Knowledge of, and attitudes towards, adult vaccination among General Practitioners in Piedmont, Italy: results from a cross-sectional study.

Background: "Life-course immunization" is increasingly recognized as important. In Italy, adults are recommended to receive influenza; pneumococcal; tetanus toxoid, reduced diphtheria toxoid, acellular pertussis (Tdap); and herpes zoster (HZ) vaccines at various ages. Study design: Cross-sectional study. Methods: To study the knowledge and attitudes of Italian general practitioners (GPs) towards adult vaccination, we surveyed 335 GPs in Piedmont from December 2019 through March 2020; and compared the results by GPs' age (≤50 vs >50 years). Results: The most common vaccination information source was the regional/local educational courses (72.8%), with older vs younger GPs more likely to attend (79.4% vs 64.4%; p=0.002). Approximately half felt that they needed further information on vaccine co-administration (55.5%), duration of protection (49.6%), and safety/tolerability (48.7%), with older vs younger GPs being more interested in safety/tolerability. Overall, most respondents (86.0%) felt that information for the patient would most engage them, and 68.1% planned to co-administer vaccines. Respondents felt most comfortable proposing influenza, but were also comfortable about pneumococcal/Tdap/HZ vaccination. However, younger vs older GPs were more comfortable about proposing Tdap and HZ. The most common ways to inform patients about influenza or pneumococcal/Tdap/HZ vaccination eligibility were personally during a visit (42.7% or 54.3%, respectively) or via an information poster (30.7% or 17.9%). Conclusions: The surveyed GPs had favorable attitudes towards adult vaccination and were interested in ongoing education.

Trends in thyroid function testing, neck ultrasound, thyroid fine needle aspiration, and thyroidectomies in North-eastern Italy.

PURPOSE: Evidence of an increased diagnostic pressure on thyroid has emerged over the past decades. This study aimed to provide estimates of a wide spectrum of surveillance indicators for thyroid dysfunctions and diseases in Italy. METHODS: A population-based study was conducted in North-eastern Italy, including 11.7 million residents (20% of the total Italian population). Prescriptions for TSH testing, neck ultrasound or thyroid fine needle aspiration (FNA), surgical procedures, and drugs for hypo- or hyperthyroidism were extracted from regional health databases. Proportions and rates of selected examinations were calculated from 2010 to 2017, overall and by sex, calendar years, age, and region. RESULTS: Between 2010 and 2017 in North-eastern Italy, 24.5% of women and 9.8% of men received at least one TSH test yearly. In 2017, 7.1% of women and 1.5% of men were prescribed drugs for thyroid dysfunction, 94.6% of whom for hypothyroidism. Neck ultrasound examinations were performed yearly in 6.9% of women and 4.6% of men, with a nearly two-fold variation between areas. Thyroid FNA and thyroidectomies were three-fold more frequent in women (394 and 85 per 100,000) than in men (128 and 29 per 100,000) with a marked variation between areas. Both procedures decreased consistently after 2013. CONCLUSIONS: The results of this population-based study describe recent variations over time and between surrounding areas of indicators of 'diagnostic pressure' on thyroid in North-eastern Italy. These results emphasize the need to harmonize practices and to reduce some procedures (e.g., neck ultrasound and total thyroidectomies) in certain areas.

Effects of phenanthrene on different levels of biological organization in larvae of the sediment-dwelling invertebrate Chironomus sancticaroli (Diptera: Chironomidae).

