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The period between adolescence to young adulthood can be stressful for parents of transition-aged children (14 to 22 years old) with autism spectrum disorder. A systematic review was undertaken to examine if existing interventions address the unique parental stressors of this phase and if the scales used to measure parental stress and anxiety are suitable for this group. Of the 9813 studies screened, only 13 studies met the inclusion criteria. Findings indicated that interventions focused on mindfulness, social functioning, or multiple components, of which only two addressed the transition period and only three specifically targeted parents of this age group. Moreover, of the six scales which assessed stress or anxiety, none were designed for these parents. Findings highlight the urgent need for more suitable scales and targeted interventions.

Inclusive Postsecondary Education (IPSE) programs offer students with intellectual disabilities (ID) the opportunity to enhance academic, career, and independent living skills, with the ultimate goal of preparing them for meaningful employment. Given the significance of such programs and their rapid growth across the country and in Florida, an ongoing examination of the progress, challenges, and support needs of IPSE programs is crucial. To extend current research efforts at the state level, two focus groups (n = 12) were conducted representing 11 of Florida's IPSE programs and one state agency to explore the experiences of IPSE programs in Florida. Four major themes were generated following thematic analysis of data: the need for preparing students and families for postsecondary education environments, the types of support Florida's IPSE programs have received, the major barriers IPSE programs are currently facing, and finally, what IPSE programs need in the future to continue to support students with ID. Findings from this study offer significant insights into the current status and needs of Florida's IPSE programs and serve to inform the work of disability resource providers, and the creation, expansion, and sustainability of IPSE programs across the state.

Abstract Background Few studies have evaluated masticatory ability and habits in relation to physical function. This study aimed to investigate the association of physical function with both masticatory ability and masticatory habits. Methods In this cohort study, we followed up with 146 community-dwelling older adults aged 65–84 years for 1 year. Physical function domain scores on the Kihon Checklist were used to assess physical function. Masticatory ability was examined using objective measurements and self-administered questionnaires. Data on masticatory habits were obtained using self-administered questionnaires. The Mann–Whitney U test was used to analyze the association between masticatory ability and masticatory habits as exposures; logistic regression analysis was used to analyze the effect of exposure on the outcome. Results A relationship was found between objective and subjective masticatory ability; however, no relationship was found between objective masticatory ability and masticatory habits. Furthermore, subjective masticatory ability and masticatory habits appeared to influence physical function 1 year later (odds ratio [OR]: 6.00, 95% confidence interval [CI]: 1.44–25.05; OR: 6.49, 95% CI: 2.45–17.22). Conclusion Masticatory ability and habits may be associated with a decline in physical function after 1 year in community-dwelling older adults. To maintain the physical function of these individuals, early intervention that addresses not only masticatory ability but also masticatory habits is necessary. Graphical Abstract

Currently, the leatherback turtle population in Indonesia tends to decline. One of the factors that cause turtles' existence is the turtle eggs that fail to hatch because bacteria contaminate them, 80% of the reasons turtle eggs fail to hatch are due to infection by microorganisms found on the eggshell. Turtle eggs have a soft structure and there are pores that function for gas exchange and water absorption. Microorganisms in sand can infect turtle eggs through the pores and cause hatching failure. This study aims to isolate and identify pathogenic bacteria found in leatherback turtle eggshell (Dermochelys coriacea) from Lampuuk Beach, Aceh Besar, based on the 16S rRNA gene analysis. Eight eggshell samples from leatherback turtle eggs that failed and hatched were cultured on Nutrient Agar (NA) medium. Then, the samples were inoculated on a blood agar medium for haemolysis test. Molecular identification of the 16S rRNA gene was also carried out to determine bacterial species. A total of five bacterial colonies from leatherback turtle eggshells were successfully isolated consisting of two Gram-negative bacteria (Penyu Belimbing Aceh (PBA) = PBA-1 and PBA-2 and three Gram-positive bacteria (PBA-3, PBA-4, and PBA-5). Based on the haemolysis test, the five bacterial isolates were unable to haemolyze blood. Bacterial DNA of PBA-1 and PBA-2 were successfully isolated and amplified using polymerase chain reaction (PCR) with a DNA target of ~1500 bp. Analysis using BLASTN and phylogenetic tree construction showed that PBA-1 isolate had 98.64% similarity with Acinetobacter baumannii, while PBA-2 isolate had 97.82% similarity with Enterobacter kobei. Both bacteria are members of the Enterobacteriaceae family. It can be concluded that, there were two pathogenic bacteria can potentially be opportunistic pathogens found in leatherback turtle eggshells that failed or succeeded in hatching, namely A. baumannii and E. Kobei

