Electronic Cigarette Use in 12 European Countries: Results From the TackSHS Survey.

BACKGROUND: Limited data on electronic cigarette prevalence, patterns, and settings of use are available from several European countries. METHODS: Within the TackSHS project, a face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). Overall, 11,876 participants, representative of the population aged ⩾15 years in each country, provided information on electronic cigarette. RESULTS: 2.4% (95% confidence interval [CI], 2.2-2.7%) of the subjects (2.5% among men and 2.4% among women; 0.4% among never, 4.4% among current- and 6.5% among ex-smokers) reported current use of electronic cigarette, ranging from 0.6% in Spain to 7.2% in England. Of the 272 electronic cigarette users, 52.6% were dual users (ie, users of both electronic and conventional cigarettes) and 58.8% used liquids with nicotine. In all, 65.1% reported using electronic cigarette in at least one indoor setting where smoking is forbidden; in particular, at workplaces (34.9%) and bars and restaurants (41.5%). Multivariable logistic regression analysis showed that electronic cigarette use was lower among older individuals (P for trend <0.001) and higher among individuals with high level of education (P for trend = 0.040). Participants from countries with higher tobacco cigarette prices more frequently reported electronic cigarette use (odds ratio 3.62; 95% CI, 1.80-7.30). CONCLUSION: Considering the whole adult population of these 12 European countries, more than 8.3 million people use electronic cigarettes. The majority of users also smoked conventional cigarettes, used electronic cigarettes with nicotine, and consumed electronic cigarettes in smoke-free indoor areas.

Drug Use Changes at the Individual Level: Results from a Longitudinal, Multisite Survey in Young Europeans Frequenting the Nightlife Scene.

BACKGROUND: Monitoring emerging trends in the increasingly dynamic European drug market is vital; however, information on change at the individual level is scarce. In the current study, we investigated changes in drug use over 12 months in European nightlife attendees. METHOD: In this longitudinal online survey, changes in substances used, use frequency in continued users, and relative initiation of use at follow-up were assessed for 20 different substances. To take part, participants had to be aged 18-34 years; be from Belgium, Italy, the Netherlands, Sweden, or the UK; and have attended at least 6 electronic music events in the past 12 months at baseline. Of 8,045 volunteers at baseline, 2,897 completed the survey at both time points (36% follow-up rate), in 2017 and 2018. RESULTS: The number of people using ketamine increased by 21% (p < 0.001), and logarithmized frequency of use in those continuing use increased by 15% (p < 0.001; 95% CI: 0.07-0.23). 4-Fluoroamphetamine use decreased by 27% (p < 0.001), and logarithmized frequency of use in continuing users decreased by 15% (p < 0.001, 95% CI: -0.48 to -0.23). The drugs with the greatest proportion of relative initiation at follow-up were synthetic cannabinoids (73%, N = 30), mephedrone (44%, N = 18), alkyl nitrites (42%, N = 147), synthetic dissociatives (41%, N = 15), and prescription opioids (40%, N = 48). CONCLUSIONS: In this European nightlife sample, ketamine was found to have the biggest increase in the past 12 months, which occurred alongside an increase in frequency of use in continuing users. The patterns of uptake and discontinuation of alkyl nitrates, novel psychoactive substances, and prescription opioids provide new information that has not been captured by existing cross-sectional surveys. These findings demonstrate the importance of longitudinal assessments of drug use and highlight the dynamic nature of the European drug landscape.

Dietary habits, lifestyle, and gestational diabetes in immigrant women: a survey in Northwestern Tuscany (Central Italy).

