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Human attention is naturally directed where others are looking. Primate research indicates that this phenomenon is influenced by the social rank of the gazer. Whether this applies to human societies remains underexplored. Diverging from the typical approach based on transient social rank manipulations in convenience samples, we tested low- and high-rank individuals permanently working in a large-scale organization. Participants executed saccades toward positions matching or not the gaze direction of distractor faces varying in dominance level (low, neutral, and high). The analysis of saccadic reaction time revealed that high-rank participants were more interfered by face distractors, regardless of dominance. Our results suggest that an important feature of leadership is related to the fine-tuning of social attention. These findings not only contribute to understanding how hierarchical rank shapes social cognition but also have implications for organizational behavior and leadership training strategies., Competing Interests: The authors declare no competing interests., (© 2024 The Author(s).)

The term Proteus effect refers to the changes in attitudes and behavior induced by the characteristics of an embodied virtual agent. Whether the effect can extend to the moral sphere is currently unknown. To deal with this issue, we investigated if embodying virtual agents (i.e., avatars) with different characteristics modulate people's moral standards differentially. Participants were requested to embody an avatar resembling the Christian God in His anthropomorphic appearance or a control human avatar and to perform a text-based version of incidental and instrumental dilemmas in a virtual environment. For each participant, we recorded (1) chosen options (deontological vs. utilitarian), (2) decision times, (3) postdecision feelings, and (4) physiological reactions (skin conductance response and heart rate). We found that embodying God vs. a control avatar did not change the performance in the moral dilemma task, indicating that no strong Proteus effect was at play in our experimental conditions. We interpreted this result by examining the constraints and limitations of our task, reasoning about the necessary conditions for eliciting the Proteus effect, and discussing future developments and advances in the field. Moreover, we presented compelling effects concerning dilemma type, chosen option, personality traits, and religion affiliation, thus supporting and extending literature on decision making in moral dilemmas.

Objectives: the objective of this review is to give an overall view of the knowledge on COVID-19 bivalent vaccines and to explore the available real-world evidence on their effectiveness in the Omicron era. Currently, bivalent vaccines are generally offered to all groups eligible for their next booster, as defined by the national vaccination campaigns, with varying policies between countries.The use of bivalent vaccines is supported by immunogenity studies, but these have produced contradictory conclusions and are not generally designed to measure clinical impact., Design: in order to critically evaluate the available research on real-world efficacy, a systematic literature search was performed; three different web engines were used, including early-stage search platforms: PubMed, medRxiv and the Global research on coronavirus disease (COVID-19) database., Setting: no restrictions were imposed on language, setting or publication date. The research was last updated on 20 March 2023., Main Outcome Measures: the following outcomes were considered: infection, hospitalisation due to COVID-19 disease, admission to the emergency/urgency department, death. The following were considered as additional outcomes: variant-specific vaccine effectiveness; vaccine effectiveness waning over time., Results: out of 876 references reviewed, 14 studies were finally included and extracted. The results of this review show modest to moderate additional protection from vaccination with bivalent BA.4-5 or BA.1 vaccines mRNA-booster against COVID-19-associated disease - Relative VE% ranging from 8 (95% CI 0-16) to 58.7 (95% 54.6-62.5)- and hospitalisation - Relative VE% ranging from 32.2 (2.5-60.1) to 80.5 (95% CI 69.5-91.5)-, when compared with a booster with a monovalent vaccine or with having completed only the primary course, during a period when BA.5 and other Omicron sublineage viruses predominated globally., Conclusions: the additional benefit of bivalent booster vaccines - compared to one or two monovalent booster vaccinations or compared to the primary course alone - in the prevention of SARS-CoV-2 Omicron infection appears to be small, especially in persons with previous Omicron infection, whereas modest to moderate protection from vaccination with bivalent BA.4-5 or BA.1 mRNA-booster vaccines as a fourth dose against COVID-19-associated illness and hospitalisation has been reported.

