The health-economy trade-off during the Covid-19 pandemic: Communication matters.

How do people balance concerns for general health and economic outcomes during a pandemic? And, how does the communication of this trade-off affect individual preferences? We address these questions using a field experiment involving around 2000 students enrolled in a large university in Italy. We design four treatments where the trade-off is communicated using different combinations of a positive framing that focuses on protective strategies and a negative framing which refers to potential costs. We find that positive framing on the health side induces students to give greater relevance to the health dimension. The effect is sizeable and highly effective among many different audiences, especially females. Importantly, this triggers a higher level of intention to adhere to social distancing and precautionary behaviors. Moreover, irrespective of the framing, we find a large heterogeneity in students' preferences over the trade-off. Economics students and students who have directly experienced the economic impact of the pandemic are found to give greater value to economic outcomes.

Stability of Film-Forming Dispersions: Affects the Morphology and Optical Properties of Polymeric Films.

Starch-based films are promising alternatives to synthetic films in food packaging. They were widely studied in terms of mechanical and optical properties. In food packaging, optical properties are of great interest because ultra violet (UV-light) protection is strictly required. Nevertheless, the characterization of film-forming dispersions was poorly addressed, especially regarding its correlation with the film produced. In this work, we characterized film-forming dispersions at different compositions of starch and carboxymethyl cellulose (CMC) by Turbiscan. This instrument is based on multiple light scattering and gives significant information about the miscibility of polymers in the dispersed phase. Indeed, it identifies the phenomena of destabilization and phase separation before their visibility to the unaided eye. This work aimed to study whether the homogeneous/inhomogeneous morphology of films could be forecast by the analysis of profiles obtained in the dispersed phase. The films produced were investigated by optical microscopy and absorbance analysis. As the CMC fraction increased, Turbiscan showed reduced phase separation. This implies better miscibility of mixture components and higher gelification degree. The related film was more homogeneous and presented higher UV absorbance. Consequently, film-forming dispersions and optical properties of films are strictly correlated and Turbiscan-based analysis is very useful to investigate the dispersion stability and predict the film quality.

Genetic variation in CHRNA7 and CHRFAM7A is associated with nicotine dependence and response to varenicline treatment.

The role of nicotinic acetylcholine receptors (nAChR) in nicotine dependence (ND) is well established; CHRNA7, encoding the α7 subunit, has a still uncertain role in ND, although it is implicated in a wide range of neuropsychiatric conditions. CHRFAM7A, a hybrid gene containing a partial duplication of CHRNA7, is possibly involved in modulating α7 nAChR function. The aim of this study was to investigate the role of CHRNA7 and CHRFAM7A genetic variants in ND and to test the hypothesis that α7 nAChR variation may modulate the efficacy of varenicline treatment in smoking cessation. We assessed CHRNA7 and CHRFAM7A copy number, CHRFAM7A exon 6 ∆2 bp polymorphism, and sequence variants in the CHRNA7 proximal promoter in an Italian sample of 408 treatment-seeking smokers. We conducted case-control and quantitative association analyses using two smoking measures (cigarettes per day, CPD, and Fagerström Test for Nicotine Dependence, FTND). Next, driven by the hypothesis that varenicline may exert some of its therapeutic effects through activation of α7 nAChRs, we restricted the analysis to a subgroup of 142 smokers who received varenicline treatment. The CHRNA7 promoter variant rs28531779 showed association with both smoking quantitative measures (FNTD p = 0.026, ß = 0.89, 95% CI 0.11-1.67; CPD p = 0.006, ß = 4.82 95% CI 1.42-8.22). Moreover, in the varenicline-treated subgroup we observed association of CHRFAM7A copy number with 6 months smoking abstinence (p = 0.035, OR = 3.18, 95% CI = 1.09-9.30). Thus, our study points to a possible role of genetic variation in CHRNA7 and CHRFAM7A in tobacco addiction mechanisms and response to varenicline treatment.