BACKGROUND: immigrant women diagnosed with gestational diabetes mellitus (GDM) have additional language and cultural obstacles in following lifestyle and dietary recommendations within a Western health care setting. OBJECTIVES: to describe: • sociodemographic characteristics and dietary and lifestyle behaviours in Italian and immigrant pregnant women who underwent a GDM screening; • any differences in these aspects among GDM Italian and immigrant women; • any differences in terms of primary maternal-neonatal outcomes among GDM and normal glucose tolerance (NGT) cohorts. DESIGN: survey. SETTING AND PARTICIPANTS: this survey was conducted in three hospitals located in Tuscany Region (Central Italy). According to a convenience sampling, an ad hoc questionnaire was administered both to Italian and immigrant women who underwent an oral glucose tolerance test. MAIN OUTCOME MEASURES: information about nutrition and lifestyle, medical and obstetric history, clinical and therapy data, maternal and neonatal primary outcomes was analysed. Eating habits have been investigated referring to the prudent diet, in order to also include those foods specifically consumed by the immigrant women, in addition to the Mediterranean Diet which is more widespread among Italians. RESULTS: a total of 117 Italian women (42 diagnosed with GDM) and 95 immigrant women (36 with GDM) were enrolled. Immigrant women showed lower adherence to the prudent diet compared to Italian women (p<0.05) and a broader use of unhealthy food preparation (e.g., frying; p<0.05). Primary maternal and neonatal outcomes (preterm birth, caesarean section, macrosomia) showed no statistical differences among GDM and NGT cohorts. CONCLUSIONS: even if immigrant and Italian women gained similar pregnancy outcomes, immigrant women showed lower adherence to the prudent diet at the time of GDM screening. An ethnic and tailored meal plan is needed to overcome cultural barriers in dietary recommendations during pregnancy in immigrant women.

Rapid COVID-19 Screening Based on Self-Reported Symptoms: Psychometric Assessment and Validation of the EPICOVID19 Short Diagnostic Scale.

BACKGROUND: Confirmed COVID-19 cases have been registered in more than 200 countries, and as of July 28, 2020, over 16 million cases have been reported to the World Health Organization. This study was conducted during the epidemic peak of COVID-19 in Italy. The early identification of individuals with suspected COVID-19 is critical in immediately quarantining such individuals. Although surveys are widely used for identifying COVID-19 cases, outcomes, and associated risks, no validated epidemiological tool exists for surveying SARS-CoV-2 infection in the general population. OBJECTIVE: We evaluated the capability of self-reported symptoms in discriminating COVID-19 to identify individuals who need to undergo instrumental measurements. We defined and validated a method for identifying a cutoff score. METHODS: Our study is phase II of the EPICOVID19 Italian national survey, which launched in April 2020 and included a convenience sample of 201,121 adults who completed the EPICOVID19 questionnaire. The Phase II questionnaire, which focused on the results of nasopharyngeal swab (NPS) and serological tests, was mailed to all subjects who previously underwent NPS tests. RESULTS: Of 2703 subjects who completed the Phase II questionnaire, 694 (25.7%) were NPS positive. Of the 472 subjects who underwent the immunoglobulin G (IgG) test and 421 who underwent the immunoglobulin M test, 22.9% (108/472) and 11.6% (49/421) tested positive, respectively. Compared to NPS-negative subjects, NPS-positive subjects had a higher incidence of fever (421/694, 60.7% vs 391/2009, 19.5%; P<.001), loss of taste and smell (365/694, 52.6% vs 239/2009, 11.9%; P<.001), and cough (352/694, 50.7% vs 580/2009, 28.9%; P<.001). With regard to subjects who underwent serological tests, IgG-positive subjects had a higher incidence of fever (65/108, 60.2% vs 43/364, 11.8%; P<.001) and pain in muscles/bones/joints (73/108, 67.6% vs 71/364, 19.5%; P<.001) than IgG-negative subjects. An analysis of self-reported COVID-19 symptom items revealed a 1-factor solution, the EPICOVID19 diagnostic scale. The following optimal scores were identified: 1.03 for respiratory problems, 1.07 for chest pain, 0.97 for loss of taste and smell 0.97, and 1.05 for tachycardia (ie, heart palpitations). These were the most important symptoms. For adults aged 18-84 years, the cutoff score was 2.56 (sensitivity: 76.56%; specificity: 68.24%) for NPS-positive subjects and 2.59 (sensitivity: 80.37%; specificity: 80.17%) for IgG-positive subjects. For subjects aged ≥60 years, the cutoff score was 1.28, and accuracy based on the presence of IgG antibodies improved (sensitivity: 88.00%; specificity: 89.58%). CONCLUSIONS: We developed a short diagnostic scale to detect subjects with symptoms that were potentially associated with COVID-19 from a wide population. Our results support the potential of self-reported symptoms in identifying individuals who require immediate clinical evaluations. Although these results come from the Italian pandemic period, this short diagnostic scale could be optimized and tested as a screening tool for future similar pandemics.

Low thyroid function is not associated with an accelerated deterioration in renal function.

