Online health information seeking and Covid-19 vaccine hesitancy: Evidence from 50+ Europeans

We use recently released data from the Survey of Health Ageing and Retirement in Europe (SHARE) to investigate the role of online health information seeking on Covid-19 vaccine hesitancy, which is defined as the reluctance or refusal to receive vaccinations despite the availability of vaccines. We adopt an instrumental variable strategy that exploits the computerization of workplaces occurred in the last century to deal with endogeneity. We find that searching for health information strongly reduces vaccine hesitancy. Results also show that individuals whose social networks suffered more during the outbreak, in terms of hospitalisations and deaths, are less likely to be hesitant. Improving individuals' technological skills might have positive spill-over effects for public health.

[Renal Damage and Obesity: a Silent Pairing]

Obesity is recognized as a true chronic disease and an independent risk factor for kidney disease. In particular, a correlation was observed between obesity and the development of focal segmental glomerulosclerosis. The clinical consequences of obesity on the kidney can include albuminuria, nephrotic syndrome, nephrolithiasis, and increased risk of development and progression of renal failure. Conventional therapy, which includes low-calorie diet, exercise, lifestyle changes, and drug therapy, including GLP1-RA, phentermine, phentermine/topiramate, bupropion/naltrexone, orlistat, is not always able to achieve the desired results and above all does not guarantee stabilization of body weight over time. On the other hand, bariatric surgery is giving excellent results in terms of efficacy and duration. Bariatric surgery techniques that are generally divided into restrictive, malabsorptive, and mixed are not free from possible metabolic complications such as anemia, vitamin deficiency, and stones. However, they are able to ensure a good maintenance of weight loss obtained with disappearance or reduction of the incidence and severity of comorbidities related to obesity.

Identification of the gamma irradiation dose applied to ground beef that reduces Shiga toxin producing Escherichia coli but has no impact on consumer acceptance

The aims of the present study were: a) to estimate the minimal dose of gamma irradiation required to reduce 5 log CFU/g of native O157 and non-O157 Shiga toxin-producing Escherichia coli population in ground beef samples inoculated with high inoculum; b) to assess its effectiveness in samples with low inoculum and 3) to evaluate consumer acceptance. Based on the results, 1 kGy was estimated as the minimal dose of gamma irradiation required to reduce 5 log CFU/g of STEC in ground beef. However, when samples with low inoculum level were subjected to 1 kGy, 3.9% of the samples were positive for stx and eae genes after an enrichment step. Consumer acceptance analysis was carried out with samples subjected to 2.5 kGy and no significant differences were found between irradiated and control samples. Therefore, 2.5 kGy was identified as the gama irradiation dose that reduces STEC but has no impact on consumer acceptance of ground beef.

Death by austerity? The impact of cost containment on avoidable mortality in Italy

Does austerity in health care affect health and healthcare outcomes? We examine the intended and unintended effects of the Italian austerity policy Piano di Rientro aimed at containing the cost of the healthcare sector. Using an instrumental variable strategy that exploits the temporal and geographical variation induced by the policy rollout, we find that the policy was successful in alleviating deficits by reducing expenditure, mainly in the southern regions, but also resulted in a 3% rise in avoidable deaths among both men and women, a reduction in hospital capacity and a rise in south-to-north patient migration. These findings suggest that-even in a high-income country with relatively low avoidable mortality like Italy-spending cuts can hurt survival.

Do-It-Yourself medicine? The impact of light cannabis liberalization on prescription drugs

Governments worldwide are increasingly concerned about the booming use of CBD (cannabidiol) products. However, we know little about the impact of their liberalization. We study a unique case of unintended liberalization of a CBD-based product (light cannabis) that occurred in Italy in 2017. Using unique and high-frequency data on prescription drug sales and by exploiting the staggered local availability of the new product in each Italian province, we document a significant substitution effect between light cannabis and anxiolytics, sedatives, opioids, anti-depressants and anti-psychotics. Results are informative for regulators and suggest that bans on light cannabis use would disregard the needs of patients to seek effective reliefs of their symptoms.

Vaccine hesitancy and (fake) news: Quasi-experimental evidence from Italy

The spread of fake news and misinformation on social media is blamed as a primary cause of vaccine hesitancy, which is one of the major threats to global health, according to the World Health Organization. This paper studies the effect of the diffusion of misinformation on immunization rates in Italy by exploiting a quasi-experiment that occurred in 2012, when the Court of Rimini officially recognized a causal link between the measles-mumps-rubella vaccine and autism and awarded injury compensation. To this end, we exploit the virality of misinformation following the 2012 Italian court's ruling, along with the intensity of exposure to nontraditional media driven by regional infrastructural differences in Internet broadband coverage. Using a Difference-in-Differences regression on regional panel data, we show that the spread of this news resulted in a decrease in child immunization rates for all types of vaccines.