A novel PALB2 truncating mutation in an Italian family with male breast cancer.

Male breast cancer (MBC) is a rare disease, accounting for ~1% of all breast cancer cases worldwide. Although other genes are also involved, predisposing genetic factors to MBC include germline mutations in the BRCA genes (BRCA2). Among the other genes, partner and localizer of BRCA2 (PALB2) is considered a moderate-penetrance breast cancer susceptibility gene that may also play a role in MBC predisposition. Thus, the aim of the present study was to determine the PALB2 gene status in 8 MBC cases selected from a cohort of 181 hereditary breast and/or ovarian cancer probands. We performed PALB2 mutational analysis by direct sequencing of 13 exons and adjacent intronic regions. This study showed the presence of a PALB2 truncating mutation in 1/8 (12.5%) cases. This novel mutation was named c.1285_1286delAinsTC (p.I429SfsX12) and is localized in exon 4 of PALB2, in the region encoding for the ChAM motif which is important for the efficient association of PALB2 to chromatin and for recruitment of the BRCA complex to accumulate RAD51 at double-strand break sites. Our findings indicate that PALB2 could be added to the list of breast cancer susceptibility genes also in families with MBC cases.

More apples fewer chips? the effect of school fruit schemes on the consumption of junk food.

OBJECTIVES: Using Italian data, we evaluate the effects on the consumption of unhealthy snacks of a European Union-wide campaign providing fruit and vegetables to school children and promoting healthy diet habits. METHODS: We use scanner data of supermarket sales in the city of Rome. Using a difference-in-difference approach, we compare the sales of these snacks before and after the campaign in supermarkets located within a 500 m radius of schools that participated to the program (the treated group) and in supermarkets located outside that radius (control group). RESULTS: We find that the campaign has been effective in reducing the increase in the sales of unhealthy snacks in treated stores - relative to control stores - only in the case of regular stores, which tend to locate in the wealthier areas of Rome. No effect is found, instead, for discount stores, where people with a higher risk of developing obesity are more likely to shop. CONCLUSIONS: Our results suggest that the European School Fruit campaign has restrained the consumption of junk food in the sub-group of the population (wealthier families) who is less likely to be exposed to overweight and obesity problems, but has not been effective at all for the sub-group more at risk.

Double heterozygosity in the BRCA1 and BRCA2 genes in Italian family.

BACKGROUND: Double heterozygosity (DH) is an extremely rare event in which both BRCA1 and BRCA2 are mutated simultaneously in a family. To date, few cases of DH have been reported, especially in Ashkenazi populations. In Italy some cases of DH have been reported. In this study, we have described an Italian family with double heterozygosity in the BRCA genes. METHODS: The proband is a 43-year-old woman with bilateral breast cancer. She presented two pathogenic mutations in both BRCA genes, IVS8+2T>A (c.547+2T>A;p.Gln148Aspfsx51) in BRCA1, K944X (c.2830A>T;p.Lys944X) in BRCA2 and a novel variant IVS4-57A>G (c.426-57A>G) in BRCA2, not previously described. Both mutations were inherited from the paternal lineage in the proband's family. We investigated all available members of this family and we identified other two family members with DH. RESULTS AND CONCLUSIONS: Our observations support the hypothesis of a non-specific severe phenotype in DH carriers in terms of age of disease onset, cumulative lifetime risk and multiple primary tumours. Furthermore, our findings confirm that in order to identify all cases of DH, it is important not to limit the identification of mutations in a single gene, but extend the analysis to BRCA1 and BRCA2 and other breast cancer susceptibility genes.

An unusual case report on the possible role of Warfarin in migraine prophylaxis.

BACKGROUND: Migraine is a complex disease whose physiopathological mechanisms are still not completely revealed. FINDINGS: We describe an unusual case, not yet described in literature, of a patient who reported migraine remission, but still presented aura attacks, since starting a therapy with Warfarin. CONCLUSIONS: This case report brings out new questions on the role of the coagulation, especially the blood coagulation pathway, in migraine with aura pathogenesis, and on the possibility to use vitamin K synthesis inhibitors, Warfarin or new generation drugs, as possible therapy to use in migraine prophylaxis.

