Search

Background: Medical imaging is an integral part of healthcare. Globalization has resulted in increased mobilization of migrants to new host nations. The association between migration status and utilization of medical imaging is unknown., Methods and Findings: A retrospective population-based matched cohort study was conducted in Ontario, Canada from April 1, 1995 to December 31, 2016. A total of 1,848,222 migrants were matched 1:1 to nonmigrants in the year of migration on age, sex, and geography. Utilization of computed tomography (CT), magnetic resonance imaging (MRI), radiography, and ultrasonography was determined. Rate differences per 1,000 person-years comparing migrants to nonmigrants were calculated. Relative rates were calculated using a recurrent event framework, adjusting for age, sex, and time-varying socioeconomic status, comorbidity score, and access to a primary care provider. Estimates were stratified by migration age: children and adolescents (≤19 years), young adults (20 to 39), adults (40 to 59), and older adults (≥60). Utilization rates of CT, MRI, and radiography were lower for migrants across all age groups compared with Ontario nonmigrants. Increasing age at migration was associated with larger differences in utilization rates. Older adult migrants had the largest gap in imaging utilization. The longer the time since migration, the larger the gap in medical imaging use. In multivariable analysis, the relative rate of imaging was approximately 20% to 30% lower for migrants: ranging from 0.77 to 0.88 for CT and 0.72 to 0.80 for MRI imaging across age groups. Radiography relative rates ranged from 0.84 to 0.90. All migrant age groups, except older adults, had higher rates of ultrasonography. The indication for imaging was not captured, thus it was not possible to determine if the imaging was necessary., Conclusions: Migrants utilized less CT, MRI, and radiography but more ultrasonography. Older adult migrants used the least amount of imaging compared with nonmigrants. Future research should evaluate whether lower utilization is due to barriers in healthcare access or health-seeking behaviors within a universal healthcare system., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Di Giuseppe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This cross-sectional study aimed at evaluating the knowledge and attitudes concerning influenza vaccination in Southern Italy, and investigating the potential determinants of vaccine uptake. The sample consisted of 700 adults (mean age 58.7y) with chronic diseases attending four public specialty clinics in Italy. Overall, 64.7% of the participants were aware that influenza can be prevented with vaccines and that patients with chronic diseases are at higher risk of developing severe complications. Less than half of the sample (42.1%) received influenza vaccine in the last season, and 46.9% declared the will to receive influenza vaccination in the next season. The level of awareness was significantly lower among the elderly (> = 65y) and those with a higher self-reported health. A significantly higher likelihood of vaccination was observed among the elderly, the subjects with a higher knowledge about vaccine utility and safety, the participants with chronic respiratory diseases, and those who had taken more drugs. Future education programs and communication strategies are strongly needed in adults with chronic diseases to improve influenza vaccination knowledge and uptake., Competing Interests: The authors have declared that no competing interests exist.

The role of hepatitis C virus (HCV) infection in increasing the risk of cardiovascular disease (CVD) is controversial. The objective of the present study is to estimate the 10-year risk of CVD in HCV- positive subjects and describe their profile of cardiometabolic risk markers compared to HCV-negative subjects. We conducted a cross-sectional study to estimate 10-year CVD risk, calculated using the Framingham Risk Score (FRS), in participants from the Canadian Health Measures Survey (CHMS; 2007-2015, n = 10,115) and the US-National Health and Nutrition Examination Survey (NHANES; 2007-2016, n = 16,668). Subjects included in our analysis were aged 30 to 74 years with no prior history of CVD. FRS estimates, sociodemographic and cardiometabolic risk factors were compared between HCV- positive and -negative subjects in the two surveys. HCV-positive subjects had a distinct sociodemographic profile compared to their HCV-negative counterparts. Cardiometabolic risk factors, inflammatory markers and serum levels of micronutrients were comparable between the two survey populations, both in HCV-positive and -negative subjects. The average FRS in HCV-positive patients was in the range of "intermediate" 10-year CVD risk (i.e., 10-20%) and was significantly higher (P<0.01) than their HCV-negative counterparts who were within the "low" 10-year CVD risk range (i.e., ≤10%). Using a multivariable linear regression model adjusted for ethnicity, number of metabolic syndrome components and BMI, HCV infection was significantly associated with a 2.5-3.5% absolute risk increase of 10-year CVD (P<0.01). The results of the present study suggest a potential association between HCV infection and risk of subclinical and clinical CVD. The expansion of anti-HCV therapy may also contribute to reduced CVD risk and burden in patients with chronic HCV infection and should be explored further in other datasets and population modelling studies., Competing Interests: The authors have declared that no competing interests exist.

