Microwave ablation followed by cTACE in 5-cm HCC lesions: does a single-session approach affect liver function?

PURPOSE: Microwave ablation (MWA) and conventional transarterial chemoembolization (cTACE) are locoregional treatments commonly performed in very early, early and intermediate stages of hepatocellular carcinoma (HCC). Despite combined locoregional approaches have shown encouraging results in obtaining complete tumor necrosis, their application in a single session is poorly described. Our aim was to evaluate the safety and efficacy of single-session MWA and cTACE treatment in 5-cm HCCs and its influence on liver function. MATERIALS AND METHODS: All 5-cm HCCs treated by MWA and cTACE performed in a single-session in our Interventional Radiology unit between January 2020 and December 2022 were retrospectively recorded and analyzed. Patients with poor or missing pre- and post-treatment imaging were excluded. Technical success, clinical success, and complications rate were examined as primary endpoints. Pre- and post-treatment liver function laboratory parameters were also evaluated. RESULTS: A total of 15 lesions (mean lesion diameter, 5.0 ± 1.4 cm) in 15 patients (11 men; mean age, 67.1 ± 8.9 years) were retrospectively evaluated. Technical and clinical success were 100% and 73%, respectively. Four (27%) cases of partial response and no cases of progressive or stable disease were recorded. AST and ALT values have found to be significantly higher in post-treatment laboratory tests. No other significant differences between pre- and post-treatment laboratory values were registered. AST and ALT pre- and post-treatment higher differences (ΔAST and ΔALT) were significantly associated with a lower clinical success rate. CONCLUSION: MWA and cTACE single-session approach is safe and effective for 5-cm HCCs, without significant liver function impairment. A post-treatment increase in AST and ALT values may be a predictor for clinical failure.

Lifestyles and Quality of Life of People with Mental Illness During the COVID-19 Pandemic.

The COVID-19 pandemic has had a significant impact on the quality of life (QoL), daily lifestyle, and mental health of people suffering from a mental disorder. This study aimed to investigate the effects of the prolongation of the COVID-19 emergency on QoL and lifestyles in a sample of 100 outpatients at the Psychiatry Unit in Palermo University Hospital, Italy. QoL was measured through the 12-item Short Form Survey and the COV19-Impact on Quality of Life. Lifestyle changes during the pandemic were measured through the lifestyle change questionnaire. The majority of participants reported a great impact of COVID-19 on the QoL, and almost half reported worsened lifestyles. Worsened lifestyles were predictive of both poor mental and physical health related QoL. These results suggest that people with mental illness need interventions targeting lifestyles, and the mental health service in Italy should adjust to the ongoing pandemic, developing virtual treatments.

Green-sustainable extraction techniques for the recovery of antioxidant compounds from "citrus Limon" by-products.

In this work, optimized techniques of conventional, ultrasound and microwave-assisted extraction were applied for the recovery of antioxidant compounds from lemon by-products (Citrus limon L). Specifically, the effect of solvent, temperature, microwave power, time and their interaction on the extraction was investigated. Among the tested solvents, the hydroalcoholic mixture (ethanol:water, 50:50) was the optimal one for all extraction techniques: in particular assisted by ultrasounds at 70 °C for 30 minutes (total phenolic content: 6.93 mg GAE g-1, total flavonoids: 2.07 mg CE g-1, ABTS assay: 18.36 µM TE g-1). Also, the other techniques allowed to obtain valuable extracts, although with relative lower amounts. The analyses of individual phenols revealed hesperidin and eriocitrin as the main compounds (respectively about 1650 and 1150 mg kg-1) after ultrasound assisted and conventional extraction. Results of this work can be useful to valorize an industrial by-product by sustainable techniques for the high-added value substances recovery.

Chemical Composition and Cytotoxic Evaluation of the Essential Oil of Phyllogonium viride (Phyllogoniaceae, Bryophyta).

