According to current evidence and guidelines, continued antipsychotic treatment is key for preventing relapse in people with schizophrenia‐spectrum disorders, but evidence‐based recommendations for the choice of the individual antipsychotic for maintenance treatment are lacking. Although oral antipsychotics are often prescribed first line for practical reasons, long‐acting injectable antipsychotics (LAIs) are a valuable resource to tackle adherence issues since the earliest phase of disease. Medline, EMBASE, PsycINFO, CENTRAL and CINAHL databases and online registers were searched to identify randomized controlled trials comparing LAIs or oral antipsychotics head‐to‐head or against placebo, published until June 2021. Relative risks and standardized mean differences were pooled using random‐effects pairwise and network meta‐analysis. The primary outcomes were relapse and dropout due to adverse events. We used the Cochrane Risk of Bias tool to assess study quality, and the CINeMA approach to assess the confidence of pooled estimates. Of 100 eligible trials, 92 (N=22,645) provided usable data for meta‐analyses. Regarding relapse prevention, the vast majority of the 31 included treatments outperformed placebo. Compared to placebo, “high” confidence in the results was found for (in descending order of effect magnitude) amisulpride‐oral (OS), olanzapine‐OS, aripiprazole‐LAI, olanzapine‐LAI, aripiprazole‐OS, paliperidone‐OS, and ziprasidone‐OS. “Moderate” confidence in the results was found for paliperidone‐LAI 1‐monthly, iloperidone‐OS, fluphenazine‐OS, brexpiprazole‐OS, paliperidone‐LAI 1‐monthly, asenapine‐OS, haloperidol‐OS, quetiapine‐OS, cariprazine‐OS, and lurasidone‐OS. Regarding tolerability, none of the antipsychotics was significantly worse than placebo, but confidence was poor, with only aripiprazole (both LAI and OS) showing “moderate” confidence levels. Based on these findings, olanzapine, aripiprazole and paliperidone are the best choices for the maintenance treatment of schizophrenia‐spectrum disorders, considering that both LAI and oral formulations of these antipsychotics are among the best‐performing treatments and have the highest confidence of evidence for relapse prevention. This finding is of particular relevance for low‐ and middle‐income countries and constrained‐resource settings, where few medications may be selected. Results from this network meta‐analysis can inform clinical guidelines and national and international drug regulation policies.

SummaryAmyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder that affects central and peripheral motor neuron cells. Its etiology is unknown, although a relationship between genetic background and environmental factors may play a major role in triggering the neurodegeneration. In this review, we analyze the role of environmental factors in ALS: heavy metals, electromagnetic fields and electric shocks, pesticides, β-N-methylamino-L-alanine, physical activity and the controversial role of sports. The literature on the single issues is analyzed in an attempt to clarify, as clearly as possible, whether each risk factor significantly contributes to the disease pathogenesis. After summarizing conflicting observations and data, the authors provide a final synthetic statement.

The ongoing pandemic scenario, due to the coronavirus disease 2019 (COVID-19), has had a considerable impact on public health all over the world. Italy was one of the most affected countries, as the first European full-blown outbreak occurred there. The exposure of the Italian health care workers to COVID-19 may be an important risk factor for psychological distress. The aim of this cross-sectional study was to describe worries and risk perception of being infected among Italian Health Care Workers (HCWs) during the first wave of the pandemic. In total, 2078 HCWs participated in a web survey (78.8% were females). The highest percentage of respondents were physicians (40.75%) and nurses (32.15%), followed by medical (18.00%), health care support (4.50%) and administrative (4.60%) staff. In a score range between 0 (not worried) and 4 (very worried), our results showed that participants declared that they were worried about the Coronavirus infection with a median score of 3 (IQR 2-3) and for 59.19% the risk perception of being infected was very high. In addition, HCWs reported they suffered from sleep disturbances (63.43%). From the analysis of the psychological aspect, a possible divergence emerged between the perceived need for psychological support (83.85%) and the relative lack of this service among health care providers emerged (9.38%). Our findings highlight the importance of psychological and psychiatric support services not only during the COVID-19 pandemic, but also in other emerging infectious diseases (EIDs) scenarios. These services may be useful for health authorities and policymakers to ensure the psychological well-being of health care professionals and to promote precautionary behaviors among them.

Our findings suggest that air pollution may be a risk factor for MS favoring inflammatory exacerbations.