An estimated 19% of students enrolled in postsecondary education in the US have a disability. However, students with disabilities often face barriers, including accessibility challenges, that result in lower attendance and graduation rates. It is therefore critical that universities take action to ensure campuses are fully inclusive and accessible. Using the Design Thinking Model, a workshop was conducted at a large Southeastern University to bring together a diverse group of stakeholders (n = 32) to brainstorm innovative solutions to accessibility challenges. Four potential solutions were generated that aimed to improve campus infrastructure, the mobile map application, and general advocacy of people with disabilities, and to establish a task force to ensure that addressing accessibility concerns remains a long-term priority. After the workshop, participants reported having greater knowledge of accessibility policies, awareness of accessibility issues on campus, and an increased ability to address accessibility issues when they arise. Participants without disabilities also reported being more likely to notice accessibility challenges on campus and felt more confident talking to individuals with disabilities. Workshops that leverage the Design Thinking Model show promise in generating solutions that could tackle accessibility challenges on postsecondary campuses and increase knowledge of university policies and procedures related to accessibility.

The adenohypophysis is composed of the anterior and intermediate lobes (AL and IL, respectively), and secretes hormones that play an important role in reproduction. CD9- and SOX2-double (CD9/SOX2) positive cells located in the marginal cell layer (MCL) facing the Rathke’s cleft in the AL and IL form the primary stem cell niche in the adult adenohypophysis of rats. In this study, we successfully obtained 3-dimensional (3D) cell aggregates that closely resembled the primary niche of MCL in vivo. After incubation in a Matrigel containing several growth factors, approximately 20% of the cells in the CD9/SOX2-positive cell aggregates were differentiated into hormone-producing cells. The cell aggregates generated in this study may provide insight into the regulation of the pituitary stem/progenitor cell niche and the turnover of hormone-producing cells.

Abstract Hydroxyurea is the preferred first‐line cytoreductive treatment for high‐risk essential thrombocythaemia (ET), but many patients are intolerant or refractory to hydroxyurea. Ruxolitinib has been shown to improve symptoms in patients with ET. This post hoc analysis compared the clinical outcomes of patients with ET who received hydroxyurea only with those who switched from hydroxyurea to ruxolitinib due to intolerance/resistance to hydroxyurea. Patients with ET refractory/intolerant to hydroxyurea treated with ruxolitinib in a completed phase 2 study (HU‐RUX) were propensity score matched with patients who received hydroxyurea only in an observational study (HU). Changes in leukocyte and platelet counts were reported at 6‐month intervals during the 48‐month follow‐up. Following propensity score matching, 37 patients were included for analysis in each cohort. Mean (standard deviation [SD]) leukocyte and platelet counts at index were higher for HU‐RUX versus HU (leukocyte: 9.3 [5.1] vs. 6.8 [3.1] × 109/L; platelet: 1027.4 [497.8] vs. 513.9 [154.7] × 109/L), both of which decreased significantly from index to 6 months through to 48 months in HU‐RUX (mean [SD] change from index at 6 months—leukocyte: −1.8 [4.6] × 109/L; platelet: −391.7 [472.9] × 109/L; at 48 months—leukocyte: −3.8 [5.3] × 109/L; platelet: −539.0 [521.8] × 109/L), but remained relatively stable in HU (mean [SD] change from index at 6 months—leukocyte: 0 [1.8] × 109/L; platelet: −5.7 [175.3] × 109/L; at 48 months—leukocyte: −0.1 [2.7] × 109/L; platelet: −6.9 [105.1] × 109/L). In conclusion, these results demonstrate that switching from hydroxyurea to ruxolitinib in patients with ET who are intolerant or refractory to hydroxyurea could improve abnormal haematologic values similar to those who receive first‐line hydroxyurea.