In two studies we aimed at developing the Attitude towards Italian Mafias Scale (AIMS). In study 1 ( N  = 292) we used an Exploratory Factor Analysis to reduce the number of the items and explore their latent constructs. In study 2 ( N  = 393) we performed a Confirmatory Factor Analysis on the resulting 18-item questionnaire, whose latent structure was best identified by a general factor Mafia Attitude and three specific factors related to Behaviors, Cognitions and Emotions-Cognitions towards mafias. Moreover, we showed that the AIMS has (i) discriminant validity compared to a measure of attitudes towards crime, (ii) predictive validity of donation behavior to an association against mafias, (iii) internal consistency, and (iv) invariance for people of the five deep-rooted mafia regions of Southern Italy and those from the rest of Italy. Finally, we observed a difference between the participants from the five deep-rooted mafia regions ( i.e. , Apulia, Basilicata, Calabria, Campania, Sicily) and the rest of Italy, with the former having surprisingly more negative attitudes towards mafias compared to the latter. The AIMS might help to reliably survey people's sentiment towards Italian mafias and promote targeted and effective law-related education interventions., Competing Interests: Marco Tullio Liuzza is an Academic Editor for PeerJ., (©2023 Schepisi et al.)

Immersive virtual reality can give people the illusion of owning artificial bodies (i.e., avatars) and controlling their actions. Tellingly, people appear to adhere to the newly embodied entities not just on the basis of physical traits but also behaving accordingly with the hallmarks of the represented characters. In two studies we pushed the limits of this process by testing if one's own sense of power could be affected by embodying the anthropomorphic representation of the Christian God, that is considered an omnipotent entity. A human Muscled and a Normotype avatar were used as controls. Results showed that participants embodying the God-avatar: (i) reacted to a threatening event compromising their physical safety by exhibiting a lower skin conductance response and heart rate deceleration compared to the Normotype-control avatar (Study 1); (ii) estimated they had more physical abilities compared to both the Normotype-control and the Muscled-control avatars (Study 2). Taken together, our findings suggest that embodying an omnipotent agent may exert an influence on people's perception of their own limits and capabilities, nourishing feelings of physical invulnerability and strength. Our study indicates that effectively embodying virtual role models may boost achievements and have translational implications in the field of empowerment., (© 2022. The Author(s).)

Background: This meta-analysis aims to assess the effectiveness of the current Sars-Cov2 vaccine regimens against Omicron infection. A secondary endpoint aims to investigate the waning effectiveness of primary vaccination against symptomatic infection and related hospitalization., Research Design and Methods: The systematic review started on 1 December 2021 and was concluded on 1 March 2022. Random-effects frequentist meta-analyses and multiple meta-regressions were performed., Results: In total, 15 studies are included in the quantitative synthesis. According to the meta-analysis results, the overall risk of Sars-Cov2 infection in vaccinated individuals is on average 31 · 5% lower than the infection risk in unvaccinated while vaccinated with one booster dose have a 70 · 4% risk reduction of Omicron infection compared to unvaccinated. In particular, one booster dose significantly decreases by 69% the risk of symptomatic Omicron infection with respect to unvaccinated. Six months after the primary vaccination, the average risk reduction declines to 22% against symptomatic infection and to 55% against hospitalization., Conclusions: Primary vaccination does not provide sufficient protection against symptomatic Omicron infection. Although the effectiveness of the primary vaccination against hospitalization due to Omicron remains significantly above 50% after 3 months, it dramatically fades after 6 months.

