Health literacy in Mediterranean general population

INTRODUCTION Health literacy refers to "the ability to obtain, process, and understand basic health information and access health services in order to make informed choices." In essence, being able to acquire, understand, and use information for one's own health. METHODS Observational study through the administration of a face-to-face questionnaire conducted between July and September 2020 on 260 individuals residing between Calabria and Sicily, aged between 18 and 89 years. Questions related to education, lifestyle (alcohol, smoking, and physical activity). Multiple-choice questions to assess health literacy and conceptual skills, ability to find information on health topics and services, use of preventive medicine especially vaccinations, and ability to make decisions about one's own health. RESULTS Of 260, 43% were male and 57% female. The most represented age group is between 50 and 59 years. Forty-eight percent of respondents had a high school diploma. 39% smoke and 32% habitually consume alcoholic beverages; only 40% engage in physical activity. Ten percent had a low level of health literacy, average 55%, adequate 35%. CONCLUSIONS Given the importance of adequate HL on health choices and on individual and public wellbeing, it is essential to expand the knowledge of the individual, through public and private information campaigns and with an increasing involvement of family physicians, who are fundamental in training and informing their patients

Self-reported halitosis and emotional state: impact on oral conditions and treatments

<p>Abstract</p> <p>Background</p> <p>Halitosis represents a common dental condition, although sufferers are often not conscious of it. The aim of this study was to examine behavior in a sample of Italian subjects with reference to self-reported halitosis and emotional state, and specifically the presence of dental anxiety.</p> <p>Methods</p> <p>The study was performed on Italian subjects (N = 1052; range 15-65 years). A self-report questionnaire was used to detect self-reported halitosis and other variables possibly linked to it (sociodemographic data, medical and dental history, oral hygiene, and others), and a dental anxiety scale (DAS) divided into two subscales that explore a patient's dental anxiety and dental anxiety concerning dentist-patient relations. Associations between self-reported halitosis and the abovementioned variables were examined using multiple logistic regression analysis. Correlations between the two groups, with self-perceived halitosis and without, were also investigated with dental anxiety and with the importance attributed to one's own mouth and that of others.</p> <p>Results</p> <p>The rate of self-reported halitosis was 19.39%. The factors linked with halitosis were: anxiety regarding dentist patient relations (relational dental anxiety) (OR = 1.04, CI = 1.01-1.07), alcohol consumption (OR = 0.47, CI = 0.34-0.66), gum diseases (OR = 0.39, CI = 0.27-0.55), age > 30 years (OR = 1.01, CI = 1.00-1.02), female gender (OR = 0.71, CI = 0.51-0.98), poor oral hygiene (OR = 0.65, CI = 0.43-0.98), general anxiety (OR = 0.66, CI = 0.49-0.90), and urinary system pathologies (OR = 0.46, CI = 0.30-0.70). Other findings emerged concerning average differences between subjects with or without self-perceived halitosis, dental anxiety and the importance attributed to one's own mouth and that of others.</p> <p>Conclusions</p> <p>Halitosis requires professional care not only by dentists, but also psychological support as it is a problem that leads to avoidance behaviors and thereby limits relationships. It is also linked to poor self care. In the study population, poor oral health related to self-reported halitosis was associated with dental anxiety factors.</p

Thyroid dysfunction in patients treated with the immune checkpoint inhibitor nivolumab: different clinical features

