McMaster Model of Family Functioning: adattamento alla realtà italiana, implicazioni cliniche e di ricerca

Il presente lavoro comincia con una descrizione dettagliata del “McMaster Model of Family Functionig” (MMFF), modello che al suo interno integra una teoria multidimensionale sul funzionamento familiare, diversi strumenti di auto ed etero valutazione e chiare indicazioni terapeutiche racchiuse all’interno della “Problem Centered System Therapy of the Family” (PCSTF). Grazie alla sua completezza il Modello fornisce ai clinici metodi coerenti, pratici ed empiricamente validi per valutare e trattare le famiglie, essi inoltre, sono stati formulati in modo da essere adattabili a differenti setting clinici e di ricerca, applicabili ad un’ampia gamma di problematiche e verificabili empiricamente. Obiettivo finale della presente ricerca è stato quello di porre le basi per l’esportazione del MMFF in Italia e poter quindi procedere alla sua applicazione in ambito clinico. La ricerca è cominciata alla Brown University con la traduzione dall’inglese all’italiano del Family Assessment Device (FAD), uno degli strumenti di autovalutazione compresi nel MMFF, ed è in seguito continuata con la validazione del suddetto strumento in un campione di 317 soggetti appartenenti alla popolazione generale italiana. Il FAD si è dimostrato uno strumento valido ed affidabile, in grado quindi di fornire valutazioni stabili e coerenti anche nella sua versione italiana. Il passo successivo è stato caratterizzato dalla somministrazione di FAD, Symptom Questionnaire (SQ) e delle Psychological Well-Being scales (PWB) a 289 soggetti reclutati nella popolazione generale. In accordo con il modello bipsicosociale che vede l’ambiente familiare come il più immediato gruppo di influenza psicosociale dello stato di benessere o malessere dell’individuo, i nostri dati confermano una stretta relazione tra scarso funzionamento familiare, spesso espresso attraverso difficoltà di comunicazione, di problem solving e scarso coinvolgimento affettivo e distress psicologico esperito con sintomi depressivi, ansiogeni ed ostilità. I nostri dati sottoliano inoltre come un funzionamento familiare positivo sia altamente correlato ad elevati livelli di benessere psicologico. Obiettivo della parte finale del lavoro ed anche il più importante, è stato quello di esplorare l’efficacia della Problem Centered Systems Therapy of the Family nella gestione della perdita di efficacia degli antidepressivi nel trattamento della depressione ricorrente. 20 soggetti con diagnosi di depressione maggiore ricorrente secondo il DSM-IV sono stati randomizzati a due diverse condizioni di trattamento: 1) aumento del dosaggio dell’antidepressivo e clinical management, oppure 2) mantenimento dello stesso dosaggio di antidepressivo e PCSTF. I dati di questo studio mettono in evidenza come, nel breve termine, PCSTF e farmacoterapia sono ugualmente efficaci nel ridurre la sintomatologia depressiva. Diversamente, ad un follow-up di 12 mesi, la PCSTF si è dimostrata altamente superiore all’aumento del farmaco ner prevenire le ricadute. Nel gruppo sottoposto all’aumento del farmaco infatti ben 6 soggetti su 7 ricadono entro l’anno. Nel gruppo assegnato a terapia familiare invece solo 1 soggetto su 7 ricade. Questi risultati sono in linea con i dati della letteratura che sottolineano l’elevata probabilità di una seconda ricaduta dopo l’aumento dell’antidepressivo all’interno di una farmacoterapia di mantenimento e suggeriscono l’efficacia dell’utilizzo di strategie psicoterapiche nella prevenzione della ricaduta in pazienti con depressione ricorrente.

Physiology and Biotechnology of the Hydrogen Production with the Green Microalga Chlamydomonas reinhardtii