Objectives: To compare the characteristic competencies of public health nurses working for the older adult’s health and welfare in public administration (“PA”) with those at community general support centers (“CGSC”) in Japan. Methods: We conducted a questionnaire survey by mail for PA and CGSC public health nurses. A competency list that was developed to compare three groups (PA, CGSC experts with ≥5 years of experience, and CGSC newcomers with ≤2 years of experience) was used. The following characteristics were examined: (1) competencies acquired early after arriving at the CGSC, (2) competencies acquired through a certain amount of CGSC experience, (3) common competencies, (4) competencies that even experts lacked, and (5) competencies that the newcomers lacked. Results: We examined the responses of 171 PA nurses, 185 CGSC expert public health nurses, and 165 CGSC newcomer public health nurses. The results of comparison of the three groups showed that (1) had no applicable items; (2) had nine items for individual support associated with preventive care management; (3) had 14 items including teamwork among three professionals (social workers, senior care manager, public health nurse)/other professionals and self-improvement; (4) had three items for community development, (5) had two items for individual support and 16 items for community development. Conclusion: Initiatives for preventive care and coordination of care teams should be supported and suggested as characteristic competencies for CGSC public health nurses.

Introduction: Contracts form the backbone of business dealings, establishing the foundations and binding all collaborative endeavors between parties involved. In the Indonesian context, the use of the national language in contractual agreements has been explicitly governed by laws and regulations, specifically Law Number 24 of 2009 concerning the National Flag, Language, Emblem, and Anthem. Purposes of the Research: This study aims to scrutinize and analyze the regulatory framework surrounding the use of the Indonesian language in contract drafting, as mandated by the positive laws of Indonesia. Additionally, it seeks to elucidate the legal ramifications that may arise from non-compliance with these provisions. Furthermore, the research endeavors to provide legal clarity and offer recommendations pertaining to this issue. Methods of the Research: This research adopts a normative legal approach, employing both statutory and conceptual frameworks. The legal materials utilized encompass primary, secondary, and tertiary sources. The collection of legal materials is facilitated through library research, while the analysis of these materials is conducted qualitatively, employing content analysis and legal interpretation techniques. Results of the Research: The findings of this research present a comprehensive analysis of the regulations governing the use of the Indonesian language in contract drafting, shedding light on the legal implications of non-compliance with these provisions. Furthermore, the research offers recommendations and suggestions tailored for government agencies, business entities, and legal practitioners, guiding them in implementing the use of the Indonesian language in contracts in accordance with the applicable legal framework.

Abstract Background Few reported studies evaluate the status of those who have a family dentist (FD) by regional differences and the socioeconomic factors associated with this status. This study aimed to assess the prevalence of having an FD among Japanese individuals across three samples of municipality type: urban, intermediate, and rural areas, and determine the factors associated with having an FD. Methods This was a cross-sectional study involving a web-based survey. In total, 2,429 participants (comprising men and women aged 20–69 years) were randomly selected from among the registrants of a web research company: 811 urban residents, 812 intermediate residents, and 806 rural residents. In each area, we categorized the participants into those who had an FD (FD group) and those who did not (non-FD group). A multivariate modified Poisson regression analysis was used to determine the factors associated with the FD group as compared to the non-FD group. Results The proportion of the FD group was lowest in rural areas (42.3%), followed by intermediate (48.6%) and urban areas (49.7%). The regression analysis revealed a statistically significant tendency between associated factors in the two groups; that is, the higher the household income, the more likely that the family belonged to the FD group (prevalence ratio (95%CI), JPY 4–6 million: 1.43 (1.00–2.03), JPY ≥ 8 million: 1.72 (1.21–2.44)). Conclusions Rural areas have the lowest proportion of people with an FD among the three areas, and income inequality is associated with having an FD. Thus, when planning policies to encourage individuals to have an FD to manage their oral health, it is necessary to consider regional differences.