The present study aimed to determine the chemical composition and biological activity of the essential oil obtained from Phyllogonium viride Brid. (Phyllogoniaceae, Bryophyta), whose samples were collected in southern Brazil. For the first time, the cytotoxic activity of the essential oil of P. viride in breast and colorectal tumor cells (MCF-7 and HCT-116) was evaluated, as well as the cytotoxic potential of this oil in non-tumoral cells of human immortalized keratinocytes (HaCaT) via MTT assay. The compounds majorly found in P. viride essential oil were ß-bazzanene (20.30 %), ß-caryophyllene (17.06 %), ß-chamigrene (14.02), and germacrene B (11.72 %). Treatment with P. viride essential oil in the different tested cell lines did not induce any toxicity in most of the tested concentrations. These data contribute to generating new scientific information about this understudied plant species. Furthermore, the chemical characterization of the compounds present in the essential oil of P. viride can lead to greater elucidation of its biotechnological potential.

Antioxidant quantification in different portions obtained during olive oil extraction process in an olive oil press mill.

BACKGROUND: Different antioxidant compounds are generally transferred from olives to olive oil during the production process. This work characterized the principal total bioactive compounds (tocopherols and phenols) in olives, olive oil and by-products of four cultivars grown in Calabrian areas (southern Italy), considering the effect of harvesting period. Antioxidant capacity, total and individual phenolic compounds were also analysed. RESULTS: Drupes, olive paste, pomace and olive wastewater showed similar phenolic compounds, while olive oil possessed a different composition, suggesting that phenols are not only transferred from drupe to oil, but also they change during oil production. Tocopherols varied among cultivars and harvesting period: generally, they were more abundant in samples produced in the first harvesting period. Qualitative and quantitative differences in phenolic composition and antioxidant activity were significantly found among cultivars in all the matrices. CONCLUSION: The highest amount of total phenolic antioxidants ended up in olive wastewater with variability due to the olive cultivar, while only a small part of them finished in the oil. This work shows evidence that the availability of bioactive compounds in different portions from the olive oil extraction belong to different varietal origins. In particular, new information was acquired on Ottobratica Calipa, a new olive clone, that produced an olive oil with an interesting antioxidant amount. © 2020 Society of Chemical Industry.

Urgent Psychiatric Consultations at Mental Health Center during COVID-19 Pandemic: Retrospective Observational Study.

The coronavirus pandemic and related social distancing measures have brought about dramatic changes in people's lives. In particular, health workers have been forced to change their activities both for the different needs of patients and for preventive measures against the spread of the virus. This study is aimed at comparing the urgent psychiatric consultations (UPC) performed at the outpatient Mental Health Center (MHC) of Modena during the coronavirus outbreak period, from 1 March to 31 August 2020, with the same period in 2019. We retrospectively collected in a database the demographic and clinical characteristics of patients who required UPC in the MHC during the 6-month observation periods in both 2019 and 2020. Data were statistically analyzed. We analyzed 656 urgent psychiatric consultations in 2019 and 811 in 2020, requested by 425 patients in 2019 and 488 in 2020, respectively. In the pandemic period, we observed an increase in the total and daily number of UPC which were more frequently required by patients in care at local outpatient services in comparison with the previous period. During 2020, an increased number of UPC was carried out remotely and the outcome was more frequently represented by discharge at home, avoiding hospitalization as much as possible. In the course of the coronavirus pandemic, MHC had to face an increased demand for clinical activity especially from the most clinically and socially vulnerable patients, who more frequently required UPC in outpatient psychiatric services.

Antineoplastic potential and chemical evaluation of essential oils from leaves and flowers of Tagetes ostenii Hicken.

Breast and cervical cancer represent a major problem of women's global public health. Here, we investigated the chemical composition of essential oils from leaves and flowers of T. ostenii and the antineoplastic potential in a cervical cancer and breast cancer cell line, SiHa and MCF-7; and non-tumoral cells, HaCat. The chemical analysis revealed a predominance of oxygenated monoterpenes in both essential oils. The IC50 after 24 h of treatment was 72 ng/mL for EO 1 and 83 ng/mL for EO 2 in SiHa cells. For MCF-7 the IC50 was 174.3 ng/mL for EO 1. For HaCat cells it was 54.45 ng/mL for EO 1 and 20.83 ng/mL for EO 2. A synergistic effect with both essential oils and cisplatin was also verified. SiHa cells had their wound healing capacity reduced after 48 h of treatment with EO 2 and both essential oils were able to significantly inhibit the adhesion process and clonogenic ability after 24 h of treatment. Our results suggest a long-lasting inhibitory activity in SiHa cells because of the low recovery capacity of cells after treatment withdrawal. Flow cytometer with annexin V/propidium iodide demonstrated a majority cell death through late apoptosis after 24, 48 and 72 hours of treatment.