The hydrogen production in the green microalga Chlamydomonas reinhardtii was evaluated by means of a detailed physiological and biotechnological study. First, a wide screening of the hydrogen productivity was done on 22 strains of C. reinhardtii, most of which mutated at the level of the D1 protein. The screening revealed for the first time that mutations upon the D1 protein may result on an increased hydrogen production. Indeed, productions ranged between 0 and more than 500 mL hydrogen per liter of culture (Torzillo, Scoma et al., 2007a), the highest producer (L159I-N230Y) being up to 5 times more performant than the strain cc124 widely adopted in literature (Torzillo, Scoma, et al., 2007b). Improved productivities by D1 protein mutants were generally a result of high photosynthetic capabilities counteracted by high respiration rates. Optimization of culture conditions were addressed according to the results of the physiological study of selected strains. In a first step, the photobioreactor (PBR) was provided with a multiple-impeller stirring system designed, developed and tested by us, using the strain cc124. It was found that the impeller system was effectively able to induce regular and turbulent mixing, which led to improved photosynthetic yields by means of light/dark cycles. Moreover, improved mixing regime sustained higher respiration rates, compared to what obtained with the commonly used stir bar mixing system. As far as the results of the initial screening phase are considered, both these factors are relevant to the hydrogen production. Indeed, very high energy conversion efficiencies (light to hydrogen) were obtained with the impeller device, prooving that our PBR was a good tool to both improve and study photosynthetic processes (Giannelli, Scoma et al., 2009). In the second part of the optimization, an accurate analysis of all the positive features of the high performance strain L159I-N230Y pointed out, respect to the WT, it has: (1) a larger chlorophyll optical cross-section; (2) a higher electron transfer rate by PSII; (3) a higher respiration rate; (4) a higher efficiency of utilization of the hydrogenase; (5) a higher starch synthesis capability; (6) a higher per cell D1 protein amount; (7) a higher zeaxanthin synthesis capability (Torzillo, Scoma et al., 2009). These information were gathered with those obtained with the impeller mixing device to find out the best culture conditions to optimize productivity with strain L159I-N230Y. The main aim was to sustain as long as possible the direct PSII contribution, which leads to hydrogen production without net CO2 release. Finally, an outstanding maximum rate of 11.1 ± 1.0 mL/L/h was reached and maintained for 21.8 ± 7.7 hours, when the effective photochemical efficiency of PSII (ΔF/F'm) underwent a last drop to zero. If expressed in terms of chl (24.0 ± 2.2 µmoles/mg chl/h), these rates of production are 4 times higher than what reported in literature to date (Scoma et al., 2010a submitted). DCMU addition experiments confirmed the key role played by PSII in sustaining such rates. On the other hand, experiments carried out in similar conditions with the control strain cc124 showed an improved final productivity, but no constant PSII direct contribution. These results showed that, aside from fermentation processes, if proper conditions are supplied to selected strains, hydrogen production can be substantially enhanced by means of biophotolysis. A last study on the physiology of the process was carried out with the mutant IL. Although able to express and very efficiently utilize the hydrogenase enzyme, this strain was unable to produce hydrogen when sulfur deprived. However, in a specific set of experiments this goal was finally reached, pointing out that other than (1) a state 1-2 transition of the photosynthetic apparatus, (2) starch storage and (3) anaerobiosis establishment, a timely transition to the hydrogen production is also needed in sulfur deprivation to induce the process before energy reserves are driven towards other processes necessary for the survival of the cell. This information turned out to be crucial when moving outdoor for the hydrogen production in a tubular horizontal 50-liter PBR under sunlight radiation. First attempts with laboratory grown cultures showed that no hydrogen production under sulfur starvation can be induced if a previous adaptation of the culture is not pursued outdoor. Indeed, in these conditions the hydrogen production under direct sunlight radiation with C. reinhardtii was finally achieved for the first time in literature (Scoma et al., 2010b submitted). Experiments were also made to optimize productivity in outdoor conditions, with respect to the light dilution within the culture layers. Finally, a brief study of the anaerobic metabolism of C. reinhardtii during hydrogen oxidation has been carried out. This study represents a good integration to the understanding of the complex interplay of pathways that operate concomitantly in this microalga.