Identification of a novel in-frame deletion in BRCA2 and analysis of variants of BRCA1/2 in Italian patients affected with hereditary breast and ovarian cancer.

BACKGROUND: An estimated 5 % ­ 10 % of all breast cancers are due to an inherited predisposition and, out of these, about 30 % are caused by germline mutations of the BRCA1 and BRCA2 genes. The prevalence of germline mutations in theBRCA1 and BRCA2 genes varies among ethnic groups. The aims of this study are to evaluate deleterious mutations and genomic rearrangements in BRCA1/2 genes and the CHEK21100delC mutation in a cohort of Italian women affected with hereditary breast and/or ovarian cancer. In addition we clarify the effect of the novel variants identified in BRCA2 gene bymRNA analysis and prediction software. METHODS: We enrolled 103 consecutive Italian patients affected with hereditary breast and/or ovarian cancer, aged23 ­ 69 years. RESULTS: We found BRCA1/2 mutations in 15/103 probands(14.6 % ). Among these, a BRCA2 gene mutation has not been described previously. In addition, we identified five novel BRCA2 variants (S1341, IVS1-59t > c, IVS11-74insA, IVS12 + 74c > g and I1167V). No genomic BRCA1/2re arrangements or CHEK2 1100delC mutation was found in our patients. The novel BRCA2 mutation NS1742del(p.N1742_S1743del) was an in-frame 6 bp deletion that results in loss of two amino acids. CONCLUSIONS: In silico analysis conducted for S1341, IVS1-59t > c, IVS11-74insA and IVS12 + 74c > g of BRCA2 predicted the variants as neutral and benign, whereas the results for I1167V was inconclusive. mRNA analysis for the novel BRCA2 intronic variant IVS11-74insA and the already published BRCA1 variant C197 shows that they have no effect on the splicing. These results are in agreement with in silico analysis.

Height and subjective well-being in Italy.

Using an Italian survey, we investigate the effect of height on individual happiness. We find that a large part of the effect of height on well-being is driven by a positive correlation between height and economic and health conditions. However, for young men the effect of height on happiness persists even after controlling for these variables, implying that height is associated with some psycho-social direct effects on well-being. Consistent with this hypothesis, we find that men care not only about their own height but also about the height of others in their reference group. Well-being is greater for individuals who are taller than other men in their reference group. Results are robust to different definitions of reference group and controlling for a number of other reference group characteristics.

Erratum to: A novel frameshift mutation in exon 12 of the adenomatous polyposis coli gene in an Italian family with familial adenomatous polyposis and desmoid tumour.

[This corrects the article on p. 235 in vol. 4, PMID: 20589194.].

Kinetics of enzymatic trans-esterification of glycerides for biodiesel production.

In this paper, the reaction of enzymatic trans-esterification of glycerides with ethanol in a reaction medium containing hexane at a temperature of 37 degrees C has been studied. The enzyme was Lipase from Mucor miehei, immobilized on ionic exchange resin, aimed at achieving high catalytic specific surface and recovering, regenerating and reusing the biocatalyst. A kinetic analysis has been carried out to identify the reaction path; the rate equation and kinetic parameters have been also calculated. The kinetic model has been validated by comparison between predicted and experimental results. Mass transport resistances estimation was undertaken in order to verify that the kinetics found was intrinsic. Model potentialities in terms of reactors design and optimization are also shown.

Body image is a major determinant of sexual dysfunction in stable HIV-infected women.