Quality of shredded carrots minimally processed by different dipping solutions.

The whiteness of shredded carrots is generally caused by enzymatic reactions after removal of natural protection during the minimal processing. Moreover, the use of chlorinated solution in sanitizing step of processing, promotes the formation of halogenated by-products, with correlated environmental and health risks in processing areas. This study investigated the effect of different acidic solutions on the quality of shredded carrots during the storage at two refrigerated temperatures (4 °C and 7 °C), as alternative agents to chlorine in food industry. Carrots dipped in 1.5% citric acid solution did not present colour variation at both storage temperatures. Moreover they showed the lowest microbial charge after processing and during storage at 4 °C. Carrots dipped in 0.5% citric acid + 0.05% ascorbic acid + 0.05% calcium chloride evidenced lower PAL and POD activities during the storage respect to the other tested samples. Therefore, the dipping of shredded carrots in acidic solutions, as alternative sanitizers to chlorine, contributed to preserve their quality, also controlling the whiteness index of carrots' surface. In particular, the dipping in 1.5% citric acid extended the shelf life of shredded carrots up to 14 days of storage at 4 °C.

Antioxidant activity shown by olive pomace extracts.

In this study, the effects of experimental variables such as type of solvent, sample/solvent ratio, and time of extraction have been evaluated to individuate the best results in phenolic recovery by Olive Pomaces (OP) belonging to Carolea and Ottobratica cultivars. Folin-Ciocaulteu procedure and DPPH and ABTS assays were used, respectively, for total phenol quantification and total antioxidant activity of pomace extracts. The ethanol/water mixture was resulted the most efficient extraction solvent for both olive cultivars. The highest amount of phenolic compounds (171 ± 4 mg of gallic acid 100 g-1 of dry pomace) was obtained after extraction at 120 min with 2:1 solvent/OP (v/w) of Ottobratica Olive Pomace. The recovery of phenol compounds from olive wastes increases the sustainability of sector, allowing obtaining an extract that could be a suitable alternative in the food industry to the use of synthetic antioxidants in order to improve the quality of foods.

Qualitative variations on Calabrian Provola cheeses stored under different packaging conditions.

Calabrian Provola cheese, an Italian typical dairy product, is commonly sold unwrapped with an expiry date of 45 d. The influence of different packagings and subsequent storage at 4 and 7 °C on maintaining cheese quality and prolonging its shelf life was evaluated. The following packaging systems were used: Polyamide/Polyethylene pouch under vacuum; Polyethylene/Polyethylene terephthalate lid over a Polyethylene/Ethylene vinyl alcohol/Polyvinyl Chloride + Polyvinyl alcohol thermoformed tray; Polyethylene/Ethylene vinyl alcohol/Polyamide/Polyethylene pouch. Concerning the two last systems, cheeses were packaged in a modified atmosphere (70:30 N2:CO2). All studied packaging prolonged Calabrian Provola cheese shelf life to 65 d. In particular, the packaging in modified atmosphere with Polyethylene/Ethylene vinyl alcohol/Polyamide/Polyethylene pouch preserved Provola cheeses best, not only showing a decrease of the original total microbial count but also showing the lowest peroxide value and hardness at both temperatures of storage. The results of this study will help local Italian firms to expand their business in more distant markets.

Ectonucleotidase expression profile and activity in human cervical cancer cell lines.

Cervical cancer is the third most frequent cancer in women worldwide. Adenine nucleotide signaling is modulated by the ectonucleotidases that act in sequence, forming an enzymatic cascade. Considering the relationship between the purinergic signaling and cancer, we studied the E-NTPDases, ecto-5'-nucleotidase, and E-NPPs in human cervical cancer cell lines and keratinocytes. We evaluated the expression profiles of these enzymes using RT-PCR and quantitative real-time PCR analysis. The activities of these enzymes were examined using ATP, ADP, AMP, and p-nitrophenyl-5'-thymidine monophosphate (p-Nph-5'-TMP) as substrate, in a colorimetric assay. The extracellular adenine nucleotide hydrolysis was estimated by HPLC analysis. The hydrolysis of all substrates exhibited a linear pattern and these activities were cation-dependent. An interesting difference in the degradation rate was observed between cervical cancer cell lines SiHa, HeLa, and C33A and normal imortalized keratinocytes, HaCaT cells. The mRNA of ecto-5'-nucleotidase, E-NTPDases 5 and 6 were detectable in all cell lines, and the dominant gene expressed was the Entpd 5 enzyme, in SiHa cell line (HPV16 positive). In accordance with this result, a higher hydrolysis activity for UDP and GDP nucleotides was observed in the supernatant of the SiHa cells. Both normal and cancer cells presented activity and mRNAs of members of the NPP family. Considering that these enzymes exert an important catalytic activity, controlling purinergic nucleotide concentrations in tumors, the presence of ectonucleotidases in cervical cancer cells can be important to regulate the levels of extracellular adenine nucleotides, limiting their effects.