Well-being, distress and health status in a population of adolescent students

The present work explores the psychosocial issues emerging from a large cross-sectional study aimed to assess the prevalence, clinical manifestations, and psychosocial correlates of hyperandrogenism in a population of Italian high school students. Participants were 1804 adolescents, aged between 15 and 19 years, who volunteered to fill in a package of self-report questionnaires (including the Psychosocial Index, the Symptom Questionnaire and Ryff’s Psychological Well-Being scales for the assessment of psychological aspects) and undergo a comprehensive physical examination. Significant gender differences were found with regard to psychological distress, with females reporting higher scores compared with males, but not on well-being dimensions. The relationships of well-being to distress were found to be complex. Although inversely associated, well-being and ill-being appeared to be distinct domains of mental functioning. The evaluation of the moderating effects of well-being in the association between stress and psychological distress indicated that well-being may act as a protective factor, contributing to less pronounced psychological distress as stress levels increased. Higher rates of somatic complaints were found among current smokers. However, substance use (i.e., smoking and drug use) was also found to be positively associated with some well-being dimensions. A considerable number of participants were found to present with disordered eating symptoms, particularly females, and associated higher stress levels and lower quality of life. Sport activities were found to favourably affect psychological health. As to clinical signs of hyperandrogenism, a significant impairment in psychosocial functioning was found among females, whereas no effects on psychological measures could be detected among males. Subgroups of adolescents with distinct clinical and psychological characteristics could be identified by means of cluster analysis. The present study provides new insights into better understanding of the complex relationships between well-being, distress and health status in the adolescent population, with important clinical implications.

Spatial and temporal variability and ecological processes in the epibenthic assemblages of the northern Adriatic Sea

Several coralligenous reefs occur in the soft bottoms of the northern Adriatic continental shelf. Mediterranean coralligenous habitats are characterised by high species diversity and are intrinsically valuable for their biological diversity and for the ecological processes they support. The conservation and management of these habitats require quantifying spatial and temporal variability of their benthic assemblages. This PhD thesis aims to give a relevant contribution to the knowledge of the structure and dynamics of the epibenthic assemblages on the coralligenous subtidal reefs occurring in the northern Adriatic Sea. The epibenthic assemblages showed a spatial variation larger compared to temporal changes, with a temporal persistence of reef-forming organisms. Assemblages spatial heterogeneity has been related to morphological features and geographical location of the reefs, together with variation in the hydrological conditions. Manipulative experiments help to understand the ecological processes structuring the benthic assemblages and maintaining their diversity. In this regards a short and long term experiment on colonization patterns of artificial substrata over a 3-year period has been performed in three reefs, corresponding to the three main types of assemblages detected in the previous study. The first colonisers, largely depending by the different larval supply, played a key role in determining the heterogeneity of the assemblages in the early stage of colonisation. Lateral invasion, from the surrounding assemblages, was the driver in structuring the mature assemblages. These complex colonisation dynamics explained the high heterogeneity of the assemblages dwelling on the northern Adriatic biogenic reefs. The buildup of these coralligenous reefs mainly depends by the bioconstruction-erosion processes that has been analysed through a field experiment. Bioconstruction, largely due to serpulid polychaetes, prevailed on erosion processes and occurred at similar rates in all sites. Similarly, the total energy contents in the benthic communities do not differ among sites, despite being provided by different species. Therefore, we can hypothesise that both bioconstruction processes and energetic storage may be limited by the availability of resources. Finally the major contribution of the zoobenthos compared to the phytobenthos to the total energetic content of assemblages suggests that the energy flow in these benthic habitats is primarily supported by planktonic food web trough the filter feeding invertebrates.

Psychobiological correlates of allostatic load

Introduction: The term Clinimetric was introduced by Feinstein in 1982, who first noticed that despite all the improvements in the assessment methods, a number of clinical phenomena were still unconsidered during the evaluation process. Yet today clinical phenomena, such as stress, relevant in diseases progression and course, are not completely evaluated. Only recently, according to the clinimetric approach, Fava and colleagues have introduced specific criteria for evaluating the allostatic overload in clinical setting. Methods: Participants were 240 blood donors recruited from May 2007 to December 2009 in 4 different blood Centers (AVIS) in Italy. Blood samples from each participant were collected for laboratory test the same day the self-rating instruments were administered (Psychosocial Index, Symptom Questionnaire, Psychological well-being scales, Temperament and Character inventory, Self-Report Altruism scale). The study explore different aspects describing sample characteristics and correlates of stress in the total sample (part I), new selection criteria applied to existing instruments to identify individuals reporting allostatic load (part II), and differences on biological correlates between subjects with vs without AL. Results: Significant differences according to gender and past illnesses have been found in different dimensions of well-being and distress. Further, distress was explained for more than 60% by 4 main factors such as anxiety, somatic symptoms, environmental mastery and persistence. According to the new criteria, 98 donors reported AL. Allostatic load individuals reported to engage in less altruistic behaviours. Also they differ in personality traits and characters from controls. In the last part, results showed significant differences among donors according to allostatic load on diverse biological parameters (RBC, MCV, immune essay). Conclusion: This study presents obvious limitations due to its preliminary nature. Further research are need to confirm that these new criteria may lead to identify high risk individuals reporting not only stressful situations but also vulnerabilities.