BACKGROUND: Prevalence and factors associated with sexual dysfunction in HIV-positive women are poorly known. METHODS: This was a cross-sectional study in a cohort of HIV-infected women. Clinically stable women were invited to participate in a female sexual dysfunction (FSD) evaluation with Female Sexual Function Index (FSFI) exploring desire, arousal, lubrication, orgasm, pain and satisfaction. An FSFI score <23 was used for defining FSD. Variables evaluated included body appearance satisfaction, interference of body changes with habits, social life and attitudinal aspects of body image, health-related quality of life, hormonal assessment, menopause, cumulative exposure to antiretroviral drug classes and immune-virological parameters. Lipodystrophy was defined according to the HIV Outpatient Study definition. RESULTS: A total of 185 women completed the FSFI. The mean (+/-SD) age was 42 years (+/-5), 27% had CDC stage C, the mean (+/-SD) CD4+ T-cell count was 508 cells/microl (+/-251) and median HIV RNA was 1.7 log10 copies/ml (interquartile range 1.7-2.6). Among 161 evaluable patients, 59 (32%) reported FSD. In a multiple linear regression analysis, desire, arousal and satisfaction domains were associated with interference of body changes with habits, social life and attitudinal aspects of body image (beta = 0.22, 95% confidence interval [CI] 0.06-0.37; beta = 0.29, 95% CI 0.10-0.48; and beta = 0.20, 95% CI 0.02-0.38, respectively). Lubrication and orgasm domains were associated with body image satisfaction (beta = -0.49, 95% CI -0.88 - -0.10 and beta = -0.58, 95% CI -1.00 - -0.16, respectively). No significant associations with sex hormones, CDC stage, CD4+ T-cell count, HIV RNA viral load and cumulative exposure to antiretroviral drug classes were found. In women with FSD, severity of self-perceived abdominal fat accumulation showed a trend towards lower FSFI scores (ANOVA P = 0.02). CONCLUSIONS: FSD was highly prevalent in this cohort. Self-perceived body changes was identified as its major determinant.

Severity of lipodystrophy is associated with decreased health-related quality of life.

The impact of lipodystrophy (LD) on quality of life is high, but it has not been demonstrated in literature. The objective of the study was to assess the impact of LD on the health-related quality of life (HRQOL) in HIV-infected people on highly active antiretroviral therapy (HAART). Patients with LD phenotype defined by the Multicenter AIDS Cohort Study (MACS) were included. Three different methods were used to define LD severity: both patient and physician evaluation using the HIV Outpatient Study (HOPS) severity scales and the Lipodystrophy Case Definition (LDCD). The HRQOL was evaluated by MOS-HIV Health Survey. Four hundred one patients on HAART for a mean of 108 +/- 52 months were evaluated for LD at the Metabolic Clinic of Modena and Reggio Emilia University were enrolled from January 2003 to July 2006. According to self-perceived or physician-based HOPS, 106 (26.5%) and 122 (30.4%) patients had severe LD. Females had significantly more severe LD. Few HRQOL scores correlated to LD severity using the physician-based score (both HOPSph and LDCD), while all the HRQOL scores correlated with LD severity when a patient-based score was used (HOPSpt). In multiple linear regression analysis, Mental Health HRQOL score, gender, body mass index, age, body image satisfaction were independent predictors of patient-based (HOPSpt) LD, while none of the HRQOL scores, but female gender, age, waist-to-hip ratio, limb fat, and body image satisfaction were correlated with physician-estimated HOPSph LD severity. HRQOL was strongly correlated with LD severity when a patient-based score was used. For an overall assessment of the impact of LD on HIV-infected people, both patient-based and physician-based measures are required.

Sexual dysfunction in HIV-infected men: role of antiretroviral therapy, hypogonadism and lipodystrophy.