Background: The aim of this study was to evaluate the knowledge, attitudes and behaviors towards prostate cancer and its prevention., Methods: A cross-sectional survey was conducted on a random sample of 625 fathers of students attending eight public schools. The self-administered questionnaire included questions on: socio-demographic characteristics, personal and familiar medical history of prostate cancer, knowledge about prostate cancer and the prostate-specific antigen (PSA) test, perception of risk towards prostate cancer, perception of the benefits of having a PSA-test, willingness to receive the PSA-test and sources of and needs of information regarding prostate cancer and the PSA-test., Results: 72.7% of respondents had heard about the PSA-test and 51.1% of those had heard about it through their physicians. This knowledge was higher: in men with older age, in those that had a higher level of education, in those who had a relative with prostrate problems or prostate cancer and in those with prostate problems. Perceived personal risk of contracting prostate cancer was associated with a higher level of education, in those who had received information about prostate cancer from a physician and in those with prostate problems. Only 29.6% of men had undergone a PSA-test and 59.4% were willing to do so in the future. The significant predictors of the willingness to receive a PSA-test were the belief that the PSA-test was useful, the perception of not very good personal health status, and need of additional information about the PSA-test., Conclusion: Respondents have a moderate knowledge about prostate cancer and a good propensity to undergo the PSA-test. Therefore, it would be necessary to increase information on the risks of prostate cancer and the benefits of prostate cancer prevention.

A cross-sectional study was carried out on 641 medical students, 359 students attending a degree course in the healthcare professions, and 500 resident physicians, all undergoing health surveillance at the ambulatory of the Division of Occupational Medicine, Second University of Naples, Italy. 76.1% of the participants drank alcohol, with 85.5% of medical students, 77.4% of resident physicians, and 63% of healthcare-professions students reporting regular alcohol use. In the whole sample, the mean Audit-C score was 1.6 for men and 1.1 for women; only 5.5% of men and 7.1% of women had a hazardous alcohol consumption with an Audit-C score of respectively ≥4 and ≥3. Multivariate regression modeling revealed that regular alcohol use was more likely in individuals who were men, were younger, had a lower body-mass index, were active smokers, were habitual coffee drinkers, and who were resident physicians or medical students rather than healthcare-professions students. This finding identifies a need to assess alcohol use in medical-profession workers in order to identify risky behavior early on and to carry out rapidly effective preventive and curative interventions.

Ciliates comprise a diverse and ecologically important phylum of unicellular protists. One of the most specious and best-defined genera is Euplotes, which constitutes more than 70 morphospecies, many of which have never been molecularly tested. The increasing number of described Euplotes taxa emphasizes the importance for detailed characterizations of new ones, requiring standardized morphological observations, sequencing of molecular markers and careful comparison with previous literature. Here we describe Euplotes curdsi sp. nov., distinguishable by the combination of the following features: 45-65 μm length, oval or elongated shape with both ends rounded, narrow peristome with 25-34 adoral membranelles, conspicuous paroral membrane, double-eurystomus dorsal argyrome type, 6-7 dorsolateral kineties and 10 frontoventral cirri. Three populations of the novel species have been found in brackish and marine samples in the Mediterranean and the White Sea. We provide the SSU rRNA gene sequences of these populations, and an updated phylogeny of the genus Euplotes. Using the molecular phylogenetic tree, we inferred aspects of the biogeographical history of the genus and the evolution of its most important taxonomic characters in order to provide a frame for future descriptions. Ultimately, these data reveal recurrent trends of freshwater invasion and highlight the dynamic, yet convergent, morphological evolution of Euplotes., Competing Interests: The authors have declared that no competing interests exist.

Background: The aims of this study were to assess the levels of knowledge, attitudes and behaviors of women about the main maternal risk factors in pregnancy and to identify the factors linked to the main outcomes of interest., Materials and Methods: A cross-sectional survey was conducted in 513 pregnant women randomly selected from the gynecological ambulatory services of five hospitals located in Naples, Italy., Results: Only 42% of women correctly knew all the main maternal risk factors in pregnancy (alcohol, smoking, passive smoking and obesity). Only 21.7% of women were very worried about causing harm to the fetus or child with their risk behaviors, and 22.3% of women reported smoking during pregnancy. Approximately one-third of women (28.9%) reported regularly drinking alcohol before pregnancy and 74.8% of these women reported stopping drinking alcohol during pregnancy. However, only 27.3% of women who were drinking alcohol during pregnancy had the intention of stopping. Only 43.7% of women indicated that during ambulatory gynecological examinations they received information from physicians about the possible damage resulting from all the main risk factors in pregnancy (alcohol, smoking, passive smoking and obesity)., Conclusion: The results indicate that pregnant women lack knowledge regarding the main maternal risk factors. Pregnant women claim to receive little information during gynecological examinations and, therefore, some continue to smoke and drink alcohol during pregnancy. Our results suggest an urgent need for the design of interventions to improve women's levels of knowledge and to promote appropriate behavior in relation to the major risk factors in pregnancy.