Intensificazione di processi biologici per la Bioremediation aerobica di suoli contaminati

Enzyveba, a partially characterized complex consortium of not-adapted microorganisms developed through prolonged stabilization of organic wastes, was found to markedly intensify the aerobic remediation of aged PAH- and PCB-contaminated soil by acting as a source of exogenous specialized microorganisms and nutrients. Thus, Enzyveba was tested in the bioremediation of Diesel (G1) and HiQ Diesel (G2) contaminated soils under aerobic slurry-phase conditions by means of a chemical, microbiological, ecotoxicological integrated analytical procedure. The addition of Enzyveba resulted in a higher availability of cultivable specialized bacteria and fungi but this resulted in a slight intensification of soil remediation, probably because of the high content of nutrients and specialized microorganisms of the soil. In many cases, the biotreatability of soils impacted by diesel fuel is limited by their poor content of autochthonous pollutant-degrading microorganisms. Thus, bioaugmentation with stable and reproducible cultures with the required broad substrate specificity might be the solution for a successful remediation. Two microbial consortia, ENZ-G1 and ENZ-G2, were enriched from Enzyveba on G1 and G2. Both consortia consist of a similar composition of bacterial and fungal species. They exhibited a comparable and significant biodegradation capability by removing about 90% of 1 g/l of diesel fuel under liquid culture conditions. Given their remarkable biodegradation potential, richness of quite diverse microbes, stability and resistance after cryopreservation at -20 °C for several months, both consortia appear very interesting candidates for bioaugmentation on site. The mycoflora of a soil historically contaminated by high concentration of PCBs was characterised before, at the beginning and at the end of the biotreatment mentioned above. Several mitosporic fungi isolated from soil grew in presence of a mixture of three PCBs congeners when also glucose was provided. This is the first study in which 5 strains of mitosporic species able to biodegrade PCB are reported in the literature.

Biometanazione della frazione organica dei rifiuti solidi urbani attraverso codigestione con letame bovino

An anaerobic consortium, capable of efficiently converting into methane the organic fraction of mechanically sorted municipal solid waste (MS-OFMSW), was obtained through a dedicated enrichment procedure in a 0.36 L up-flow anaerobic recirculated reactor. This result was obtained after several micro-reactor fed-batch procedures that allowed to obtain only a few methanization of the MS-OFMSW.

Fermentative processes for environmental remediation

The growing interest in environmental protection has led to the development of emerging biotechnologies for environmental remediation also introducing the biorefinery concept. This work mainly aimed to evaluate the applicability of innovative biotechnologies for environmental remediation and bioenergy production, throught fermentative processes. The investigated biotechnologies for waste and wastewater treatment and for the valorisation of specific feedstocks and energy recovery, were mainly focused on four research lines. 1. Biotechnology for textile wastewater treatment and water reuse that involving anaerobic and aerobic processes in combination with membrane technologies. Combinations of different treatments were also implemented for water reuse in a textile company. 2. Biotechnology for the treatment of solid waste and leachate in landfill and for biogas production. Landfill operated as Bioreactor with recirculation of the generated leachate was proposed for organic matter biostabilisation and for ammonia removal from leachate by favouring the Anammox process. 3. An innovative two-stage anaerobic process for effective codigestion of waste from the dairy industry, as cheese whey and dairy manure, was studied by combining conventional fermentative processes with a simplified system design for enhancing biomethanisation. 4) The valorisation of the glycerol waste as surplus by-product of the biodiesel industry was investigated via microbial conversion to value-added chemicals, as 1,3-propanediol. The investigated fermentative processes have been successfully implemented and reached high yields of the produced bio-chemical. The studied biotechnological systems proved to be feasible for environmental remediation and bioenergy and chemicals production.