BACKGROUND: Both psychological and organic factors have been recognized to be associated with sexual dysfunction in HIV-infected individuals. METHODS: In this cross-sectional study we evaluated the prevalence and factors associated with sexual dysfunction in a cohort of HIV-infected adult men. Evaluation tools included: the International Index of Erectile Function (erectile dysfunction [ED], desire, orgasm, intercourse satisfaction, overall satisfaction), the Assessment of Body Change and Distress (body image satisfaction), the Medical Outcomes Study HIV Health Survey (mental and physical health-related quality of life), and plasma free and total testosterone level (hypogonadism). RESULTS: Three-hundred and fifty-seven men were enrolled. Among 336 patients reporting sexual activities in the 4 weeks before, 94 (29.6%) had mild, 30 (9.4%) moderate and 34 (10.1%) severe dysfunction. The Mental Health Summary score was 2.28 units (95% confidence interval [CI] 1.51, 3.06) lower for each unit higher of body image dissatisfaction and 0.31 units (95% CI 0.27, 0.36) higher for each unit higher of the score for body change interference with habits. At regression analysis, ED was independently related to the body mass index (B = 0.31, 95% CI 0.08, 0.62). Desire, orgasm and overall satisfaction domains were associated with mental health score (B = 0.87, 95% CI 0.47, 1.27; B = 0.75, 95% CI 0.23, 1.26; B = 0.86, 95% CI 0.45, 1.28, respectively). An improved intercourse satisfaction domain was associated with a lower interference of body changes with habits and social life (B = 0.39, 95% CI 0.05, 0.73). Testosterone, metabolic alterations and HAART were not associated with sexual function domains. CONCLUSIONS: Body image and mental health but not HAART or hypogonadism were associated with sexual function domains.

Prevalence of and risk factors for pubic lipoma development in HIV-infected persons.

BACKGROUND: The natural history of HIV-associated body habitus changes is unclear. In this report, we describe a novel manifestation of HIV-associated lipoaccumulation. METHODS: We noted the presence of suprapubic fat pads (pubic lipomas [PLs]) in several patients with preexisting HIV-associated body habitus abnormalities. Subsequently, we evaluated the prevalence of and associated risk factors for development of PLs by undertaking an observational cross-sectional study among patients with known lipodystrophy who attended a metabolic clinic in northern Italy. Inclusion criteria were a physician-confirmed diagnosis of lipodystrophy according to the Multicenter AIDS Cohort Study definition and, for those affected with PL, a readily noticeable PL on physical examination. RESULTS: We evaluated 582 patients with lipodystrophy: 214 female (36.7%) and 368 male (63.3%). The overall PL prevalence was 9.4% (95% confidence interval [CI]: 7.2% to 12.1%; P < 0.0001). PLs were more common among obese than nonobese individuals (34.5%, 95% CI: 17.9% to 5l.3% vs. 8%, 95% CI: 5.9% to 10.6%, respectively; P < 0.0001) and those with preexisting dorsocervical fat pads, commonly called "buffalo humps" (BHs) (18.5%, 95% CI: 12.7% to 25.4% vs. 6.1%, 95% CI: 4.03% to 8.83%, respectively, P < 0.0001; relative risk = 3.02, 95% CI: 1.84% to 4.96%, P < 0.0001). The PL prevalence in the nonobese HIV-infected population (body mass index [BMI] <30, n = 550) was 8.0% (95% CI: 5.9% to 10.6%; P < 0.0001). Logistic regression analyses identified the following factors as associated with a greater likelihood for PL: BMI >30 (beta = 0.18, SE = 0.04; P < 0.001), female gender (beta = 1.06, SE = 0.31; P < 0.001), and shorter duration of HIV infection (beta = -0.005, SE = 0.003; P = 0.04). We used a chain graph model to evaluate risk factors for BH and PL simultaneously. A nonnull interaction between these entities was evident, and this association seemed to be independent of factors positively associated with both (BMI and gender). CONCLUSIONS: PL is a newly recognized manifestation of HIV-associated lipoaccumulation that is more likely to occur among those with coexisting dorsocervical fat pads, suggesting the possibility of a common pathogenesis between the 2 entities. Likewise, PLs are more common among women, obese individuals, and those with a shorter duration of HIV infection. We suggest that PL should be considered part of the HIV-associated lipodystrophy syndrome.