Quality Evaluation of Bergamot Juice Produced in Different Areas of Calabria Region.

Citrus fruits are extensively cultivated worldwide, with Italy and Spain being major producers. In Southern Italy, particularly in Reggio Calabria, a typical citrus fruit is produced, namely, bergamot (Citrus bergamia Risso et Poiteau), known for its mysterious origins and exceptional quality essential oil protected by the EU's PDO (Protected Designation of Origin) designation. Despite historical challenges, bergamot has regained prominence for its nutraceutical potential, especially its flavonoid-rich juice, offering significant health benefits. However, little attention has been paid to understanding the qualitative and quantitative differences of bergamot juice in Calabrian production areas. For this reason, this work aims to investigate the quality characteristics of bergamot juice produced in different areas of Calabria sites. The results showed the best quality attributes of bergamot fruits harvested in the PDO area. In particular, higher levels of total soluble solids, stable acidity, and higher juice were found. In addition, higher contents of ascorbic and citric acids, which are nutritionally valuable and tasteful, were found. The phenolic profile, characterized by the key compounds of bergamot, highlighted the better nutraceutical potential of the fruit grown in the PDO area.

A Novel Use of Autologous Fibrin by Intracatheter Injection in Persistent Postoperative Biliary Defects: Technical Note on a Preliminary Experience.

PURPOSE: To introduce percutaneous selective injection of autologous platelet-rich fibrin as a novel technique for persistent bile leakage repair and sharing the results of our preliminary experience. MATERIALS AND METHODS: Seven patients (57.1% females; mean age 69.6 ± 8 years) with the evidence of persistent bile leak secondary to hepatobiliary surgery and ineffective treatment with percutaneous transhepatic biliary drainage were submitted to fibrin injection. Platelet-rich fibrin, a dense fibrin clot promoting tissue regeneration, was obtained from centrifuged patient's venous blood. Repeated percutaneous injections through a catheter tip placed in close proximity to the biliary defect were performed until complete obliteration at fistulography. Technical and clinical success were evaluated. RESULTS: Bile leaks followed pancreaticoduodenectomy in five and major hepatectomy in two patients. Technical success defined as fibrin injection at BD site was achieved in all seven patients, and clinical success defined as a complete healing of the BD at fistulography was achieved in six patients. The median time to BD closure was 76.7 ± 40.5 days and the average procedure number was 3 ± 1 per patient. In one patient, defect persistance after four treatments required gelatin sponge injection. No major complications occurred. One case of post-procedural transitory hyperpirexia was registered. CONCLUSION: In persistent biliary defects, despite prolonged biliary drainage stay, percutaneous injection of autologous platelet-rich fibrin appears as a readily available and feasible emergent technique in promoting fistulous tracts obliteration still mantaining main ducts patency.

Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding: A useful predictor of positive angiographic findings.