The hydrocarbon phenanthrene is an organic compound commonly found in the environment. In aquatic ecosystems, it is highly toxic to organisms, although little is known about its effects on sediment-dwelling organisms. The purpose of this study was to evaluate phenanthrene effects on biochemical, histological, and ontogenetic levels in larvae of the sediment-dwelling invertebrate Chironomus sancticaroli at acute and chronic exposure. Lethal concentrations were estimated and toxicity (acute-96 h and chronic- 8 d) tests were performed at phenanthrene concentrations from 0.12 to 1.2 mg L-1. At acute and chronic exposure, we evaluated acetylcholinesterase (AChE), alpha esterase (EST-α), and beta esterase (EST-ß) activities as well as histological alterations. In the assays with chronic exposure, effects on larval development were estimated using antennae length (instar estimative) and body length (growth estimative). The EST-α showed a significantly increased activity after 48 h at acute exposure to high concentrations of phenanthrene, while EST-ß activity was increased after 48 and 72 h at acute exposure at higher concentrations and at 0.12 mg L-1 at chronic exposure. At acute exposure, the midgut showed alterations such as brush border disruption, gastric caeca regression, and lumen area reduction; the fat body showed nuclear alteration in the trophocytes, while the Malpighian tubules showed brush border reduction and the salivary glands were subject to cytoplasm vacuolation. At chronic exposure, the same alterations were observed, in addition to vacuolar coalescence in the trophocytes of the fat body. Regarding larval development, a reduction of body length was observed with increasing phenanthrene concentrations. Similarly, molting was delayed; in the control group, all larvae were in the fourth instar, while at higher phenanthrene concentrations, larvae were predominantly in the third instar. Phenanthrene had toxic effects on this chironomid, indicating risks for natural populations.

Acute and long-term effects of trophic exposure to silver nanospheres in the central nervous system of a neotropical fish Hoplias intermedius.

Nanotechnologies are at the center of societal interest, due to their broad spectrum of application in different industrial products. The current concern about nanomaterials (NMs) is the potential risks they carry for human health and the environment. Considering that NMs can reach bodies of water, there is a need for studying the toxic effects of NMs on aquatic organisms. Among the NMs' toxic effects on fish, the interactions between NMs and the nervous system are yet to be understood. For this reason, our goal was to assess the neurotoxicity of polyvinylpyrrolidone coated silver nanospheres [AgNS (PVP coated)] and compare their effects in relation to silver ions (Ag+) in carnivorous Hoplias intermedius fish after acute and subchronic trophic exposure through the analysis of morphological (retina), biochemical (brain) and genetic biomarkers (brain and blood). For morphological biomarkers, damage by AgNS (PVP coated) in retina was found, including morphological changes in rods, cones, hemorrhage and epithelium rupture, and also deposition of AgNS (PVP coated) in retina and sclera. In the brain biomarkers, AgNS (PVP coated) did not disturb acetylcholinesterase activity. However, lowered migration of the DNA tail in the Comet Assay of blood and brain cells was observed for all doses of AgNS (PVP coated), for both acute and subchronic bioassays, and in a dose-dependent manner in acute exposure. Ag+ also reduced the level of DNA damage only under subchronic conditions in the brain cells. In general, the results demonstrated that AgNS (PVP coated) do not cause similar effects in relation to Ag+. Moreover, the lowered level of DNA damage detected by Comet Assay suggests that AgNS (PVP coated) directly interacts with DNA of brain and blood cells, inducing DNA-DNA or DNA-protein crosslinks. Therefore, the AgNS (PVP coated) accumulating, particularly in the retina, can lead to a competitive disadvantage for fish, compromising their survival.

Benzo(a)pyrene Exposure Causes Genotoxic and Biochemical Changes in the Midge Larvae of Chironomus sancticaroli Strixino & Strixino (Diptera: Chironomidae).

Benzo(a)pyrene (BaP) is a carcinogenic polycyclic aromatic hydrocarbon, also found in nature due to human activities. BaP adheres to sediments showing toxic effects on benthic organisms, including midge larvae of the family Chironomidae. We tested for toxic effects of benzo(a)pyrene on Chironomus sancticaroli Strixino & Strixino 1981 using biochemical and genotoxic biomarkers, to identify changes in metabolic and antioxidant pathways, besides neurotoxic and DNA damage. Enzyme activity was compared by exposing larvae to four nominal concentrations (0.47, 2.13, 3.41, and 4.73 µg l-1) and DNA damage to two concentrations (0.47 and 4.73 µg l-1), after exposure at 24, 48, 72, and 96 h. BaP caused neurotoxic effect, showing acetylcholinesterase alterations at different treatments. Changes in the biotransformation pathway were detected, with an increased activity of alpha and beta esterase in 48 h and reduction of glutathione-S-transferase activity in all periods at the highest concentrations. Damage to the antioxidant system was observed by the increase of the superoxide dismutase and reduction of the catalase, in 48 h. Genotoxicity was detected by an increased DNA damage at 48 and 72 h. The lowest concentration (0.47 µg l-1), even presenting low mortality, also altered the biochemical parameters of the larvae. Thus, these results indicate that BaP causes metabolic, neurotoxic, and genotoxic effects on C. sancticaroli, even at low concentrations and short-term exposure. BaP can cause damage of immature invertebrates, and the ecological dynamics can be affected, since these organisms have trophic importance in the aquatic environment.