Multidisciplinary approach to the treatment of metabolic and morphologic alterations of HIV-related lipodystrophy.

BACKGROUND: Treatment for metabolic and morphologic alterations in HIV-related lipodystrophy include medical therapy, physical exercise, and surgical interventions. METHOD: We assessed the efficacy and safety of a comprehensive multidisciplinary approach for treating morphological and metabolic alterations of the lipodystrophy syndrome in consecutive patients attending the Metabolic Clinic (MC) of the University of Modena and Reggio Emilia who had at least 2 evaluations over a 48-week period. 245 patients were evaluated: 143 (62.4%) were men, 74 (36.1%) presented with lipoatrophy, 10 (4.9%) with fat accumulation, 93 (45%) with mixed forms, 24 (11.3%) had hypercholesterolemia (LDL >160 mg/dL), 87 (38%) had hypertriglyceridemia (TG >150 mg/dL), 13 (5.7%) had diabetes (glucose >126 mg/dL), and 78 (44%) had insulin resistance (HOMA-IR >4). RESULTS: At follow-up, a significant improvement was observed in both objective and subjective variables. Anthropometric improvement was observed in waist to hip ratio, waist circumference, and right and left cheek dermal thickness measurements. A nonsignificant improvement was observed in fat and lean regional mass by DEXA; CT showed improvement in visceral and subcutaneous adipose tissue. Glucose, HOMA-IR, total cholesterol, and APO B improved. Subjective variables improved in aesthetic satisfaction. CONCLUSION: We conclude that the medical and surgical interventions proposed in this multidisciplinary therapeutic approach are efficacious and safe in the management of lipodystrophy.

Avaliaçäo da disponibilidade de formas farmacêuticas sólidas comercializadas no mercado brasileiro empregando o teste de dissoluçäo / Evaluation of availability of solid pharmaceutical forms sold in the Braszilian market employing dissolution test

A avaliaçäo da qualidade físico-química de comprimidos e cápsulas é verificada, dentre outras determinaçöes, pelo teste de dissoluçäo. Este envolve as características quali e quantitativas de liberaçäo e dissoluçäo do fármaco, simulando seu comportamento no organismo. Nesta primeira etapa do trabalho, avaliam-se diversos lotes de comprimidos de metildopa e de hidroclorotiazida (anti-hipertensivos), oriundos de diversos laboratórios farmacêuticos e comercializados em farmácias da cidade de Säo Paulo. O teste de dissoluçäo seguiu as orientaçöes oficiais da "Farmacopéia Americana", 24.ed. Das especialidades analisadas contendo cloridrato de metildopae hidroclorotiazida todos os lotes avaliados avaliados foram aprovados apenas na primeira etapa do ensaio. Os resultados apontam adequeçäo das formulaçöes de comprimidos contendo estes princípios ativos garantindo a qualidade do medicamento e a eficácia terapêutica.(au)

Formulaçäo e avaliaçäo "in vitro" de comprimidos de liberaçäo controlada contendo cloridrato de propanolol / Formulation and evaluation in vitro of release control tablets containing propanolol hydrochloride

Esta pesquisa envolveu o desenvolvimento de comprimidos de liberaçäo controlada contendo cloridrato de propanolol. Este fármaco é indicado no tratamento de doenças cardíacas, e no caso de estar contido neste tipo de formulaçào poderá ser administrado 2 vezes ao dia, de modo a propiciar um perfil uniforme no nível plasmático do fármaco com liberaçäo gradual no decorrer do tempo. Foram preparadas formulaçöes segundo o planejamento estatístico projeto fatorial com dois níveis com polo central, empregando-se como matrizes o methocel (R) K4M e 8mg de PVP-30, e as com 15mg de Polyox (R) WSR-303 e 8mg de PVP-30 foram as que apresentaram, os perfis de liberaçäo mais indicados para que o fármaco exerça a açäo terapêutica desejada