Comparison between CT and CEUS in the diagnosis of pancreatic adenocarcinoma

PURPOSE

The aim of this study is to compare CEUS and MDCT features of pancreatic ductal adenocarcinoma in relation to tumor size.

MATERIALS AND METHODS

All patients with pathological diagnosis of pancreatic adenocarcinoma and studied by means of CEUS and MDCT were enrolled in this study. Two radiologists evaluated tumor size, site and imaging appearance. Patients in which at least one method yielded a positive result were divided into 4 groups on the basis of lesion size. For each dimensional category, sensitivity of the two imaging methods was calculated and compared using McNemar test.

RESULTS

One hundred thirty-three patients were included in this study. In 9 of 133 patients neither MDCT nor US/CEUS could identify the lesion, while in 9 of 133 patients only MDCT and in 13 of 133 only US/CEUS could identify the lesion. In the remaining 102 patients, both MDCT and US/CEUS yielded a positive result. US/CEUS sensitivity was 86.47% while MDCT sensitivity was 83.58%, with no statistically significant difference (p = 0.523). For lesions smaller than 2 cm US/CEUS had a 100% sensitivity, while MDCT had a 73.33% sensitivity with no statistically significant difference (p = 0.125). For lesions between 2.1 and 3 cm US/CEUS had a sensitivity of 95.35%, while MDCT had a sensitivity of 83.72% with no statistically significant difference (p = 0.180). For lesions between 3.1 and 4 cm, US/CEUS had a sensitivity of 87.88%, while MDCT had a sensitivity of 93.94% with no statistically significant difference (p = 0.688). For lesions larger than 4 cm US/CEUS, had a sensitivity of 90.91%, while MDCT had a sensitivity of 100% with no statistically significant difference (p = 0.250).

CONCLUSION

US/CEUS sensitivity in diagnosing pancreatic ductal adenocarcinoma is adequate and does not statistically differ from that of MDCT. US/CEUS sensitivity seems to be higher for small and medium lesions, while MDCT sensitivity is higher for large lesions. By combining both the imaging methods a higher accuracy in diagnosing pancreatic ductal adenocarcinoma can be expected.

Pancreatic multicenter ultrasound study (PAMUS)

AIM

To describe the typical CEUS pattern of pancreatic lesions and to evaluate the diagnostic accuracy of Contrast-enhanced ultrasound (CEUS) in their characterization.

MATERIALS AND METHODS

All US and CEUS examinations of focal pancreatic masses performed in six centers during a period of five years were reviewed. Inclusion criteria were: focal pancreatic mass pathologically proved, visible at ultrasound (US) and studied with CEUS. All lesions were then evaluated for size, aspect and enhancement pattern. Sensitivity, specificity, positive and negative predictive values with 95% CIs were calculated to define diagnostic accuracy of CEUS in respect to pathology. Diagnostic confidence of US and CEUS, discerning between benign and malignant lesions, were represented by using ROC (receiver operating characteristics) curves. Agreement was evaluated by means of k statistics.

RESULTS

1439 pancreatic lesions were included. At CEUS the lesions were divided into solid (89%) and cystic (12%) masses and classified into six and eight categories, respectively. Among the solid lesions, adenocarcinomas were characterized with an accuracy of 87.8%. Among the cystic lesions, cystic tumors were diagnosed with an accuracy of 97.1%. ROC curve area increased from 0.637 for US to 0.877 for CEUS (p<0.0001). Inter-observer agreement was slightly higher for solid (k=0.78) than cystic (k=0.62) lesions. In none of the centers side effects were reported.

CONCLUSION

CEUS is accurate in the characterization of pancreatic lesions. CEUS should be considered as a complementary imaging method for pancreatic lesions characterization.

Contrast-enhanced ultrasound of the pancreas

The introduction of contrast-enhanced ultrasonography (CEUS) has led to major improvements in the diagnostic capabilities of ultrasound (US). The innovative use of CEUS for study of the pancreas has created the need for a definition of the most frequent dynamic features of solid and cystic masses. CEUS is less expensive compared to computed tomography and magnetic resonance imaging and is able to significantly improve the accuracy of US, allowing better characterization and staging of pancreatic pathologies.