Purpose – This study aims to identify how the involvement of female university students in volunteer organisations is contributing to their self-empowerment in Bangladesh. Design/methodology/approach – A cross-sectional study with a qualitative approach was conducted. A total of 20 in-depth interviews with female student volunteers, two focus group discussions with student members of the volunteer organisation and ten key informant interviews with academics, gender experts and high-level representatives of civil society organisations were conducted. The data were collected from eight purposively selected universities in Dhaka. The data were collected between 1 January 2023 and 23 March 2023. Findings – The inter-organisational environment appears to be supportive and welcoming, despite the fact that some male colleagues belittle women with insulting comments. Female students are predominantly involved in public presentation activities and their advice is rarely considered. To reach a top position, they have to show more commitment than their male colleagues. Subjective prejudices discourage women from taking on positions of responsibility. Participation in voluntary organisations strengthens the self-confidence, critical thinking, networking and social capital of female students, making it easier for them to gain employment. These factors contribute to the empowerment of female students. Originality/value – This study is an excellent empirical document that establishes a link between the empowerment of female students and their participation in voluntary activities. The recommendations of this study pave the way for future research in different countries on how volunteering helps young people, especially female students, to shape their future by taking on social responsibility alongside their academic activities.

Abstract Aims There are minimal data on the prognostic impact of right atrial strain during the reservoir phase (RASr) in patients with immunoglobulin light‐chain (AL) cardiac amyloidosis. Methods and results Among 78 patients who were diagnosed with AL cardiac amyloidosis at Kumamoto University Hospital from 2007 to 2022, 72 patients with sufficient two‐dimensional speckle tracking imaging data without chemotherapy before the diagnosis were retrospectively analysed. During a median follow‐up of 403 days, 31 deaths occurred. Age and the rate of male sex were not significantly different between the all‐cause death group and the survival group (age, 70.4 ± 8.8 years vs. 67.0 ± 10.0 years, P = 0.14, male sex, 65% vs. 66%, P = 0.91). The estimated glomerular filtration rate (eGFR) was significantly lower, and B‐type natriuretic peptide (BNP) and high sensitivity cardiac troponin T (hs‐cTnT) were significantly higher, in the all‐cause death group versus the survival group (eGFR, 48.2 ± 21.0 mL/min/1.73 m2 vs. 59.4 ± 24.4 mL/min/1.73 m2, P 311.2 pg/mL) had a significantly high probability of all‐cause death (both, P

Background: Chronic obstructive pulmonary disease (COPD) represents a significant public health problem in Italy, with a high prevalence and a substantial economic burden on the National Health Service (NHS). Effective management of the disease is crucial for reducing exacerbations and improving patients’ quality of life. Methods: This study employs a dynamic predictive model to assess the economic impact of implementing three specific health policies aimed at improving COPD management over a five-year horizon. The analysis is conducted from the perspective of the NHS, focusing on the direct costs associated with disease management. Results: The implementation of the proposed policies demonstrated potential significant savings in direct healthcare costs. The first policy, focused on increasing therapeutic adherence, generated an estimated savings of 202 million €. The second, concerning the wider use of triple therapies, led to savings of about 142 million €. Finally, the third policy, aimed at reducing the delay in prescribing appropriate therapies, contributed to an additional saving of over 175 million € in the time horizon considered in the analysis. Overall, these results suggest a substantial improvement opportunity in COPD management, with significant economic benefits for the Italian NHS. Conclusion: The study confirms the importance of targeted policies in the management of COPD, highlighting how strategic interventions can lead to significant resource savings while simultaneously improving patient care. These results provide a solid foundation for further research and serve as a useful guide for decision-makers in planning effective intervention strategies, aimed at optimizing resources and enhancing disease management in the Italian healthcare context.

Background: Congenital thrombotic thrombocytopenic purpura (cTTP) is a rare genetic disorder characterized by an abnormal clotting process leading to serious health complications such as thrombocytopenia and hemolytic anemia. Despite its clinical significance, the estimated broader economic and social impacts in Italy on patients and society remain underexplored. Methods: A detailed questionnaire, developed and validated by a panel of cTTP experts, was distributed to healthcare professionals and patient associations to gather comprehensive data on the economic and social burden of cTTP in Italy. The study was focused on direct and indirect costs associated with the disease management of 15 patients with cTTP, as well as out-of-pocket expenses incurred by patients. Results: The analysis revealed that of the 15 patients diagnosed with cTTP in Italy, 60% were adults aged 40-55 years. Productivity loss and diminished quality of life dominated the economic burden of cTTP, accounting for 81.05% of total costs. Direct medical costs, while substantial, represented a smaller portion of the overall financial impact. Additionally, out-of-pocket expenses, though constituting the smallest fraction, underscored the financial contributions made by patients towards their own care management. Conclusion: The findings underscore the need for a multidisciplinary and holistic approach to cTTP management that extends beyond the clinical treatment. Addressing the economic and social implications of the disease is crucial for improving patient well-being and ensuring the sustainability of healthcare systems. The study advocates for increased awareness, research, and access to care for cTTP patients, highlighting the importance of comprehensive support networks to mitigate the disease’s broader societal impacts, estimated to be around 2 million euro for 15 patients in 10 years.