Produzione di bioetanolo da effluenti del settore lattiero-caseario con Kluyveromyces marxianus

Il siero di latte e la scotta sono effluenti provenienti rispettivamente dal processo di trasformazione del latte in formaggio e ricotta. Il siero di latte contiene minerali, lipidi, lattosio e proteine; la scotta contiene principalmente lattosio. Il siero può essere riutilizzato in diversi modi, come l'estrazione di proteine o per l’alimentazione animale, mentre la scotta è considerata solamente un rifiuto. Inoltre, a causa degli ingenti volumi di siero prodotti nel mondo, vengono a crearsi seri problemi ambientali e di smaltimento. Destinazioni alternative di questi effluenti, come le trasformazioni biotecnologiche, possono essere un modo per raggiungere il duplice obiettivo di migliorare il valore aggiunto dei processi agroindustriali e di ridurre il loro impatto ambientale. In questo lavoro sono state studiate le condizioni migliori per produrre bioetanolo dal lattosio del siero e della scotta. Kluyveromyces marxianus è stato scelto come lievito lattosio-fermentante. Sono state effettuate fermentazioni su scala di laboratorio aerobiche e anaerobiche in batch, fermentazioni semicontinue in fase dispersa e con cellule immobilizzate in alginato di calcio,. Diverse temperature sono state testate per migliorare la produzione di etanolo. Le migliori prestazioni, per entrambe le matrici, sono state raggiunte a basse temperature (28°C). Anche le alte temperature sono compatibili con buone rese di etanolo nelle fermentazioni con siero. Ottimi risultati si sono ottenuti anche con la scotta a 37°C e a 28°C. Le fermentazioni semicontinue in fase dispersa danno le migliori produzioni di etanolo, in particolare con la scotta. Invece, l'uso di cellule di lievito intrappolate in alginato di calcio non ha migliorato i risultati di processo. In conclusione, entrambi gli effluenti possono essere considerati adatti per la produzione di etanolo. Le buone rese ottenute dalla scotta permettono di trasformare questo rifiuto in una risorsa.

Vanillin production from ferulic acid with Pseudomonas fluorescens BF13-1p4

Bioconversion of ferulic acid to vanillin represents an attractive opportunity for replacing synthetic vanillin with a bio-based product, that can be label “natural”, according to current food regulations. Ferulic acid is an abundant phenolic compound in cereals processing by-products, such as wheat bran, where it is linked to the cell wall constituents. In this work, the possibility of producing vanillin from ferulic acid released enzymatically from wheat bran was investigated by using resting cells of Pseudomonas fluorescens strain BF13-1p4 carrying an insertional inactivation of vdh gene and ech and fcs BF13 genes on a low copy number plasmid. Process parameters were optimized both for the biomass production phase and the bioconversion phase using food-grade ferulic acid as substrate and the approach of changing one variable while fixing the others at a certain level followed by the response surface methodology (RSM). Under optimized conditions, vanillin up to 8.46 mM (1.4 g/L) was achieved, whereas highest productivity was 0.53 mmoles vanillin L-1 h-1). Cocktails of a number of commercial enzyme (amylases, xylanases, proteases, feruloyl esterases) combined with bran pre-treatment with steam explosion and instant controlled pressure drop technology were then tested for the release of ferulic acid from wheat bran. The highest ferulic acid release was limited to 15-20 % of the ferulic acid occurring in bran, depending on the treatment conditions. Ferulic acid 1 mM in enzymatic hydrolyzates could be bioconverted into vanillin with molar yield (55.1%) and selectivity (68%) comparable to those obtained with food-grade ferulic acid after purification from reducing sugars with a non polar adsorption resin. Further improvement of ferulic acid recovery from wheat bran is however required to make more attractive the production of natural vanillin from this by-product.

Microbial ecology of biotechnological processes

The investigation of phylogenetic diversity and functionality of complex microbial communities in relation to changes in the environmental conditions represents a major challenge of microbial ecology research. Nowadays, particular attention is paid to microbial communities occurring at environmental sites contaminated by recalcitrant and toxic organic compounds. Extended research has evidenced that such communities evolve some metabolic abilities leading to the partial degradation or complete mineralization of the contaminants. Determination of such biodegradation potential can be the starting point for the development of cost effective biotechnological processes for the bioremediation of contaminated matrices. This work showed how metagenomics-based microbial ecology investigations supported the choice or the development of three different bioremediation strategies. First, PCR-DGGE and PCR-cloning approaches served the molecular characterization of microbial communities enriched through sequential development stages of an aerobic cometabolic process for the treatment of groundwater contaminated by chlorinated aliphatic hydrocarbons inside an immobilized-biomass packed bed bioreactor (PBR). In this case the analyses revealed homogeneous growth and structure of immobilized communities throughout the PBR and the occurrence of dominant microbial phylotypes of the genera Rhodococcus, Comamonas and Acidovorax, which probably drive the biodegradation process. The same molecular approaches were employed to characterize sludge microbial communities selected and enriched during the treatment of municipal wastewater coupled with the production of polyhydroxyalkanoates (PHA). Known PHA-accumulating microorganisms identified were affiliated with the genera Zooglea, Acidovorax and Hydrogenophaga. Finally, the molecular investigation concerned communities of polycyclic aromatic hydrocarbon (PAH) contaminated soil subjected to rhizoremediation with willow roots or fertilization-based treatments. The metabolic ability to biodegrade naphthalene, as a representative model for PAH, was assessed by means of stable isotope probing in combination with high-throughput sequencing analysis. The phylogenetic diversity of microbial populations able to derive carbon from naphthalene was evaluated as a function of the type of treatment.