Long-term survival, prevalence, and cure of cancer: a population-based estimation for 818 902 Italian patients and 26 cancer types.

BACKGROUND: Persons living after a cancer diagnosis represent 4% of the whole population in high-income countries. The aim of the study was to provide estimates of indicators of long-term survival and cure for 26 cancer types, presently lacking. PATIENTS AND METHODS: Data on 818 902 Italian cancer patients diagnosed at age 15-74 years in 1985-2005 were included. Proportions of patients with the same death rates of the general population (cure fractions) and those of prevalent patients who were not at risk of dying as a result of cancer (cure prevalence) were calculated, using validated mixture cure models, by cancer type, sex, and age group. We also estimated complete prevalence, conditional relative survival (CRS), time to reach 5- and 10-year CRS >95%, and proportion of patients living longer than those thresholds. RESULTS: The cure fractions ranged from >90% for patients aged <45 years with thyroid and testis cancers to <10% for liver and pancreatic cancers of all ages. Five- or 10-year CRS >95% were both reached in <10 years by patients with cancers of the stomach, colon-rectum, pancreas, corpus and cervix uteri, brain, and Hodgkin lymphoma. For breast cancer patients, 5- and 10-year CRSs reached >95% after 19 and 25 years, respectively, and in 15 and 18 years for prostate cancer patients. Five-year CRS remained <95% for >25 years after cancer diagnosis in patients with liver and larynx cancers, non-Hodgkin lymphoma, myeloma, and leukaemia. Overall, the cure prevalence was 67% for men and 77% for women. Therefore, 21% of male and 31% of female patients had already reached 5-year CRS >95%, whereas 18% and 25% had reached 10-year CRS >95%. CONCLUSIONS: A quarter of Italian cancer patients can be considered cured. This observation has a high potential impact on health planning, clinical practice, and patients' perspective.

The contribution of underwater kicking efficiency in determining "turning performance" in front crawl swimming.

AIM: The aim of this study was to analyze the effects: 1) of maximal velocity (vout max) and acceleration (aout max) attained during the turn; 2) of deceleration (-aglide) and glide efficiency (GE) in the gliding phase after the turn; and 3) of the efficiency (hF) of the dolphin kick in determining the velocity and acceleration in the first 5 and the following 10 m after a turn (v5, v5-15, a5 and a5-15) in a 100 m simulated front crawl race. METHODS: The experiments were conducted on 13 swimmers (7M/5F) and all the above mentioned parameters were derived from underwater kinematical analysis. RESULTS: The 100 m times were smaller the larger v5, v5-15, a5 and a5-15. In turn, v5, v5-15, a5 and a5-15 were significantly related to vout max and aout max as well as to ηF and GE (R>0.57, P<0.05). CONCLUSION: Data reported in this study indicate that in the first 5-15 m after the turn, velocity is essentially sustained by the force generated by the swimmer on the pool wall but also indicate the importance of an efficient dolphin kick (and of a streamlined glide) in determining the values of velocity and acceleration in this phase of the race.

Increased susceptibility to Strongyloides venezuelensis in mice due to Mycobacterium bovis co-infection which modulates production of Th2 cytokines.

An estimated quarter of the world's population possesses an infection caused by gastrointestinal nematodes, which induce a Th2 type immune response. Concomitant infection of nematodes with Mycobacterium tuberculosis, which induces a predominantly Th1 type response, is very frequent in tropical and subtropical regions. This study examined immune responses of BALB/c mice infected with Strongyloides venezuelensis and then co-infected with Mycobacterium bovis. The number of worms in the intestine, eggs in feces, cytokine production in lungs and intestine and the expression of CD80, CD86, CTLA-4 and CD28 cell markers on pulmonary cells were analysed. Our results indicate that co-infected mice had an increased parasite burden, which correlates with elevated IFN-gamma and IL-10 cytokine production and decreased IL-4 and IL-13. Moreover, decreased expression of CD80 and increased expression of CTLA-4 were observed in co-infected mice. Our data point out that susceptibility to Strongyloides venezuelensis infection is increased by Mycobacterium bovis co-infection, resulting in higher parasite survival.

