The Impact of School and After-School Friendship Networks on Adolescent Vaccination Behavior

Psychological and social characteristics of individuals are important determinants of their health choices and behaviors. Social networks represent "pipes" through which information and opinions circulate and spread out in the social circle surrounding individuals, influencing their propensity toward important health care interventions. This paper aims to explore the relationship between students' vaccination health choices and their social networks. We administered a questionnaire to students to collect data on individual students' demographics, knowledge, and attitudes about vaccinations, as well as their social networks. Forty-nine pupils belonging to 4 classrooms in an Italian secondary school were enrolled in the study. We applied a logistic regression quadratic assignment procedure (LR-QAP) by regressing students' positive responsive behavior similarity as a dependent variable. LRQAP findings indicate that students' vaccination behavior similarity is significantly associated with after-school social ties and related social mechanisms, suggesting that pupils are more likely to share information and knowledge about health behaviors through social relationships maintained after school hours rather than through those established during the school day. Moreover, we found that vaccination behaviors are more similar for those students having the same ethnicity as well as for those belonging to the same class. Our findings may help policymakers in implementing effective vaccination strategies

Risk factors for abnormally invasive placenta: a systematic review and meta-analysis.

Purpose of the article. To explore the strength of association between different maternal and pregnancy characteristics and the occurrence of abnormally invasive placenta (AIP). MATERIALS AND METHODS: Pubmed, Embase, CINAHL databases were searched. The risk factors for AIP explored were: obesity, age > 35 years, smoking before or during pregnancy, placenta previa, prior cesarean section (CS), placenta previa and prior CS, prior uterine surgery, abortion and uterine curettage, in vitro fertilization (IVF) pregnancy and interval between a previous CS and a subsequent pregnancy. Random-effect head-to-head meta-analyses were used to analyze the data. RESULTS: Forty-six were included in the systematic review. Maternal obesity (Odd ratio, OR: 1.4, 95% CI 1.0-1.8), advanced maternal age (OR: 3.1, 95% CI 1.4-7.0) and parity (OR: 2.5, 95% CI 1.7-3.6), but not smoking were associated with a higher risk of AIP. The presence of placenta previa in women with at least a prior CS was associated with a higher risk of AIP compared to controls, with an OR of 12.0, 95% CI 1.6-88.0. Furthermore, the risk of AIP increased with the number of prior CS (OR of 2.6, 95% CI 1.6-4.4 and 5.4, 95% CI 1.7-17.4 for two and three prior CS respectively). Finally, IVF pregnancies were associated with a high risk of AIP, with an OR of 2.8 (95% CI 1.2-6.8). CONCLUSION: A prior CS and placenta previa are among the strongest risk factors for the occurrence of AIP

Outcome of fetuses with congenital parvovirus B19 infection: systematic review and meta-analysis

OBJECTIVE: To explore the outcome of fetuses affected by congenital Parvovirus B19 (PB19) Infection. METHODS: The outcomes observed were: miscarriage, perinatal death (PND), intra-uterine death (IUD), neonatal death (NND), spontaneous resolution of hydrops or fetal anemia, intra-uterine transfusion (IUT), resolution of hydrops or anemia after transfusion, fetal loss following transfusion, abnormal brain scan after birth, abnormal neurodevelopmental outcome. All the observed outcomes were reported in fetuses presenting and in those not presenting signs of hydrops on ultrasound. A sub-group analysis was performed including hydropic and non-hydropic fetuses < and ≥ 20 weeks of gestation respectively. Meta-analyses of proportions and meta-analyses using individual data random-effect logistic regression were used to analyze the data. RESULTS: Thirty-seven observational studies (654 fetuses affected by PB19 infection) were included. The risk of miscarriage (OR: 11.5, 95% CI 2.7-49.7) and PND (OR: 4.2, 95% CI 1.6-11.0) was higher in fetuses affected by PB19 infection presenting compared to those not presenting with hydrops on ultrasound. In fetuses affected by hydrops, spontaneous resolution of the infection, defined as disappearance of hydrops without the need for IUT, occurred in 5.2% (95% CI 2.5-8.8) of cases, while in the group of fetuses not affected by hydrops, resolution occurred in 49.6% (95% CI 20.7-78.6) of cases. IUT was performed in 78.7% (95% CI 66.4-88.8) of hydropic and in 29.6% (95% CI 6.0-61.6) of non-hydropic fetuses affected by congenital PB19 infection and resolution of the infection after IUT occurred in 55.1% (95% CI 34.0-75.3) of fetuses presenting and in 100% (95% CI 57.3-100) of cases not presenting signs of hydrops on ultrasound. The risk of fetal loss after IUT was higher in fetuses affected compared to those not affected by hydrops (OR: 9.8 (95% CI 2.8-34.6). Assessment of neurodevelopmental outcome was affected by the very small number of included cases, thereby precluding the achievement of adequate statistical power. The prevalence of abnormal brain imaging was 9.8% (95% CI 2.5-21.0) in fetuses affected and 0.0% (95% CI 0.0-7.0) in those not affected by hydrops, while the corresponding figures for abnormal neurodevelopmental outcome was 9.5% (95% CI2.6-20.2) and 0.0% (95% 0.0-0.8). CONCLUSION: Hydrops is the main determinant of mortality and adverse perinatal outcome in fetuses affected by PB19 infection. Perinatal outcome in non-hydropic fetuses is generally favorable