Rationale. Immune Checkpoint Inhibitors (ICIs) are approved for some advanced neoplasms, increasing survival. ICIs block inhibitor receptors cytotoxic T lymphocyte antigen 4 (CTLA4) and programmed death-1 (PD-1) and trigger T cell-mediated immunity against tumor. Their action is accompanied by several immunity-related adverse events (IRAEs), also involving the endocrine system (pituitary, thyroid, adrenals). We report two different cases of thyrotoxicosis following administration of the anti-PD-1 nivolumab. Patients. Patient 1, M, 75 years-old, treated for non-small cell lung carcinoma (NSCLC) since September 2016, with euthyroid multinodular goiter. In January 2017 (12 weeks from baseline), he developed frank hyperthyroidism, with positive TSH-receptor antibodies (TRAb) and thyroperoxidase antibodies (TPOAb). A Tc99m thyroid scintiscan showed diffuse uptake and “cold” areas. After nivolumab withdrawal, treatment with metimazole (MMI) 5 mg per day was started and euthyroidism was resumed, so to restart the drug in May 2017. Patient 2, M, 80 years-old, treated for a left-eye choroid melanoma since January 2017, with euthyroid nodular goiter. In April 2017 (6 weeks from baseline), thyrotoxicosis was detected, with positive thyroglobulin antibodies (Tg-Ab, 244 IU/ml, nv 4.5 µIU/ml (subclinical hypothyroidism). Patient was treated with replacement doses of levothyroxine (LT-4), and continued nivolumab infusions. Conclusions. Two forms of thyrotoxicosis were reported: the first with thyroid hyperfunction and positive TRAb, the latter as a destructive thyroiditis. In both cases (mean onset after 9 weeks), the moderate severity and the appropriate management of endocrine IRAEs allowed treatment continuation

An observational study on the effects of early and late risk factors on the development of childhood obesity in the South of Italy

Background: Child obesity is today one of the greatest health emergencies, on such a large scale as to be considered a global epidemic by the WHO and, unfortunately, Italy holds the worst European record. Methods: We conducted an observational study to investigate the effects of early and late risk factors on the development of primary childhood obesity. We collected anthropometric parameters, information about early risk markers and late risk factors on a sample of 280 children from March 2016 to December 2017. Results: Statistically significant associations emerged between: child's BMI and education level of the mother (p&lt;0.001) and the father (p&lt;0.05); level of parents' education and qualitative variables (subjects’ physical activity level (p&lt;0.05), consumption of carbonated beverages (p&lt;0.05), fruit juices (p &lt;0.05) and snacks (p&lt;0.05); BMI and the presence or absence of a family history of obesity, DM and cardiovascular diseases. Significant linear correlations were found between weight classification (overweight/obese) and the consumption of carbonated drinks (p&lt;0.05), snack consumption (p&lt;0.05), physical activity levels (p&lt;0.001) and duration of sleep in the afternoon (p&lt;0.05). Conclusions: In our sample we found incorrect eating habits to be frequently linked to a low level of parental education; particularly for the mother, the main childcare provider

Ovarian hyperthecosis coexisting with an incidental adrenal lesion: challenges in the diagnostic approach

Ovarian hyperthecosis is the most common cause of hyperandrogenism in women during postmenopausal age. However, its diagnosis is frequently challenging, since several causes must be ruled out, involving both adrenal glands and ovaries. Herein we describe the case of a 62 years old woman addressed to our Unit after the casual detection of an adrenal mass, compatible with an adenoma. Biochemical evaluation revealed gonadotropins in menopausal range, high testosterone and androstenedione, while the patient had been complaining of androgenetic alopecia and hirsutism for some years. Ultrasound imaging revealed only a small increase in ovarian volume, in relationship to the patient’s age. A GnRHa test was performed, demonstrating gonadotropins suppression and testosterone normalization, thus confirming the suspect of ovarian hyperthecosis. The administration of these agonists, together with the slow progression of symptoms over years, play a fundamental role into excluding an androgen-secreting neoplasia, also limiting the use of ovarian veins catheterization as second line test. Besides, they represent a valid therapeutical option, especially when surgery is contraindicated (or cannot be performed)

Hashimoto’s thyroiditis, hypoparathyroidism and coeliac disease: lessons from a rare association

We present the case of a 36 years old woman, affected by euthyroid Hashimoto’s thyroiditis (HT) from the age of 20. She reported the following symptoms for three years: weight reduction, abdominal pain, alternate constipation and diarrhoea, tiredness, paresthesias and cramps. Biochemical evaluation revealed low iron levels (21 ug/dl, with microcytic anemia) and hypocalcemia (6.6 mg/dl), first attributed to coeliac disease (EMA IgG, AGA IgG-A and tTG IgA positivity; Marsh-Oberhuber 3a/3b type at duodenal biopsy). TSH, PTH and 25-OHD3 were in the normal range. Although the patient was on a gluten-free diet for the second year, cramps persisted and facial spasms and tetanic crises appeared. One year later she came to our attention with severe hypocalcemia (Ca 5.1 mg/dl, Ca++ 0.6 nmol/L) and low PTH (2.5 pg/ml). A diagnosis of primary hypoparathyroidism was made and conventional treatment was started. In the following months, symptomatic hypocalcemia persisted (6.7 mg/dl, Ca++ 0.7 nmol/L), despite the gradual increase of calcium and calcitriol supplements. Gastro-intestinal re-evaluation demonstrated gluten contamination, so as to hypothesize that the scarce dietary compliance had caused persistent malabsorption and had made the hypocalcemia difficult to manage. The observation of these three disorders coexisting in a single patient, never reported by the literature, warns us about the virtually unlimited possibilities of autoimmune disease clustering. Clinicians should be aware of the increased risk of developing additional AIDs in patients with one autoimmune disorder

