Surveys as a tool to investigate attitudes towards health services and COVID-19 pandemic.

Le indagini campionarie sono diventate una componente essenziale nella ricerca sanitaria e sono particolarmente utili quando si valutano costrutti che richiedono un’autovalutazione individuale su conoscenze, opinioni, atteggiamenti e comportamenti. Hanno un’ampia accessibilità alla popolazione target, soprattutto quando questa è rappresentata dalla popolazione generale, permettono di raggiungere un’ampia dimensione campionaria e di raccogliere grandi quantità di informazioni in tempi relativamente brevi. Tuttavia condurre un’indagine di buona qualità è più complesso di quanto sembri. I metodi utilizzati possono infatti influenzare significativamente l'affidabilità e la generalizzabilità dei risultati. Questa tesi descrive l’impiego delle indagini campionarie in tre studi volti ad indagare: 1) le conoscenze degli studenti di medicina in materia di misure di prevenzione, la percezione del rischio di contagio e la correlazione con la formazione ricevuta, inclusa l’attività di volontariato svolta durante la pandemia da COVID-19; 2) l’atteggiamento dei cittadini emiliano-romagnoli nei confronti della vaccinazione contro COVID-19 e i fattori associati all’esitazione; 3) la fiducia nel sistema sanitario, la qualità percepita e l’utilizzo dei servizi sanitari, e come questi aspetti siano legati tra loro ed alle caratteristiche della popolazione italiana. Nel capitolo finale le tre indagini sono messe a confronto dal punto di vista metodologico, al fine di trarre insegnamenti utili per un’applicazione più appropriata alla ricerca in sanità pubblica. Da tale confronto si evince che la pianificazione e la conduzione delle indagini presuppongono una serie di scelte metodologiche che devono tener conto dell’obiettivo conoscitivo ma anche delle tempistiche e delle risorse disponibili. La letteratura come punto di partenza e il coinvolgimento di un team multidisciplinare sono fondamentali per lo sviluppo di indagini che rispondano efficacemente al quesito di ricerca generando evidenze affidabili. Le stime prodotte dalle indagini campionarie possono essere utilizzate per monitorare i progressi verso il raggiungimento degli obiettivi di salute ed individuare gli aspetti su cui indirizzare gli sforzi.Surveys have become an essential component in health research and are particularly useful when evaluating constructs that require individual self-assessment of knowledge, opinions, attitudes and behaviors. They have a wide accessibility to the target population, especially when this is represented by the general population, they can potentially reach a large sample size and collect large amounts of information in a relatively short time. However, conducting a good quality survey is more complex than it seems. Indeed, the methods used can significantly affect the reliability and generalizability of the results. This dissertation describes the use of survey in three studies aimed at investigating: 1) knowledge of prevention measures, perception of contagion risk and the correlation with training received, including volunteering during the COVID-19 pandemic, among medical students; 2) the attitude of Emilia-Romagna citizens towards vaccination against COVID-19 and the factors associated with hesitation; 3) trust in the healthcare system, perceived quality and use of health services, and how these aspects are linked to each other and to the Italian population’s characteristics. In the final chapter, the three surveys are compared from a methodological point of view, in order to draw useful lessons for a more appropriate application to research in public health. This comparison highlights how survey planning and conduction imply several methodological choices that must consider the research objective as well as timing and available resources. A literature review and the involvement of a multidisciplinary team are key ingredients for planning effective surveys, answering the research question and producing reliable evidence. The estimates provided by the surveys can be used to monitor progresses towards the achievement of health objectives and to identify aspects towards which efforts should be directed

Antifungal activity of essential oil from fruits of Indian Cuminum cyminum

The essential oil of fruits of Cuminum cyminum L. (Apiaceae), from India, was analyzed by GC and GC-MS, and its antifungal activity was tested on dermatophytes and phytopathogens, fungi, yeasts and some new Aspergilli. The most abundant components were cumin aldehyde, pinenes, and p-cymene, and a fraction of oxygenate compounds such as alcohol and epoxides. Because of the large amount of the highly volatilecomponents in the cumin extract, we used a modified recent technique to evaluate the antifungal activity only of the volatile parts at doses from 5 to 20 μL of pure essential oil. Antifungal testing showed that Cuminum cyminum is active in general on all fungi but in particular on the dermatophytes, where Trichophyton rubrum was the most inhibited fungus also at the lowest dose of 5 μL. Less sensitive to treatmentwere the phytopathogens

The Willingness toward Vaccination: A Focus on Non-Mandatory Vaccinations

The Special Issue "The Willingness toward Vaccination: A Focus on Non-mandatory Vaccinations", published in the journal Vaccines, has the main aim of gathering more data on vaccine hesitancy and the willingness of individuals to receive vaccinations, particularly in the context of non-mandatory vaccines. The aim is to address vaccine hesitancy and improve vaccine coverage rates, in addition to identifying the determinants of vaccine hesitancy itself. This Special Issue garners articles that examine the external and internal factors that can influence the decision-making process of individuals regarding vaccination. Given that vaccine hesitancy is present in a significant part of the general population, it is crucial to have a better analytical understanding of the areas where hesitancy arises to determine appropriate strategies to address this issue