Assessing the cost-effectiveness of waiting list reduction strategies for a breast radiology department: a real-life case study

Abstract Background A timely diagnosis is essential for improving breast cancer patients’ survival and designing targeted therapeutic plans. For this purpose, the screening timing, as well as the related waiting lists, are decisive. Nonetheless, even in economically advanced countries, breast cancer radiology centres fail in providing effective screening programs. Actually, a careful hospital governance should encourage waiting lists reduction programs, not only for improving patients care, but also for minimizing costs associated with the treatment of advanced cancers. Thus, in this work, we proposed a model to evaluate several scenarios for an optimal distribution of the resources invested in a Department of Breast Radiodiagnosis. Materials and methods Particularly, we performed a cost-benefit analysis as a technology assessment method to estimate both costs and health effects of the screening program, to maximise both benefits related to the quality of care and resources employed by the Department of Breast Radiodiagnosis of Istituto Tumori “Giovanni Paolo II” of Bari in 2019. Specifically, we determined the Quality-Adjusted Life Year (QALY) for estimating health outcomes, in terms of usefulness of two hypothetical screening strategies with respect to the current one. While the first hypothetical strategy adds one team made up of a doctor, a technician and a nurse, along with an ultrasound and a mammograph, the second one adds two afternoon teams. Results This study showed that the most cost-effective incremental ratio could be achieved by reducing current waiting lists from 32 to 16 months. Finally, our analysis revealed that this strategy would also allow to include more people in the screening programs (60,000 patients in 3 years)

Symptoms-to-emergency-call timing delay in acute coronary syndrome before and during COVID-19: independent predictors and their impact on mortality

The COVID-19 pandemic severely impacted global health. The aim of this study was to compare predictors of symptoms-to-emergency-call timing delay in Acute Coronary Syndrome (ACS) and their impact on mortality before and during the COVID-19 outbreak

The Incidence and Impact of In-Hospital Bleeding in Patients with Acute Coronary Syndrome during the COVID-19 Pandemic

Background: The COVID-19 pandemic increased the complexity of the clinical management and pharmacological treatment of patients presenting with an Acute Coronary Syndrome (ACS). Aim: to explore the incidence and prognostic impact of in-hospital bleeding in patients presenting with ACS before and during the COVID-19 pandemic. Methods: We evaluated in-hospital Thrombolysis In Myocardial Infarction (TIMI) major and minor bleeding among 2851 patients with ACS from 17 Italian centers during the first wave of the COVID-19 pandemic (i.e., March-April 2020) and in the same period in the previous two years. Results: The incidence of in-hospital TIMI major and minor bleeding was similar before and during the COVID-19 pandemic. TIMI major or minor bleeding was associated with a significant threefold increase in all-cause mortality, with a similar prognostic impact before and during the COVID-19 pandemic. Conclusions: the incidence and clinical impact of in-hospital bleeding in ACS patients was similar before and during the COVID-19 pandemic. We confirmed a significant and sizable negative prognostic impact of in-hospital bleeding in ACS patients