BACKGROUND: Chronic kidney disease (CKD) is frequently accompanied by thyroid hormone dysfunction. It is currently unclear whether these alterations are the cause or consequence of CKD. This study aimed at studying the effect of thyroid hormone alterations on renal function in cross-sectional and longitudinal analyses in individuals from all adult age groups. METHODS: Individual participant data (IPD) from 16 independent cohorts having measured thyroid stimulating hormone, free thyroxine levels and creatinine levels were included. Thyroid hormone status was defined using clinical cut-off values. Estimated glomerular filtration rates (eGFR) were calculated by means of the four-variable Modification of Diet in Renal Disease (MDRD) formula. For this IPD meta-analysis, eGFR at baseline and eGFR change during follow-up were computed by fitting linear regression models and linear mixed models in each cohort separately. Effect estimates were pooled using random effects models. RESULTS: A total of 72 856 individuals from 16 different cohorts were included. At baseline, individuals with overt hypothyroidism (n = 704) and subclinical hypothyroidism (n = 3356) had a average (95% confidence interval) -4.07 (-6.37 to -1.78) and -2.40 (-3.78 to -1.02) mL/min/1.73 m2 lower eGFR as compared with euthyroid subjects (n = 66 542). In (subclinical) hyperthyroid subjects (n = 2254), average eGFR was 3.01 (1.50-4.52) mL/min/1.73 m2 higher. During 329 713 patient years of follow-up, eGFR did not decline more rapidly in individuals with low thyroid function compared with individuals with normal thyroid function. CONCLUSIONS: Low thyroid function is not associated with a deterioration of renal function. The cross-sectional association may be explained by renal dysfunction causing thyroid hormone alterations.

A long way to go: 20-year trends from multiple surveillance systems show a still huge use of tobacco in minors in Italy.

Background: Main aim was to describe youth smoking prevalence in Italy over the last two decades, and to provide recent trends in knowledge, attitudes towards smoking, awareness of anti-tobacco mass media campaigns, second-hand smoke (SHS) exposure and access to cigarettes. Methods: Figures from three surveillance systems, with 12 representative cross-sectional surveys (about 43 000 participants): European School Survey Project on Alcohol and Other Drugs, 15-16-year-old students, 1995-2015; Health Behaviour in School-aged Children, 11-, 13-, 15-year-old students, 2002-14 and Global Youth Tobacco Survey, 13-15-year-old students, 2010, 2014. Results: Among 11- and 13-year-old students, daily and non-daily smokers decreased by 30-50% from 2002 to 2014. Among 15-16-year-old adolescents, ever smokers significantly decreased by 10% in the period 1995-2015, whereas current and daily smokers have been stalling or even increased. Appeal of smoking increased in 2014 compared to 2010, perception of SHS as harmful, and awareness of recent anti-tobacco mass media campaigns decreased. Moreover, a significant 30% reduction in reporting retailers did not refuse to sell cigarettes to adolescents and a decrease in reporting to buy cigarettes were reported. Conclusions: Policies enforced in Italy over the last 20 years slightly reduced ever smokers, but did not decrease current and daily smokers in 15-16-year-old adolescents, and determined an impact among younger adolescents. Stricter rules on youth tobacco access reduced ease of access to cigarettes, but did not affect adolescents' tobacco use. Stronger tobacco control measures are urgently needed in order to determine a steeper decline in smoking prevalence in adolescents.

Development and validation of a risk stratification score for new-onset atrial fibrillation in STEMI patients undergoing primary percutaneous coronary intervention.

AIM: New-onset atrial fibrillation (NOAF) is a complication not infrequent in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) and has been associated with worse in-hospital and long-term prognosis. We aimed to develop and validate a risk score based on common clinical risk factors and routine blood biomarkers to assess the early incidence of NOAF post-pPCI, before discharge. METHODS: The risk score for NOAF occurrence during hospitalisation (about 5 days) was developed in a cohort of 1135 consecutive STEMI patients undergoing pPCI while was externally validated in a temporal cohort of 771 STEMI patients. Biomarkers and clinical variables significantly contributing to predicting NOAF were assessed by multivariate Cox-regression analysis. RESULTS: Independent predictors of NOAF were age ≥80 years (6.97 [3.40-14.30], hazard ratio [95% CI], P < .001), leukocyte count > 9.68 × 103 /µL (2.65 [1.57-4.48], P < .001), brain natriuretic peptide (BNP) > 80 ng/L (2.37 [1.13-4.95], P = .02) and obesity (2.07 [1.09-3.92], P = .03). By summing the hazard ratios of these predictors we derived the ALBO (acronym derived from: Age, Leucocyte, BNP and Obesity) risk score which yielded high C-statistics in both the derivation (0.734 [0.675-0.793], P < .001) and validation cohort (0.76 [0.688-0.831], P < .001). In both cohorts, using Kaplan-Meier risk analysis, the ALBO score identified a tertile of patients at highest risk (ALBO >4 points), with percentages of NOAF incidence of 30.8% and 27.4% in the derivation and validation cohort, respectively. CONCLUSION: The ALBO risk score, comprising biomarkers and clinical variables that can be assessed in hospital setting, could help to identify high-risk patients for NOAF after pPCI so that a prompter action can be taken.