Objective:. We explored the oncological impact of tumor deposits (TDs) on colon cancer and proposed optimal modifications to the current staging system. Background:. In the existing American Joint Committee on Cancer colon cancer staging system, TDs are incorporated into the N category as N1c. When lymph node metastases (LNMs) are present, their number is considered to determine nodal stages, such as N1a/b or N2a/b, regardless of TDs. Methods:. 4212 patients with primary colon cancer who underwent surgical resection in the Seoul Colorectal Group (2010–2020) and 93,057 patients from the Surveillance, Epidemiology, and End Results*Stat database (2000–2017) were included in this study. Patients were classified according to the number of metastatic lymph nodes (LNs) (0/1–3/≥4) and the presence of TDs. Results:. TDs were significantly associated with left colon cancer, a higher T category, and vascular/perineural invasion. Patients with TDs had higher recurrence rates (23.1 vs 7.5%, P < 0.001). The TD-positive patients had notably worse overall survival (OS) and recurrence-free survival rates. The survival outcomes of TD-positive patients without LNM were inferior to those of TD-negative patients with LN1–3 (5-year OS: 78.9 vs 87.8%, P = 0.04). The survival outcomes of TD-positive patients with LN1–3 were similar to those of TD-negative patients with LN ≥4 (5-year OS: 87.0 vs 77.1%, P = 0.11). Survival outcomes obtained using the Surveillance, Epidemiology, and End Results *Stat database yielded consistent results. Conclusions:. TDs were associated with poor prognostic factors and had a significant impact on survival outcomes. The incorporation of tumor deposits into nodal classifications beyond the current N1c criteria may improve the staging system and more accurately reflect the recurrence and survival rates among patients with colon cancer. TD-positive in N1a or N1b could be categorized as N2.

Objective:. To evaluate the feasibility and clinical impact of minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) on postoperative nutritional and immunological indices. Background:. The surgical advantages of MIPD over OPD are controversial, and the postoperative nutritional and immunological statuses are unknown. Methods:. In total, 306 patients who underwent MIPD (n = 120) or OPD (n = 186) for periampullary tumors from April 2016 to February 2024 were analyzed. Surgical outcomes and postoperative nutritional and immunological indices (albumin, prognostic nutritional index [PNI], neutrophil-to-lymphocyte ratio [NLR], and platelet-to-lymphocyte ratio [PLR]) were examined by 1:1 propensity score matching (PSM) with well-matched background characteristics. Results:. PSM resulted in 2 balanced groups of 99 patients each. Compared with OPD, MIPD was significantly associated with less estimated blood loss (P < 0.0001), fewer intraoperative blood transfusions (P = 0.001), longer operative time, shorter postoperative hospital stay (P < 0.0001), fewer postoperative complications (P = 0.001) (especially clinically relevant postoperative pancreatic fistula [P = 0.018]), and a higher rate of textbook outcome achievement (70.7% vs 48.5%, P = 0.001). The number of dissected lymph nodes and the R0 resection rate did not differ between the 2 groups. In elective cases with textbook outcome achievement, the change rates of albumin, PNI, NLR, and PLR from before to after surgery were equivalent in both groups. Conclusions:. MIPD has several surgical advantages (excluding a prolonged operative time), and it enhances the achievement of textbook outcomes over OPD. However, the postoperative nutritional and immunological statuses are equivalent for both procedures.