Background: The objectives of the study were to investigate the level of knowledge, attitudes, and behaviors regarding antibiotics of the general population in Italy, and to assess the correlates of these outcomes of interest., Methods: A cross-sectional survey was conducted on a random sample of 630 parents of students attending nine randomly selected public primary and secondary schools. A self-administered questionnaire included questions on demographic characteristics, knowledge about antibiotic use and resistance, attitudes and behaviors towards antibiotic use, and sources of information., Results: A total of 419 parents participated. Only 9.8% knew the definition of antibiotic resistance and 21.2% knew when it was appropriate to use antibiotics. Respondents with higher education, employed, with a family member working in the health care sector, and with no need for additional information on antibiotics were more likely to know the definition of antibiotic resistance. One third (32.7%) self-classified them as users of self-medication with antibiotics and those with a lower self-rated health status, who did not use the physician as source of information on antibiotics, and who have attended a physician in the last year were more likely to use self-medication. One-fourth (22.7%) of those who had never been self-medicated would be willing to take an antibiotic without a prescription of a physician. Respondents were more likely to be willing to take antibiotics without a prescription if they were under 40 years of age, if they had a lower self-rated health status, if they did not know that antibiotics are not indicated for treating flu and sore throat, and if they knew that antibiotics are not indicated for treating colds., Conclusions: The survey has generated information about knowledge, attitudes, and behaviors regarding antibiotics in the general population and effective public education initiative should provide practical and appropriate means to change their behavior.

Background: Older people often need comprehensive treatment, including many medications, and polypharmacy is common. The aims of this cross-sectional investigation were to examine the potentially inappropriate medication during the hospitalization and to identify the factors that may influence such inappropriateness among elderly in Italy., Methods: A sample of 605 individuals aged 65 years and older admitted in non-academic public acute care hospitals was randomly selected. Prescription of inappropriate medications were evaluated during the period from the day of admission to a randomly preselected day (index day). Beers Criteria were used to evaluate appropriateness., Results: At least one potentially inappropriate medication prescription from the day of hospital admission to the index day has been observed in 188 patients (31.1%), and respectively 84.1% and 15.9% of them had received one or two inappropriate medications. A total of 15 medications was prescribed inappropriately to these 188 patients, for 215 times with a total of 1143 doses. The multivariate logistic regression analysis revealed that the significant predictors for having at least one potentially inappropriate medication prescription during the hospitalization were: patients having an elementary education level, a lower pre-admission performance-based measure of basic activities of daily living, having received an inappropriate drug before the hospitalization, a hospital stay in the general and in the specialties surgical wards, a longer length of hospital stay from the admission to the index day, and having received a higher number of drugs from the day of the hospital admission to the index day. The most prevalent inappropriate medications administered were ketorolac (27.4%), amiodarone (19.1%), and clonidine (11.2%)., Conclusions: This study supports the need for clinical guidelines implementation to assist physicians in choosing the most appropriate drugs for the elderly and for effective education of all physicians.

Background: The appropriate use of antibiotics prophylaxis in the prevention and reduction in the incidence of surgical site infection is widespread. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy) and the factors associated with a poor adherence., Methods: A sample of 382 patients admitted to 23 surgical wards and undergoing surgery in five hospitals were randomly selected., Results: Perioperative antibiotic prophylaxis was appropriate in 18.1% of cases. The multivariate logistic regression analysis showed that patients with hypoalbuminemia, with a clinical infection, with a wound clean were more likely to receive an appropriate antibiotic prophylaxis. Compared with patients with an American Society of Anesthesiologists (ASA) score ≥4, those with a score of 2 were correlated with a 64% reduction in the odds of having an appropriate prophylaxis. The appropriateness of the timing of prophylactic antibiotic administration was observed in 53.4% of the procedures. Multivariate logistic regression model showed that such appropriateness was more frequent in older patients, in those admitted in general surgery wards, in those not having been underwent an endoscopic surgery, in those with a higher length of surgery, and in patients with ASA score 1 when a score ≥4 was chosen as the reference category. The most common antibiotics used inappropriately were ceftazidime, sultamicillin, levofloxacin, and teicoplanin., Conclusions: Educational interventions are needed to improve perioperative appropriate antibiotic prophylaxis.