Enhancing COVID-19 Vaccines Acceptance: Results from a Survey on Vaccine Hesitancy in Northern Italy

In March 2021, the coronavirus disease 2019 (COVID-19) pandemic still poses a threat to the global population, and is a public health challenge that needs to be overcome. Now more than ever, action is needed to tackle vaccine hesitancy, especially in light of the availability of effective and safe vaccines. A cross-sectional online survey was carried out on a representative random sample of 1011 citizens from the Emilia-Romagna region, in Italy, in January 2021. The questionnaire collected information on socio-demographics, comorbidities, past vaccination refusal, COVID-19-related experiences, risk perception of infection, and likelihood to accept COVID-19 vaccination. Multiple logistic regression analyses and classification tree analyses were performed to identify significant predictors of vaccine hesitancy and to distinguish groups with different levels of hesitancy. Overall, 31.1% of the sample reported hesitancy. Past vaccination refusal was the key discriminating variable followed by perceived risk of infection. Other significant predictors of hesitancy were: ages between 35 and 54 years, female gender, low educational level, low income, and absence of comorbidities. The most common concerns about the COVID-19 vaccine involved safety (54%) and efficacy (27%). Studying the main determinants of vaccine hesitancy can help with targeting vaccination strategies, in order to gain widespread acceptance-a key path to ensure a rapid way out of the current pandemic emergency

Early csf biomarkers and late functional outcomes in spinal cord injury. A pilot study

open9noThis research was funded by the Italian Ministry of Health—call “Ricerca Finalizzata 2010” (project code RF-2010-2315118).Although, biomarkers are regarded as an important tool for monitoring injury severity and treatment efficacy, and for predicting clinical evolution in many neurological diseases and disorders including spinal cord injury, there is still a lack of reliable biomarkers for the assessment of clinical course and patient outcome. In this study, a biological dataset of 60 cytokines/chemokines, growth factorsm and intracellular and extracellular matrix proteins, analyzed in CSF within 24 h of injury, was used for correlation analysis with the clinical dataset of the same patients. A heat map was generated of positive and negative correlations between biomarkers and clinical rating scale scores at discharge, and between biomarkers and changes in clinical scores during the observation period. Using very stringent statistical criteria, we found 10 molecules which correlated with clinical scores at discharge, and five molecules, which correlated with changes in clinical scores. The proposed methodology may be useful for generating hypotheses regarding “predictive” and “treatment effectiveness” biomarkers, thereby suggesting potential candidates for disease‐modifying therapies using a “bed‐to‐bench” approach.openCapirossi R.; Piunti B.; Fernandez M.; Maietti E.; Rucci P.; Negrini S.; Giovannini T.; Kiekens C.; Calza' L.Capirossi R.; Piunti B.; Fernandez M.; Maietti E.; Rucci P.; Negrini S.; Giovannini T.; Kiekens C.; Calza' L

Suicidality in patients with obsessive-compulsive and related disorders (OCRDs): A meta-analysis

© 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/Introduction Previous meta-analyses showed that OCD is associated with a substantial risk of suicidal behaviours. Conclusive rates of suicidal ideation (current and lifetime) and suicide attempts based on pooled prevalence rates have not so far been calculated using meta-analysis for the other DSM-5 Obsessive-Compulsive Related Disorders (OCRDs). Objectives This meta-analysis aims to separately calculate the pooled prevalence rates of lifetime suicide attempts and current or lifetime suicidal ideation in BDD, Hoarding Disorder (HD), Skin Picking Disorder (SPD) and Trichotillomania (TTM) and to identify factors associated with increased suicide rates. Methods Our protocol was pre-registered with PROSPERO (CRD42020164395). A systematic review and meta-analysis following PRISMA reporting guidelines was performed by searching in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases from the date of the first available article to April 20th, 2020. Stata version 15 was used for the statistical analysis. Given the small number of studies in TTM and SPD, the two grooming disorders were grouped together. Meta-analyses of proportions based on random effects (Der-Simonian and Laird method) were used to derive the pooled estimates. Results Thirty-nine studies (N=4559 participants) were included: 23 for BDD, 8 for HD, 7 for Grooming Disorders. For BDD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was, respectively 35.2% (CI:23.4-47.8), 37.2% (CI:23.8-51.6) and 66.1% (CI:53.5-77.7). For HD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was 24.1% (CI:12.8-37.6), 18.4% (CI:10.2-28.3) and 38.3% (CI:35.0-41.6), respectively. For Grooming Disorders, the pooled prevalence of lifetime suicide attempts and current suicidal ideation were 13.3% (CI:5.9-22.8) and 40.4% (CI:35.7-45.3), respectively (no data available for lifetime suicidal ideation). Conclusions The OCRDs as a group are associated with relatively high rates of suicidal behaviour. Through indirect comparisons, we infer that BDD has the greatest risk. Comorbid substance abuse, possibly reflecting poor underlying impulse control, is associated with higher rates of suicidal behaviour in BDD. Our data emphasize the need for clinicians to consider the risk of suicidal behaviour in the management of patients presenting with all forms of OCRDs.Peer reviewe

