This study was aimed to identify intermediary organizations active in nature conservation initiatives by adopting a multi-level (ML) and network governance (NG) framework and using social network analysis (SNA). We identified 256 coordinating beneficiaries and 1090 associated beneficiaries connected through 8310 project relations and financed through the EU-funded LIFE Programme from 2014 to 2020. Our results evidence a central component of the network where organizations from Italy, Spain, and the United Kingdom play a central role. In contrast, peripheral components return a framework of partnerships mainly constituted by actors of the same country (68%). Moreover, the characterization by type of actor confirms the widespread implementation of a multi-level governance approach in LIFE-Nature (NAT) projects, evidencing the significant presence of non-governmental organizations and foundations, mainly at a national level, in nature conservation initiatives. Our findings reveal that the intermediary capacity of key actors should be further reinforced, particularly toward the promotion of transnational cooperation and cross-sector alliances, by encouraging the involvement of stakeholders operating at the ground level (i.e., provincial and municipal levels).

Green Care initiatives (GCIs) encompass various interventions that support physical, mental, and social well-being through interaction with nature. Integrating GCIs into conventional healthcare systems is a complex task that requires multi-actor and multi-level governance efforts. This study examines, through a systematized literature review, the relevant governance dimensions to facilitate the inclusion of GCIs in traditional care pathways. From the analysis of the 36 selected studies, four key dimensions were identified: organizational structure, knowledge, legitimacy, and decentralization. The analysis highlights the need to strengthen the responsibility of Green Care actors as healthcare service providers, enhance local authorities’ role in creating new integrated service delivery networks, combine different knowledge perspectives, and legitimize non-healthcare actors. Recommendations are made to address these governance aspects to facilitate the integration of GCIs and channel their benefits in prevention and health promotion. Adopting an adequate governance framework is fundamental for mainstreaming GCIs in current healthcare systems.

Pouchitis is an idiopathic inflammatory disease that may occur in ileal pouches, and it can lead to ileal pouch failure. This was a single-center, randomized, double-blinded, placebo-controlled trial that assessed the effect of Lactobacillus casei (L. casei) DG®, a probiotic strain, on the ileal pouch mucosa to determine the crosstalk between microbiota and mucosal immune system. Fifty-two patients undergoing restorative proctocolectomy were recruited and randomly assigned to receive a daily oral supplementation of L. casei DG® (n = 26) or placebo (n = 26) for 8 weeks from the ileostomy closure (T0) to a pouch endoscopy after 8 weeks (T1) and 1 year (T2). Ileal pouch mucosa samples were collected at T0, T1, and T2. At T1, the L. casei DG®-supplemented group showed a significant reduction of inflammatory cytokines levels compared to T0 baseline levels in the pouch mucosa, whereas in the placebo group cytokines levels resulted stable. In conclusion, probiotic manipulation of mucosal microbiota by L. casei DG®-supplementation after stoma closure in patients who underwent restorative proctocolectomy has a beneficial impact on the ileal pouch microenvironment. Registration number: NCT03136419 (http://www.clinicaltrials.gov).

Chronic medical conditions, such as inflammatory bowel diseases(IBD),have been associated with impaired quality of life (QoL) and the presence of mood disorders compared with the general population. The aim of this observational study was to evaluate in a single-centre cohort of IBD patients: QoL, state and trait anxiety, depression and alexithymia. Consecutive adult IBD outpatients from January to March 2018 were enrolled in the study. Main inclusion criteria were: confirmed diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) from at least 1 year and age between 18 and 70 years. Disease activity was evaluated by the Harvey–Bradshaw Index (HBI) for CD and the partial Mayo Score (pMS) for UC. Quality of life was evaluated with the SF36 and the results summarised in the physical and mental component scales (PCS and MCS). The PCS and MCS composite means and standard deviations (SD) are 50 ± 10 for the U.S. general population. Anxiety was evaluated with the State-Trait Anxiety Inventory which consists of two axes (Year 1 for state anxiety and Year 2 for trait anxiety; STAI scores >40: clinically significant symptoms of anxiety); depression was measured with the Beck Depression Inventory-II; alexithymia was investigated through the TAS-20. 48 patients were enrolled (M/F 26/22, mean age at test 39 (SD 13.6) years; mean time from diagnosis 11.5 (SD 8.2), CD/UC 32/16). Thirteen of our patients had active disease at the time of the study and 20 was on biologic therapy. The mean PCS value was 50.3 (SD 11.9) and the mean MCS value was 40.15 (SD 7.60). Twenty patients (41.7%) had a pathological STAI1 (existing anxiety) and 25 (52.1%) a pathological STAI 2 (a predisposition to anxious reactions as a personality characteristic). Thirty-three (68.7%) had minimal depression while only one (2.1%) was severely depressed. Six patients (12.5%) reported borderline alexithymia and four clear alexithymia (8.3%). PCS and MCS scores were negatively correlated with depression and anxiety scores (worse quality of life in term of physical and mental aspects, worse depression and anxiety) while they were not related to alexithymia. No correlation was found between scales used and age at test, time from diagnosis and pMS. Instead, we found a relationship between HBI and all scales: presence of depression (r = 0.57, p = 0.0007), state anxiety (r = 0.4, p = 0.02), trait anxiety (r = 0.5, p = 0.003), alexithymia (r = 0.34, p = 0.05), mental scale (r = −0.54, p = 0.004) and physical scale (r = −0.5, p = 0.004). QoL and mood disorders were not influenced by the use of biologics or disease type(CD or UC. Mood disorders affect IBD patients at any age and independently from the therapy used or the time from diagnosis. More attention should be given to the psychological aspects of IBD patients to improve their QoL.