Background: This cross-sectional study assessed the frequency of discrimination, harassment, and violence and the associated factors among a random sample of 1000 lesbian, gay men, and bisexual women and men recruited from randomly selected public venues in Italy., Methods: A face-to-face interview sought information about: socio-demographics, frequency of discrimination, verbal harassment, and physical and sexual violence because of their sexual orientation, and their fear of suffering each types of victimization., Results: In the whole sample, 28.3% and 11.9% self-reported at least one episode of victimization because of the sexual orientation in their lifetime and in the last year. Those unmarried, compared to the others, and with a college degree or higher, compared to less educated respondents, were more likely to have experienced an episode of victimization in their lifetime. Lesbians, compared to bisexual, had almost twice the odds of experiencing an episode of victimization. The most commonly reported experiences across the lifetime were verbal harassment, discrimination, and physical or sexual violence. Among those who had experienced one episode of victimization in their lifetime, 42.1% self-reported one episode in the last year. Perceived fear of suffering violence because of their sexual orientation, measured on a 10-point Likert scale with a higher score indicative of greater fear, ranges from 5.7 for verbal harassment to 6.4 for discrimination. Participants were more likely to have fear of suffering victimization because of their sexual orientation if they were female (compared to male), lesbian and gay men (compared to bisexual women and men), unmarried (compared to the others), and if they have already suffered an episode of victimization (compared to those who have not suffered an episode)., Conclusions: The study provides important insights into the violence experiences of lesbian, gay men, and bisexual women and men and the results may serve for improving policy initiatives to reduce such episodes.

Background: One quality indicator of hospital care, which can be used to judge the process of care, is the prevalence of hospital readmission because it reflects the impact of hospital care on the patient's condition after discharge. The purposes of the study were to measure the prevalence of hospital readmissions, to identify possible factors that influence such readmission and to measure the prevalence of readmissions potentially avoidable in Italy., Methods: A sample of 2289 medical records of patients aged 18 and over admitted for medical or surgical illness at one 502-bed community non-teaching hospital were randomly selected., Results: A total of 2252 patients were included in the final analysis, equaling a response rate of 98.4%. The overall hospital readmission prevalence within 30 days of discharge was 10.2%. Multivariate logistic regression analysis revealed that the proportion of patients readmitted within 30 days of discharge significantly increased regardless of Charlson et al. comorbidity score, among unemployed or retired patients, and in patients in general surgery. A total of 43.7% hospital readmissions were judged to be potentially avoidable. Multivariate logistic regression analysis showed that potentially avoidable readmissions were significantly higher in general surgery, in patients referred to hospital by an emergency department physician, and in those with a shortened time between discharge and readmission., Conclusion: Additional research on intervention or bundle of interventions applicable to acute inpatient populations that aim to reduce potentially avoidable readmissions is strongly needed, and health care providers are urged to implement evidence-based programs for more cost-effective delivery of health care.

Background: This cross-sectional study assess knowledge, attitudes, and behavior towards the human papillomavirus (HPV) and the vaccination among a random sample of 1000 lesbian, gay men, and bisexual women and men., Methods: A face-to-face interview sought information about: socio-demographic characteristics, knowledge about HPV infection, perception of risk towards HPV infection and/or cervical, anal, and oropharyngeal cancers, perception of the benefits of a vaccination to prevent cervical, anal, and oropharyngeal cancers, sexual behaviors, health-promoting behaviors, and willingness to receive the HPV vaccine., Results: Only 60.6% had heard about the HPV infection and this knowledge was significantly higher in female, in those being a member of a homosexual association, in those having had the first sexual experience at a younger age, in those having received information about the HPV infection from physicians, and in those having no need of information about HPV infection. A higher perceived risk of contracting HPV infection has been observed in those younger, lesbian and gay men, who have heard of HPV infection and knew the risk factors and its related diseases, who have received information about HPV infection from physicians, and who need information about HPV infection. Only 1.7% have undergone HPV immunization and 73.3% professed intent to obtain it in the future. The significant predictors of the willingness to receive this vaccine were belief that the vaccination is useful, perception to be at higher risk of contracting HPV infection, and perception to be at higher risk of developing cervical, anal, and oropharyngeal cancers., Conclusions: Information and interventions are strongly needed in order to overcome the lack of knowledge about HPV infection and its vaccination. Inclusion of boys in the national vaccination program and initiate a catch-up program for men who have sex with men up to 26 years may reduce their burden of HPV-related disease.