People differ in their general tendency to endorse conspiracy theories (that is, conspiracy mentality). Previous research yielded inconsistent findings on the relationship between conspiracy mentality and political orientation, showing a greater conspiracy mentality either among the political right (a linear relation) or amongst both the left and right extremes (a curvilinear relation). We revisited this relationship across two studies spanning 26 countries (combined N = 104,253) and found overall evidence for both linear and quadratic relations, albeit small and heterogeneous across countries. We also observed stronger support for conspiracy mentality among voters of opposition parties (that is, those deprived of political control). Nonetheless, the quadratic effect of political orientation remained significant when adjusting for political control deprivation. We conclude that conspiracy mentality is associated with extreme left- and especially extreme right-wing beliefs, and that this non-linear relation may be strengthened by, but is not reducible to, deprivation of political control., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

BackgroundSeveral SARS-CoV-2 variants of concern (VOC) have emerged through 2020 and 2021. There is need for tools to estimate the relative transmissibility of emerging variants of SARS-CoV-2 with respect to circulating strains.AimWe aimed to assess the prevalence of co-circulating VOC in Italy and estimate their relative transmissibility.MethodsWe conducted two genomic surveillance surveys on 18 February and 18 March 2021 across the whole Italian territory covering 3,243 clinical samples and developed a mathematical model that describes the dynamics of co-circulating strains.ResultsThe Alpha variant was already dominant on 18 February in a majority of regions/autonomous provinces (national prevalence: 54%) and almost completely replaced historical lineages by 18 March (dominant across Italy, national prevalence: 86%). We found a substantial proportion of the Gamma variant on 18 February, almost exclusively in central Italy (prevalence: 19%), which remained similar on 18 March. Nationally, the mean relative transmissibility of Alpha ranged at 1.55-1.57 times the level of historical lineages (95% CrI: 1.45-1.66). The relative transmissibility of Gamma varied according to the assumed degree of cross-protection from infection with other lineages and ranged from 1.12 (95% CrI: 1.03-1.23) with complete immune evasion to 1.39 (95% CrI: 1.26-1.56) for complete cross-protection.ConclusionWe assessed the relative advantage of competing viral strains, using a mathematical model assuming different degrees of cross-protection. We found substantial co-circulation of Alpha and Gamma in Italy. Gamma was not able to outcompete Alpha, probably because of its lower transmissibility.

(1) Background: The objective of this study was to assess the effectiveness of SARS-CoV-2 vaccines in terms of prevention of disease and transmission in the pre-Delta era. The evaluation was narrowed to two mRNA vaccines and two modified adenovirus-vectored vaccines. (2) Methods: The overall risk of any SARS-CoV-2 infection confirmed by positive real-time Polymerase Chain Reaction (PCR) test was estimated in partially and fully vaccinated individuals. The evidence synthesis was pursued through a random-effects meta-analysis. The effect size was expressed as relative risk (RR) and RRR (RR reduction) of SARS-CoV-2 infection following vaccination. Heterogeneity was investigated through a between-study heterogeneity analysis and a subgroup meta-analysis. (3) Results: The systematic review identified 27 studies eligible for the quantitative synthesis. Partially vaccinated individuals presented a RRR = 73% (95%CI = 59-83%) for positive SARS-CoV-2 PCR (RR = 0.27) and a RRR=79% (95%CI = 30-93%) for symptomatic SARS-CoV-2 PCR (RR = 0.21). Fully vaccinated individuals showed a RRR = 94% (95%CI = 88-98%) for SARS-CoV-2 positive PCR (RR = 0.06) compared to unvaccinated individuals. The full BNT162b2 vaccination protocol achieved a RRR = 84-94% against any SARS-CoV-2-positive PCR and a RRR = 68-84% against symptomatic positive PCR. (4) Conclusions: The meta-analysis results suggest that full vaccination might block transmission. In particular, the risk of SARS-CoV-2 infection appeared higher for non-B.1.1.7 variants and individuals aged ≥69 years. Considering the high level of heterogeneity, these findings must be taken with caution. Further research on SARS-CoV-2 vaccine effectiveness against emerging SARS-CoV-2 variants is encouraged.