[Structural equation model in the study of risk factors in the maintenance of binge eating]. / Un modello di equazioni strutturali per Lo studio dei fattori di rischio nel mantenimento del disturbo da alimentazione incontrollata.

This study investigated, in a sample of 483 adolescent girls, a number of risk factors associated with Binge Eating (BE) disorder, i.e. negative feelings, dieting behaviour, social influence and body dissatisfaction. Participants completed the following questionnaires: Bulimia Test, Depression Questionnaire, Dieting Self-Efficacy Measure, Dieting Success, Dieting Status Measure, Dutch Eating Behavior Questionnaire, Eating Disorder Inventory, Positive and Negative Affect Scale Revised, Rosenberg Self-Esteem Scale and Socio-cultural Attitudes Towards Appearance Questionnaire. Structural equation modeling was used in the data analysis to verify the hypothesized relations among the variables, with the aim of identifying the main predictors of BE. This methodology explains the correlation between the considered variables, and determines, using quantitative good fit indexes, both the strength of the correlations and the plausibility of the causal links between the hypothesized factors. Our findings confirm that negative feelings (Negative Affect) are the primary predictor for the maintenance of BE and highlight the significant role played by Social Influence. While Dieting Behaviour is not a primary predictor for the maintenance of BE it appears to influence it through its link with Negative Affect.

[Akrasia in ancient and modern thought--towards a cognitive model of akrasia]. / L'akrasia tra riflessioni antiche e moderne--verse un modello cognitive dell'akrasia.

Akrasia is a philosophical concept that denotes the tendency to act in contradiction with one's best judgement. This study aimed to clarify the phenomenon in psychological terms through a working construct drawn from the available philosophical and sociological literature. After redefining akrasia in terms more appropriate to cognitive science, the authors designed a self-description test suitable for measuring the latent dimensions hypothetically related to the akratic process. The questionnaire was administered to a group of 197 subjects aged between 18 and 60 years and the collected data underwent a confirmatory factorial analysis involving Structural Equations Models. The successive verification of the instrument's reliability and coherence showed the questionnaire to be a good indicator of the construct examined and confirmed that akratic behaviour--as the authors have defined it--is in fact explained by the factors which emerged.

Identification of the novel allele B*4427 and a confirmatory sequence (B*44022).

This report presents a novel allele, HLA-B*4427, which was identified in a bone marrow donor of Caucasian origin, and a confirmatory sequence (B*44022). Sequence analysis revealed the new allele differs from B*44021 by a single nucleotide exchange at position 668 (C-->T), which is located in exon 4. At the protein level, it is the only B*44 variant to produce an Ala in place of a Val at codon 199. Its structure suggests that it may have originated from a point mutation in B*44021 or by gene conversion with a variety of HLA-B alleles. Cloning and sequencing of the allele B*44022 revealed a sequence identical to B*44021 and B*44 exon 4, with the codon GTC (Val) in position 199.

Occurrence of ochratoxin A-producing fungi in raw Brazilian coffee.

Ochratoxin A (OA)-producing fungi were identified in coffee at different stages of maturation. The toxin was quantified in coffee during terrace drying and in coffee stored in barns. By direct plating, a high level of contamination (100%) was found in the coffee beans studied, with the genus Aspergillus representing 33.2%, of which Aspergillus ochraceus and Aspergillus niger represented 10.3 and 22.9%, respectively, of the strains isolated from the coffee beans. The capacity to produce ochratoxin was determined in 155 strains of A. ochraceus and A. niger using both the agar plug method and extraction with chloroform, giving positive results for 88.1% of the A. ochraceus strains and 11.5% of the A. niger strains. Analysis for OA in the terrace and barn coffee samples showed that, independent of cultivar, year harvested, or production region, all except one of the samples analyzed showed mycotoxin levels below the limit suggested by the European Common Market (8 microg/kg), thus indicating that the problem is restricted and due to severe faults in harvesting and storage practices.