Bioremediation of PCB-contaminated marine sediments: From identification of indigenous dehalorespirers to enhancement of microbial reductive dechlorination

Marine sediments are the main accumulation reservoir of organic recalcitrant pollutants such as polychlorinated biphenyls (PCBs). In the anoxic conditions typical of these sediments, anaerobic bacteria of the phylum Chloroflexi are able to attack these compounds in a process called microbial reductive dechlorination. Such activity and members of this phylum were detected in PCB-impacted sediments of the Venice Lagoon. The aim of this work was to investigate microbial reductive dechlorination and design bioremediation approaches for marine sediments of the area. Three out of six sediment cultures from different sampling areas exhibited dechlorination activities in the same conditions of the site and two phylotypes (VLD-1 and VLD-2) were detected and correlated to this metabolism. Biostimulation was tested on enriched dechlorinating sediment cultures from the same site using five different electron donors, of which lactate was the best biostimulating agent; complementation of microbial and chemical dechlorination catalyzed by biogenic zerovalent Pd nanoparticles was not effective due to sulfide poisoning of the catalyst. A new biosurfactant-producing strain of Shewanella frigidimarina was concomitantly obtained from hydrocarbon-degrading marine cultures and selected because of the low toxicity of its product. All these findings were then exploited to develop bioremediation lab-scale tests in shaken reactors and static microcosms on real sediments and water of the Venice lagoon, testing i) a bioaugmentation approach, with a selected enriched sediment culture from the same area, ii) a biostimulation approach with lactate as electron donor, iii) a bioavailability enhancement with the supplementation of the newly-discovered biosurfactant, and iv) all possible combinations of the afore-mentioned approaches. The best bioremediation approach resulted to be a combination of bioaugmentation and bioremediation and it could be a starting point to design bioremediation process for actual marine sediments of the Venice Lagoon area.

Prevention of binge drinking in young adolescents through the promotion of a balanced level of psychological well-being: be-dry

This doctoral thesis presents a project carried out in secondary schools located in the city of Ferrara with the primary objective of demonstrating the effectiveness of an intervention based on Well-Being Therapy (Fava, 2016) in reducing alcohol use and improving lifestyles. In the first part (chapters 1-3), an introduction on risky behaviors and unhealthy lifestyle in adolescence is presented, followed by an examination of the phenomenon of binge drinking and of the concept of psychological well-being. In the second part (chapters 4-6), the experimental study is presented. A three-arm cluster randomized controlled trial including three test periods was implemented. The study involved eleven classes that were randomly assigned to receive well-being intervention (WBI), lifestyle intervention (LI) or not receive intervention (NI). Results were analyzed by linear mixed model and mixed-effects logistic regression with the aim to test the efficacy of WBI in comparison with LI and NI. AUDIT-C total score increased more in NI in comparison with WBI (p=0.008) and LI (p=0.003) at 6-month. The odds to be classified as at-risk drinker was lower in WBI (OR 0.01; 95%CI 0.01–0.14) and LI (OR 0.01; 95%CI 0.01–0.03) than NI at 6-month. The odds to use e-cigarettes at 6-month (OR 0.01; 95%CI 0.01–0.35) and cannabis at post-test (OR 0.01; 95%CI 0.01–0.18) were less in WBI than NI. Sleep hours at night decreased more in NI than in WBI (p = 0.029) and LI (p = 0.006) at 6-month. Internet addiction scores decreased more in WBI (p = 0.003) and LI (p = 0.004) at post-test in comparison with NI. Conclusions about the obtained results, limitations of the study, and future implications are discussed. In the seventh chapter, the data of the project collected during the pandemic are presented and compared with those from recent literature.