Italy, Greece, Spain, and Portugal have all been strongly affected by the 2008 financial crisis, which has had a negative impact on health. We systematically evaluated the effects of the crisis on lifestyle and socioeconomic inequalities. We conducted a literature search using MEDLINE, Embase, the Cochrane Library, and health economics databases for studies reporting quantitative comparisons before and after (or during) the crisis on the following risk behaviors: alcohol consumption, smoking habit, healthy diet, physical activity, and psychotropic drugs and substance abuse, without setting any age restrictions. We selected 34 original articles published between 2011 and 2020. During/after the crisis, alcohol consumption and substance abuse decreased, while psychotropic drug use increased. We also observed a deterioration in healthy eating behavior, with a reduction in fruit and vegetable consumption. Smoking habit and physical activity showed a more complex, controversial trend. Socioeconomic inequalities were affected by the recession, and the negative effects on unhealthy lifestyle tended to be more pronounced among the disadvantaged. These results suggest the need to implement health policies and interventions aimed at monitoring risk behaviors, with special regard to disadvantaged people, and considering the potential additional impact of the COVID-19 pandemic.

The decision to lie to another person involves a conflict between one's own and others' interest. Political ideology may foster self-promoting or self-transcending values and thus may balance or fuel self vs. other related conflicts. Here, we explored in politically non-aligned participants whether oculomotor behavior may index the influence on moral decision-making of prime stimuli related to left and right-wing ideologies. We presented pictures of Italian politicians and ideological words in a paradigm where participants could lie to opponents with high vs. low socio-economic status to obtain a monetary reward. Results show that left-wing words decreased self-gain lies and increased other-gain ones. Oculomotor behavior revealed that gazing longer at politicians' pictures led participants to look longer at opponent's status-related information than at game's outcome-related information before the decision. This, in turn, caused participants to lie less to low status opponents. Moreover, after lying, participants averted their gaze from high status opponents and maintained it towards low status ones. Our results offer novel evidence that ideological priming influences moral decision-making and suggest that oculomotor behavior may provide crucial insights on how this process takes place.

Using different evaluation targets (i.e., politicians' pictures, ideological words, items referring to features attributed to political ingroup/outgroup) we characterized the intergroup bias among political groups in the Italian context (Study 1-2-3) and tested a model that may account for the bias itself (Study 3). For all evaluation targets, left-wing participants - compared to right-wing participants - showed a greater intergroup bias, expressing more negative emotions toward the outgroup. The process was influenced by a greater perceived threat of the outgroup. Conversely, right-wing participants expressed the bias only when presented with ideological words. Our results provide a detailed description of how intergroup bias in Italy is differently expressed by the two ideological groups depending on the targets used to represent the political counterpart. Moreover, the results show that the stronger bias expressed by left-wing participants is driven by perceived threat of the outgroup.

Background: The growing burden of diabetes mellitus (DM) is posing a threat to global tuberculosis (TB) control. DM triples the risk of developing TB, modifies the presenting features of pulmonary TB, and worsens TB treatment outcomes. We aimed to analyze the prevalence of DM among TB patients and to describe the characteristics and clinical presentation of TB-DM patients in Europe., Methods: We performed a cross-sectional survey on the prevalence of DM among consecutively diagnosed adult TB patients in 11 European TB referral centers located in France, Germany, Greece, Italy, Russia, Slovakia, Spain, and the United Kingdom over the period 2007-2015. We also selected DM-TB cases and TB only controls with a 1:3 ratio to perform a case-control analysis, including patients selected from the countries mentioned above plus Norway and Ukraine., Results: Among 3143 TB enrolled patients, DM prevalence overall was 10.7% and ranged from 4.4% in Greece to 28.5% in the United Kingdom. Patients' median ages ranged from 36 to 49 years, and all centers had >60% males; the proportion of foreign-born patients varied widely across sites. In the case-control study, DM was independently associated with older age and, among older patients, with being foreign-born. Among patients with pulmonary involvement, cavities on chest imaging were more frequently observed among those with DM., Conclusions: Diabetes mellitus represents a challenge for TB control in Europe, especially in foreign-born and in elderly patients. Specific screening strategies should be evaluated.