Avaliaçäo do conhecimento sobre doenças sexualmente transmissíveis (DSTs) e síndrome da imunodeficiência adquirida (AIDS) entre universitários de Ribeiräo Preto/SP / Evaluation of the knowledge on sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS) among universitary students of Ribeiräo Preto/SP

Com o objetivo de avaliar o grau de conhecimento sobre DST/AIDS entre universitários de diferentes áreas, submeteu estudantes de uma faculdade de Ribeiräo Preto-SP a questionários com perguntas abertas e fechadas, anônimos após aquiescência. As respostas foram categorizadas como corretas (C), incorretas (I), entendimento incompleto (EI) e prejudicadas (P), sendo a análise realizada por porcentagens. De 1.200 estudantes, 961 (80,80 por cento) participaram do estudo. O número de respostas näo foi harmonioso para os diferentes itens do questionário. A área em que o aluno estava matriculado näo pareceu influenciar nas respostas. Com relaçäo à transmissäo do HIV, em 2.914 respostas obteve-se 65,37 por cento como categoria EI e em 923 (31,68 por cento) como C. Quanto a medidas preventivas contra a AIDS de 1888 respostas, 1.625 (86,07 por cento) como categoria C e 207 (10,96 por cento) como EI. Sobre medidas preventivas contra AIDS, utilizadas pelo aluno, 1.126 (74,42 por cento) como categoria C e 249 (16,46 por cento) e P. Quanto a medidas preventivas contra DSTs, 1.339 (71,11 por cento) como categoria C e 284 (15,80 por cento) obteve-se 1. Sobre medidas preventivas contra DSTs utilizadas pelo aluno, obteve-se 542 (43,92 por cento) como categoria C e 350 (28,36 por cento) como P. Os universitários em sua maioria parecem possuir um conhecimento teórico correto sobre as medidas preventivas contra à AIDS e DST e entendimento incompleto sobre a transmissäo do HIV. Provavelmente existem fatores relacionados à educaçäo ou culturais que impedem aos universitários fazerem uso das medidas preventivas que conhecem. Há necessidade de identificaçao desses fatores para que os programas de difusäo possam atingir os seus objetivos. A educaçäo continuada ainda se mostra necessária.

Gastric secretion provoked by functional cytoglucopoenia in the nuclei of the solitary tract in the cat.

1. A rhomboencephalic reflex loop involved in the gastrosecretory effect of functional cytoglucopoenia caused by 2-deoxy-D-glucose (2-DG) was investigated in thirty-five cats prepared with chronic gastric fistulae. 2. Injection of 60 mg 2-DG/kg in the vertebral artery of cats subjected to acute electrolytic transection of the pontomedullary transition produced gastric secretion. 3. Microinjection of 2-DG in the medial and in the lateral components of the nuclei of the solitary tract elicited an intense gastric secretion. Sites at the level of the obex were more effective than the caudalmost portions of the nuclei in causing the secretory effect. Microinjection of saline in the same nuclei was totally ineffective whereas both saline and 2-DG solutions induced secretion when microinjected in the dorsal nuclei of the vagus. The gastrosecretory effect of microinjection of saline and 2-DG in the dorsal nuclei of the vagus is ascribed to mechanical stimulation of the effector parasympathetic neurones that innervate gastric mucosa. 4. It is concluded that rhomboencephalic neurones sensitive to functional cytoglucopoenia are located in the nuclei of the solitary tract. Activation of these neurones conveys to effector neurones information that triggers gastric secretion.

[Scanning with Au198 in experimental hepatic trauma (author's transl)]. / Cintilografia com Au198 no diagnóstico do trauma hepático experimental

Scintiscanning of the liver with Au198 was performed in 30 mongrel dogs. In 18 animals the scanning was performed after 3 different types of hepatic trauma: intraparenchymal hematoma, stab wound and lasceration of liver. In 12 days without hepatic trauma the scanning was performed with purpose to establish the pattern of the normal liver scan in the dog. Results indicate that scintiscanning of the liver is a good propaedeutic method in the evaluation of the presence and localization of traumatic hepatic lesion.