Objectives: The current study aimed to conduct a phytochemical screening of commonly known fruit red grape ( Vitis vinifera L.) seed methanolic extract through gas chromatography and mass spectrometry (GC-MS) to identify the bioactive compounds responsible for its health benefits and evaluate the pharmacological potentialities of the extract and its fractions against oxidation, inflammation, pain, and diarrhea. Methods: The in vitro antioxidant, anti-inflammatory, and cytotoxic characteristics of methanolic extracts and various solvent fractions of V. vinifera were evaluated using the DPPH free radical scavenging assay, membrane stabilizing, and brine shrimp lethality bioassay. Furthermore, the study assessed the effects of crude extracts (200, 400, and 600 mg/kg of body weight) on pain relief and reduction of diarrhea in animals using methods such as tail immersion, the acetic acid-induced writhing technique, and a diarrheal mouse model induced with castor oil. Results: A total of 73 phytoconstituents were predominantly found in the seed extract based on the GC-MS analysis. Among the identified compounds, 9-octadecenamide (13.7%), and ( 9E,11E )-octadeca-9,11-dienoate (11.07%) are most abundant. Several notable constituents, such as gamma-sitosterol, stigmasterol, paromomycin, 4,6-cholestadienol, gamma-tocotrienol, 24-Propylidenecholest-5-en-3beta-ol, and alpha-tocopherol acetate, are also present. The methanolic extract of V. vinifera seed and its different solvent fractions showed promising antioxidant properties (IC 50 = 1.19-17.42 µg/mL) compared to the standard antioxidant butylated hydroxytoluene (IC 50 = 20.46 µg/mL). Aqueous soluble fraction exerted inhibition of nearly 50% heat-induced hemolysis compared to the standard acetylsalicylic acid (42%). Besides, all the tested doses (200, 400, and 600 mg/kg bw) of the crude extract showed significant ( P

BackgroundEosinophilic esophagitis (EoE) is a chronic and progressive type 2 inflammatory disease affecting the esophagus. Its prevalence has increased in recent years due to increased awareness, evolving clinical guidelines, and heightened sensitivity among healthcare professionals managing the condition. The exact causes behind EoE’s development remain unknown, and its clinical presentation varies, often leading to significant diagnostic delays depending on the age at which symptoms manifest. Consequently, achieving long-term disease control through heightened awareness becomes imperative. EoE generates a significant clinical burden, resulting in substantial economic consequences for patients, healthcare systems, and society. This study aimed to assess the economic and social impacts on EoE patients within the Italian context.MethodsA cost-of-illness analysis was conducted from two perspectives: the National Health System (NHS) and the societal perspective. This analysis encompassed direct healthcare, indirect healthcare, and non-healthcare costs. Data were collected and assessed through a survey administered to a panel of expert clinicians and EoE-affected patients.ResultsManaging EoE incurs a significant burden on healthcare systems, amounting to €6,852.28 per patient per year. The primary cost component appears to be direct costs, comprising 60.73% of the total cost per patient for this condition, while indirect costs contribute to 29.68% of the overall management expenses.ConclusionThis analysis underscores a substantial financial burden on both the healthcare system and patients affected by eosinophilic esophagitis. It emphasizes the imperative need for a continuous and combined effort from clinicians, patients, and families to promptly recognize symptoms and adaptive behavior to mitigate diagnostic delays.

Background and Aims: We aimed to characterize the epidemiologic and comorbidities profiles of patients with chronic Hepatitis D (CHD) followed in clinical practice in Italy and explored their interferon (IFN) eligibility. Methods: This was a cross-sectional study of the PITER cohort consisting of consecutive HBsAg-positive patients from 59 centers over the period 2019-2023. Multivariable analysis was performed by logistic regression model. Results: Of 5492 HBsAg-positive enrolled patients, 4152 (75.6%) were screened for HDV, 422 (10.2%) were anti-HDV positive. Compared with HBsAg mono-infected, anti-HDV positive patients were more often younger, non-Italians, with a history of drug use, had elevated alanine transaminase (ALT), cirrhosis, or hepatocellular carcinoma (HCC). Compared with Italians, anti-HDV positive non-Italians were younger (42.2% age ≤ 40 years vs. 2.1%; P < 0.001), more often females (males 43.0% vs. 68.6%; P < 0.001) with less frequent cirrhosis and HCC. HDV-RNA was detected in 63.2% of anti-HDV-positive patients, who were more likely to have elevated ALT, cirrhosis, and HCC. Extrahepatic comorbidities were present in 47.4% of anti-HDV positive patients and could affect the eligibility of IFN-containing therapies in at least 53.0% of patients in care. Conclusions: CHD affects young, foreign-born patients and older Italians, of whom two-thirds had cirrhosis or HCC. Comorbidities were frequent in both Italians and non-Italians and impacted eligibility for IFN.