Right ventricular dysfunction in patients with end-stage renal disease

BACKGROUND

While chronic dialysis treatment has been suggested to increase pulmonary pressure values, right ventricular dysfunction (RVD) is a major cause of death in patients with end-stage renal disease. We investigated the impact of different dialysis treatments on right ventricular function.

METHODS

We examined 220 subjects grouped as follows: healthy controls (n = 100), peritoneal dialysis (PD; n = 26), hemodialysis (HD) with radial arteriovenous fistula (AVF; n = 62), and HD with brachial AVF (n = 32). Echocardiography including tissue Doppler imaging (TDI) of the right ventricle was performed in all patients.

RESULTS

Pulmonary pressure values progressively rose from controls across the 3 dialysis groups (21.7 ± 6.8, 29.7 ± 6.7, 37.9 ± 6.7 and 40.8 ± 6.6 mm Hg, respectively; p < 0.001). TDI indices of right ventricular function were more impaired in HD patients, particularly in those with brachial AVF. RVD, assessed by TDI myocardial performance index, was higher in HD patients compared with PD patients (71.3 vs. 34.6%, p < 0.001). Moreover, the prevalence of RVD further increased in patients with brachial AVF compared with the radial access (90.6 vs. 61.3%, p < 0.001).

CONCLUSIONS

Compared to DP, HD increases the risk of RVD, particularly in the presence of brachial AVF. TDI may detect early functional failure of the right ventricle in HD patients.

Resectable pancreatic adenocarcinoma: is the enhancement pattern at contrast-enhanced ultrasonography a pre-operative prognostic factor?

The aim of our study was to determine whether the enhancement pattern of pancreatic adenocarcinoma at contrast-enhanced ultrasonography (CEUS) is related to patient prognosis after resection. CEUS of 42 resected adenocarcinomas were retrospectively reviewed. Tumors were divided into two groups: group A=poorly vascularized (presence of avascular areas) or group B=well vascularized (absence of avascular areas). All lesions were resected and underwent pathological examination assessing tumor differentiation as: undifferentiated (poorly differentiated) or differentiated (moderately and well differentiated). Mean vascular density (MVD) was also evaluated. CEUS enhancement and pathology were correlated (Spearman's test). Survival was analyzed with the Kaplan-Meier method. Multivariate analysis was performed with the Cox regression model. There were 30 differentiated and 12 undifferentiated adenocarcinomas at pathology. At CEUS, 10 lesions were poorly vascularized, whereas 32 lesions were well vascularized. Positive correlation was observed between CEUS groups and tumoral differentiation (rs=0.51; p=0.001) and between CEUS and MVD (rs=0.74; p<0.0001). Median survival in patients with group A vascularization at CEUS was significantly lower than in group B (p=0.015). Cox proportional hazard model revealed the presence of poorly vascularized tumor at CEUS (p=0.0001) as a predictor of higher mortality. In conclusion, CEUS enables accurate depiction of the vascularization of adenocarcinoma, with positive correlation to histology grade and MVD.

Cardiovascular risk factor control among diabetic patients attending community-based diabetic care clinics in Italy

AIM OF THIS STUDY

To describe the extent to which hyperglycemia, hypertension, and dyslipidemia are currently detected, treated, and controlled in diabetic patients attending a network of urban community-based diabetic care clinics in Italy.

METHODS

The study population included 1078 consecutive patients with type 2 diabetes mellitus (47% women, mean age 67.6+/-9.8 years) visited at eight diabetic care clinics between 1 and 30 of November 2004. Values of glycosilated hemoglobin, blood pressure, and cholesterol subfractions, as well as clinical and medication data, were prospectively collected in all cases in a computerized database.

RESULTS

Despite a high prevalence of hypertension (66.6%), only 29.6% of patients met the treatment goal of a systolic blood pressure <130 mmHg, while a diastolic blood pressure <80 mmHg was reached by 38.6% of the study cohort. Optimal LDL cholesterol values (<100mg/dl) were present in just 25.5% of cases. Values of glycosilated hemoglobin <7% were present in 57.8% of patients.

CONCLUSIONS

We conclude that adherence to current guidelines for cardiovascular prevention and cardiovascular risk factor control represent an exception in diabetic patients attending community-based diabetic care clinics. Major efforts are required to improve the quality of health care currently delivered to diabetic patients.