The convergence between tuberculosis (TB) and diabetes mellitus (DM) will represent a major public health challenge in the near future. DM increases the risk of developing TB by two to three times and also increases the risk of TB treatment failure, relapse, and death. The global prevalence of DM is predicted to rise significantly in the next two decades, particularly in some of the low- and middle-income countries with the highest TB burden. Migration may add further complexity to the effort to control the impact on TB of the growing DM pandemic. Migration may increase the risk of DM, although the magnitude of this association varies according to country of origin and ethnic group, due to genetic factors and lifestyle differences. Migrants with TB may have an increased prevalence of DM compared to the native population, and the risk of TB among persons with DM may be higher in migrants than in autochthonous populations. Screening for DM among migrants, screening migrants with DM for active and latent TB, and improving access to DM care, could contribute to mitigate the effects of DM on TB., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Between June 2012 and December 2013 Médecins Sans Frontières launched a pilot project with the aim of testing a strategy for improving timely diagnosis of active pulmonary TB among migrants hosted in four centres of identification and expulsion (CIE) in Italy., Methods: This is a descriptive study. For active TB case finding we used an active symptom screening approach among migrants at admission in four CIE's. Here we describe the feasibility and the yield of this programme., Results: Overall, 3588 migrants were screened, among whom 87 (2.4%) had a positive questionnaire. Out of 30 migrants referred for further investigations, three were diagnosed as having TB, or 0.1% out of 3588 individuals that underwent screening. Twenty-five (29%, 25/87) migrants with positive questionnaires were not referred for further investigation, following the doctors' decision; however, for 32 (37%, 32/87) migrants the diagnostic work-out was not completed. In multivariate analyses, being over 35 years (OR 1.7; 95% CI 1.1-2.6) and being transgender (OR 4.9; 95% CI 2.1-11.7), was associated with a positive questionnaire., Conclusions: TB screening with symptom screening questionnaires of migrants at admission in closed centres is feasible. However, to improve the yield, follow-up of patients with symptoms or signs suggestive for TB needs to be improved., (© The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3-4 month isoniazid plus rifampicin; or 3-4 month rifampicin alone., (Copyright ©ERS 2015.)

Background: In Italy the proportion of cases of tuberculosis in persons originating from high-prevalence countries has been increasing in the last decade. We designed a study to assess adherence to and yield of a tuberculosis screening programme based on symptom screening conducted at primary care centres for regular and irregular immigrants and refugees/asylum seekers., Methods: Presence of symptoms suggestive of active tuberculosis was investigated by verbal screening in migrants presenting for any medical condition to 3 free primary care centres in the province of Rome. Individuals reporting at least one symptom were referred to a tuberculosis clinic for diagnostic workup., Results: Among 2142 migrants enrolled, 254 (11.9%) reported at least one symptom suggestive of active tuberculosis and 176 were referred to the tuberculosis clinic. Of them, 80 (45.4%) did not present for diagnostic evaluation. Tuberculosis was diagnosed in 7 individuals representing 0.33% of those screened and 7.3% of those evaluated for tuberculosis., Conclusion: The overall yield of this intervention was in the range reported for other tuberculosis screening programmes for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population. Further evaluation of this approach appears to be warranted.

The study was aimed to evaluate the malaria over/underdiagnosis and over/underprescription of antimalarial drugs. Between February and March 2007 blood samples were collected from 336 non-severe febrile outpatients attended in two peripheral Tanzanian hospitals. Microscopy and a rapid diagnostic test (RDT) were done locally and the accuracy evaluated by qualitative polymerase chain reaction (PCR) for Plasmodium spp. The testing was performed at National Institute for Infectious Diseases Lazzaro Spallanzani (INMI), Rome, Italy. As a result of PCR, we identified 26 malaria cases out of 336 (7.7%) patients. Microscopy and RDT accuracies were 93.5% and 97.6%, respectively. Overprescription and underdiagnosis rates were 29.3% and 30.8%, respectively. On-field training, clinical management of febrile illness, and malaria microscopy in remote settings should be considered.