Morphometric evaluation of the pedicles of the lumbar spine according to L5 lateral tilt classification

A classification of the lumbar spine according to the pedicle lateral tilt (PLT) of L5 pedicle was recently proposed [1]. In this work the sample was divided into three categories, the first or Wing Type (WT) includes people with a PLT >36° (41,8%), the second or V Type (VT) includes people with a PLT between 30° and 36° (48%) and the third or U Type (UT) includes people with a PL

Advances from probabilistic tractography in connections of the limbic system with the cerebellum

The limbic system is a complex set of brain structures located on both sides of the thalamus, right under the cerebrum. It is not a separate system but a collection of structures from the telencephalon, diencephalon, and mesencephalon, including the hippocampus, amygdala, anterior thalamic nuclei, fornix, columns of fornix, mammillary body, septum pellucidum, habenular commissure, cingulate gyrus, parahippocampal gyrus, limbic cortex, pars of olfactory system and limbic midbrain areas. Nevertheless, recent studies showed that the definition of anatomical structures considered part of the limbic system is a controversial subject. Although the role of the cerebellum was traditionally considered mainly associated to motion control, it has been recently suggested a cerebellar involvement in emotions control, cognitive processes and social behavior. In this regard, we have previously demonstrated that the cerebellum is interconnected with the hippocampus [1]. In this work, a wider sample of normal subjects was examined by using probabilistic Constrained Spherical Deconvolution (CSD) tractography, which represents a method able to overcome many limitations of other Diffusion Tensor Imaging (DTI) techniques, providing more accurate data [2]. We found evidences in the human brain that the cerebellum is widely linked with limbic-related structures and provided a more reliable demonstration of direct cerebello-limbic pathways. In addition, we further extendend our analysis to the other limbic connections including uncinated fasciculus, cingulate fasciculus, inferior longitudinal fasciculus, anterior thalamic connections and fornix. Although these pathways have been already described in the tractographic literature we provided reconstruction and quantitative analysis, which could be potentially useful to explore pathological conditions damaging this system. Finally, the demonstration of the existence of cerebello-limbic connections could constitute an important step in the knowledge of the anatomic substrate of non-motor cerebellar functions

Sarcoglycans and gabaa receptors in rat central nervous system: an immunohistochemical study

Sarcoglycan subcomplex is a transmembrane glycoprotein system which connects extracellular matrix to cytoskeleton. Although this complex has been found in several non-muscular tissues, no data exist about a sarcoglycan subcomplex in brain. Only the presence of ε-sarcoglycan in brain has been described in detail because its mutation determines Myoclonus Dystonia Syndrome. Also ζ-, β- and δ-sarcoglycans have been found in brain but only at mRNA level and their distribution in brain is still unknown. Here, we have searched for the expression of all sarcoglycans in specific brain regions of rat as hippocampus, cerebral and cerebellar cortex. Since a correlation between dystrophin glycoprotein complex and γ-amino butyric acid A (GABAA) receptor was demonstrated, we have investigated also a possible colocalization between sarcoglycans and GABAA receptor. Results have shown that all sarcoglycans are expressed in neurons of all observed regions; these proteins show a spot-like pattern of fluorescence and are mainly localized at soma level. Moreover, each sarcoglycan colocalizes with GABAA receptor. The present study shows, for the first time, the expression of all sarcoglycans in brain; moreover, the prevalent localization of sarcoglycans at post-synaptic level and the colocalization of these glycoproteins with GABAA receptor suggests that sarcoglycans play a key role in central nervous system, regulating post-synaptic receptors assembly