BACKGROUND: Gastrointestinal bleeding (GIB) is a severe and potentially life-threatening condition, especially in cases of delayed treatment. Computed tomography angiography (CTA) plays a pivotal role in the early identification of upper and lower GIB and in the prompt treatment of the haemorrhage. AIM: To determine whether a volumetric estimation of the extravasated contrast at CTA in GIB may be a predictor of subsequent positive angiographic findings. METHODS: In this retrospective single-centre study, 35 patients (22 men; median age 69 years; range 16-92 years) admitted to our institution for active GIB detected at CTA and further submitted to catheter angiography between January 2018 and February 2022 were enrolled. Twenty-three (65.7%) patients underwent endoscopy before CTA. Bleeding volumetry was evaluated in both arterial and venous phases via a semi-automated dedicated software. Bleeding rate was obtained from volume change between the two phases and standardised for unit time. Patients were divided into two groups, according to the angiographic signs and their concordance with CTA. RESULTS: Upper bleeding accounted for 42.9% and lower GIB for 57.1%. Mean haemoglobin value at the admission was 7.7 g/dL. A concordance between positive CTA and direct angiographic bleeding signs was found in 19 (54.3%) cases. Despite no significant differences in terms of bleeding volume in the arterial phase (0.55 mL vs 0.33 mL, P = 0.35), a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography (2.06 mL vs 0.9 mL, P = 0.02). In the latter patient group, a significant increase in bleeding rate was also detected (2.18 mL/min vs 0.19 mL/min, P = 0.02). CONCLUSION: In GIB of any origin, extravasated contrast volumetric analysis at CTA could be a predictor of positive angiography and may help in avoiding further unnecessary procedures.

The inhibitory effects of phenolic and terpenoid compounds from Baccharis trimera in Siha cells: differences in their activity and mechanism of action.

Baccharis trimera is used in folk medicine as a tea for digestive and liver diseases. It possesses anti-inflammatory and antioxidant properties that are related to the presence of phenolic compounds. The aim of this work was to investigate the anti-proliferative properties of phenolic (PHE) and terpenoid (SAP) compounds from B. trimera on human cervical cancer. The treatment of SiHa cells with PHE for 24 h suppressed colony formation in a dose-dependent manner, inhibited proliferation and inhibited cell motility. Although SAP inhibited the proliferation of SiHa cells in a dose-dependent manner, it increased colony formation and did not inhibit cell motility. PHE and SAP also promoted a significant increase in lactate dehydrogenase levels in the culture medium in a dose-dependent manner, indicating a loss of cell membrane integrity. Moreover, PHE promoted necrotic cell death, whereas SAP induced apoptosis. These compounds are new anticancer prototypes due their significant anticancer activity demonstrated herein.

Effect of Edible Coating Enriched with Natural Antioxidant Extract and Bergamot Essential Oil on the Shelf Life of Strawberries.

In this study, the effects of the application of edible coatings on the shelf life of the strawberry were evaluated, with the aim of extending the fruit's availability and shelf life while preserving its qualitative characteristics. In particular, the application of edible coatings enriched with a natural antioxidant to strawberries was evaluated for their physicochemical, microbial, and structural properties, during a storage period (up to 14 days) at refrigerated temperature. The experimental plan provided the formulation for edible coatings enriched with different concentrations of a natural antioxidant extract obtained from bergamot (Citrus bergamia Risso) pomace (1, 2.5, and 5%), bergamot essential oil (0.1% v/v and 0.2% v/v), and a synthetic antioxidant, butylated hydroxytoluene (BHT, 100 ppm). Moreover, a control test with untreated strawberries was considered. The enriched gum Arabic coatings provided good results related to the preservation of the qualitative parameters of the strawberries. The samples coated with the antioxidant extract (2.5%, sample D) and bergamot essential oil (0.1%, sample F) showed the best maintenance of the qualitative parameters after 14 days, showing lower decay rates (36% D and 27% F), good acceptability by consumers (between 5 and 6), and good retention of ascorbic acid (>30 mg 100 g-1).

Factors Associated with Anti-SARS-CoV-2 Vaccine Acceptance among Pregnant Women: Data from Outpatient Women Experiencing High-Risk Pregnancy.

Pregnant women are at higher risk of severe Coronavirus disease 2019 (COVID-19) complications than non-pregnant women. The initial exclusion of pregnant women from anti-SARS-CoV-2 vaccines clinical trials has caused a lack of conclusive data about safety and efficacy for this vulnerable population. This cross-sectional study aims to define the factors related to vaccination adherence in a sample of women experiencing high-risk pregnancies. The recruited women completed a questionnaire based on the Health Belief Model. Data were analyzed to evaluate the associations between socio-demographic variables and vaccination acceptance through descriptive, univariate and multivariate logistic analyses. Among the 233 women enrolled, 65.2% (n = 152) declared that they would accept the anti-SARS-CoV-2 vaccine. Multivariate analysis showed that vaccination acceptance was associated with a high educational level (aOR = 4.52, p = 0.001), a low perception of barriers to vaccination (aOR = 1.58, p = 0.005) and the gynecologist's advice (aOR = 3.18, p = 0.01). About a third of pregnant women are still hesitant about the anti-SARS-CoV-2 vaccine, probably because of the conflicting information received from media, friends, acquaintances and health institutions. Determining factors linked to vaccine hesitancy among pregnant women is useful for creating vaccination strategies that increase vaccination uptake.

