pelvic nodes (common iliac nodes included), and concurrent ADT. These favorable results may merit further investigation in a phase III randomized trial to confirm that whole pelvic radiation therapy (WPRT) combined with moderate hypofractionation and ADT could be performed safely and effectively.

Risk perception can be influenced by cultural background. The study aims to evaluate risk perception, considering different ethnicities of construction workers from vocational schools in Italy. We administered a questionnaire investigating four different dimensions: Perceived behavioral control (PBC), Danger perception (DP), Safety climate (SC), and Attitude towards safe actions (ATSA). 562 workers answered: 72.4% from Italy, 14.2% from eastern Europe, 9.4% from Balkans, and 3.9% from North Africa. The participants indicated quite low control, attributable to the haste in performing the job. The workers perceived their specific job tasks as riskier compared to the tasks of their colleagues. They reported as fundamental the respecting of safety rules, but indicating that supervisors do not adequately promote safety behaviors. Finally, construction workers judged as “brave” the colleagues working without protective equipment. When compared to Italians, North Africa workers showed a lower perception of the possibility to control their safe behaviors (p = 0.040), while both eastern Europeans and Balkan obtained higher scores at the ATSA dimension, indicating a kind of fatalistic acceptance of the risky situations at work. Eastern Europeans also showed a lower perception of the dangers (p = 0.002), while Balkan demonstrated a perception of SC even better than the Italian group (p = 0.005).