Physical activity intervention for elderly patients with reduced physical performance after acute coronary syndrome (HULK study): Rationale and design of a randomized clinical trial

Background: Reduced physical performance and impaired mobility are common in elderly patients after acute coronary syndrome (ACS) and they represent independent risk factors for disability, morbidity, hospital readmission and mortality. Regular physical exercise represents a means for improving functional capacity. Nevertheless, its clinical benefit has been less investigated in elderly patients in the early phase after ACS. The HULK trial aims to investigate the clinical benefit of an early, tailored low-cost physical activity intervention in comparison to standard of care in elderly ACS patients with reduced physical performance. Design: HULK is an investigator-initiated, prospective multicenter randomized controlled trial (NCT03021044). After successful management of the ACS acute phase and uneventful first 1 month, elderly (≥70 years) patients showing reduced physical performance are randomized (1:1 ratio) to either standard of care or physical activity intervention. Reduced physical performance is defined as a short physical performance battery (SPPB) score of 4-9. The early, tailored, low-cost physical intervention includes 4 sessions of physical activity with a supervisor and an home-based program of physical exercise. The chosen primary endpoint is the 6-month SPPB value. Secondary endpoints briefly include quality of life, on-treatment platelet reactivity, some laboratory data and clinical adverse events. To demonstrate an increase of at least one SPPB point in the experimental arm, a sample size of 226 patients is needed. Conclusions: The HULK study will test the hypothesis that an early, tailored low-cost physical activity intervention improves physical performance, quality of life, frailty status and outcome in elderly ACS patients with reduced physical performance

Frailty trajectories in ICU survivors: A comparison between the clinical frailty scale and the Tilburg frailty Indicator and association with 1 year mortality

Purpose: To test the agreement of the Clinical Frailty Scale (CFS) and the Tilburg Frailty Indicator (TFI), their association with 3, 6 months and 1-year mortality and the trajectory of frailty in a mixed population of ICU survivors. Material and methods: This is a prospective, multicenter, longitudinal study on ICU survivors ≥18 years old with an ICU stay >72 h. For each patient, sociodemographic and clinical data were collected. Frailty was assessed during ICU stay and at 3, 6, 12 months after ICU discharge, through both CFS and TFI. Results: 124 patients with a mean age of 66 years old were enrolled. The baseline prevalence of frailty was 15.3% by CFS and 44.4% by TFI. Baseline CFS and TFI correlated but showed low agreement (Cohen's K = 0.23, p < 0.001). Baseline CFS score, but not TFI, was significantly associated to 1 year mortality. Moreover, CFS score during the follow-up was independently associated 1-year mortality (OR = 1.43; 95% CI: 1.18-1.73). Conclusions: CFS and TFI identify different populations of frail ICU survivors. Frail patients before ICU according to CFS have a significantly higher mortality after ICU discharge. The CFS during follow-up is an independent negative prognostic factor of long-term mortality in the ICU population

Early Light Chains Removal and Albumin Levels with a Double Filter-Based Extracorporeal Treatment for Acute Myeloma Kidney

Renal impairment in Multiple Myeloma (MM) represents one of the most important factors that influences patient survival. In fact, before the introduction of modern chemotherapy, less than 25% of patients with acute kidney injury (AKI) and MM who required dialysis recovered sufficient renal function to become independent from dialysis, with a median overall survival of less than 1 year. There are many other factors involved in determining patient survival. In this study we aimed to investigate the role of double filter-based extracorporeal treatment for removal of serum free light chains (sFLC) in acute myeloma kidney (AKI for MM) and to evaluate patient overall survival. All patients received Bortezomib-based chemotherapy and extracorporeal treatment for sFLC removal. For each session 2 dialyzers of the same kind were used. The dialytic dose was not related to the degree of renal function but to the removal of sFLC. The factors that have been found to be significantly associated with lower mortality were reduction of sFLC at day 12 and day 30, >50% reduction of sFLC at day 30, number of sessions and independence from dialysis. Among baseline characteristics, albumin level was statistically associated with the patients' outcome. Our analysis highlights the importance of the early treatment for removal of sFLC in AKI for MM. These results indicate that the early removal of sFLC can improve patient's outcome