Host-Guest Complexes HP-ß-CD/Citrus Antioxidants: Exploratory Evaluations of Enhanced Properties in Biodegradable Film Packaging.

The aim of this work was to exploit the antioxidant potential of molecules recovered during the pectin purification process of citrus lemon waste and to encapsulate them in stable pectin films, with a view to a green and circular economy process. Antioxidant molecules were recovered during the pectin purification process, further recovering matter from the waste. Seven molecules were identified and quantified, and the antioxidant power of the mixture and its stability over time was evaluated. To improve the stability of the bioactive fraction, this was complexed with 2-hydroxypropyl-ß-cyclodextrin (HP-ß-CD); indeed, this procedure increased their thermal stability from 120 °C up to 250 °C, as verified by thermogravimetry. Furthermore, the most promising complexes were studied under autoclave-like conditions (120 °C, 28 min) to simulate thermal sterilization. The antioxidants and HP-ß-CD were combined in a pectin film, showing increased stability over time (up to three times) compared to uncomplexed antioxidants. This process represents a first step towards the development of applicable devices for the delivery of antioxidant molecules.

Artificial Intelligence in Lung Cancer Screening: The Future Is Now.

Lung cancer has one of the worst morbidity and fatality rates of any malignant tumour. Most lung cancers are discovered in the middle and late stages of the disease, when treatment choices are limited, and patients' survival rate is low. The aim of lung cancer screening is the identification of lung malignancies in the early stage of the disease, when more options for effective treatments are available, to improve the patients' outcomes. The desire to improve the efficacy and efficiency of clinical care continues to drive multiple innovations into practice for better patient management, and in this context, artificial intelligence (AI) plays a key role. AI may have a role in each process of the lung cancer screening workflow. First, in the acquisition of low-dose computed tomography for screening programs, AI-based reconstruction allows a further dose reduction, while still maintaining an optimal image quality. AI can help the personalization of screening programs through risk stratification based on the collection and analysis of a huge amount of imaging and clinical data. A computer-aided detection (CAD) system provides automatic detection of potential lung nodules with high sensitivity, working as a concurrent or second reader and reducing the time needed for image interpretation. Once a nodule has been detected, it should be characterized as benign or malignant. Two AI-based approaches are available to perform this task: the first one is represented by automatic segmentation with a consequent assessment of the lesion size, volume, and densitometric features; the second consists of segmentation first, followed by radiomic features extraction to characterize the whole abnormalities providing the so-called "virtual biopsy". This narrative review aims to provide an overview of all possible AI applications in lung cancer screening.

Changes in Students' Perceptions Regarding Adolescent Vaccinations through a Before-After Study Conducted during the COVID-19 Pandemic: GIRASOLE Project Study.

The COVID-19 pandemic caused a reduction in vaccination coverage for all age groups, especially in non-infant age. The main objective of the present study is to evaluate the effectiveness of an online intervention conducted among adolescents during the COVID-19 pandemic in increasing knowledge and positive attitudes toward vaccinations. The study, which took place online from March to May 2021, involved 267 students from six lower secondary schools in Palermo city (Italy); they filled out the questionnaire before and after the intervention. The questionnaire was based on the protection motivation theory (PMT), which estimates the improvement in vaccination-related knowledge and attitudes. The pre- and post-intervention comparison showed a significant increase in the perception of the disease severity: strongly agree pre-intervention n = 150 (58.6%) and post-intervention n = 173 (67.6%, p < 0.001), rated on a five-point Likert scale. In a multivariate analysis, the factor associated with the improvement in the score after the intervention was the school dropout index (low vs. very high dropout index OR 4.5; p < 0.03). The educational intervention was more effective in schools with lower early school leaving rates, an indirect index of socio-economic status. The topic of vaccination has caught the adolescents' attention, it is, therefore, important that interventions tackling teenagers are tailored to reduce their emotional tension about the perception of adverse effects and improve vaccination coverage.