Italian Adult Gambling Behavior: At Risk and Problem Gambler Profiles.

The present study examined adult gambling behaviours from a local perspective in order to assess the adult at risk and problem gambler's profile stratified by genre and by different forms of game. 4773 Italian adults from 18 to 94 years old were administered a survey to assess socio-cultural information related to gambling behaviour and the SOGS to evaluate gambling behaviour severity. Logistic regression evidenced that both at risk and problem gamblers are associated with male gender, players that use to play to more than one game, gambling with strategy-based games. People with a gambler father or both parents who used to gamble were significantly more associated with problem gambling behaviour than participants with non-gambler parents. These results present adult profiles of at risk and problem providing a more clear understanding about the relationships between gambling behavior severity and type of gambling.

"I Am Becoming More and More Like My Eldest Brother!": The Relationship Between Older Siblings, Adolescent Gambling Severity, and the Attenuating Role of Parents in a Large-Scale Nationally Representative Survey Study.

The present study examined the association between having older siblings who gamble and adolescent at-risk/problem gambling and how parents (i.e., parental knowledge of their whereabouts) and peers might moderate such effects. Data were drawn from the ESPAD®Italia2012 survey (European School Survey Project on Alcohol and Other Drugs) comprising a nationally representative Italian sample of adolescents. The analysis was carried out on a subsample of 10,063 Italian students aged 15-19 years (average age = 17.10; 55 % girls) who had at least one older sibling and who had gambled at some point in their lives. Respondents' problem gambling severity, older gambler sibling, gambler peers, parental knowledge, and socio-demographic characteristics were individually assessed. Multinomial logistic regression analyses including two- and three-way interactions were conducted. The odds of being an at-risk/problem gambler were higher among high school students with older siblings that gambled and those with peers who gambled. Higher parental knowledge (of who the adolescent was with and where they were in their leisure time) was associated with lower rates of at-risk/problem gambling. There was also an interaction between gamblers with older siblings and parental knowledge. The combination of having siblings who gambled and a greater level of parental knowledge was associated with lower levels of problem gambling. The present study confirmed the occurrence of social risk processes (older siblings and peers who gambled) and demonstrated that gambling among older siblings and peers represents an important contextual factor for increased at-risk/problem gambling. However, parental knowledge appears to be sufficient to counterbalance the influence of older siblings.

Carotid-Ventricular Coupling During Exercise: A Pilot Study.

OBJECTIVES: To evaluate carotid elasticity and left ventricular elastance during a graded bicycle semisupine exercise test in patients with known or suspected coronary artery disease and compare them with a control group of healthy young volunteers. METHODS: Thirty-six elderly patients and 18 young healthy volunteers were recruited. The right carotid diameter was estimated by an automatic system applied to B-mode sonographic sequences, central mean blood and pulse pressures by radial artery tonometry, and cardiac volumes by 2-dimensional transthoracic echocardiography; from these direct measurements, the carotid cross-sectional distensibility coefficient and left ventricular elastance index were obtained. Analyses were performed at rest, at peak stress, and during the recovery phase. RESULTS: The elderly patients included 20 men (mean age ± SD, 61 ± 8 years); the volunteers included 9 men (mean age, 34 ± 3 years). The mean blood pressure (at rest: patients, 97 ± 7 mm Hg; controls, 93 ± 9 mm Hg; not significant) increased similarly in both groups during exercise and decreased during the recovery phase. The diameter was higher in patients than controls (7.5 ± 1.1 versus 6.2 ± 0.5 mm) and increased significantly with exercise only in the latter group (at peak: 6.5 ± 0.6 mm; P < .05). The distensibility coefficient and elastance index were lower in patients than controls during the test phases [at rest: 24.5 ± 10.2 versus 60.8 ± 21.3 × 10(-3)/kPa and 3.6 ± 1.4 versus 1.6 ± 0.8 mm Hg/(mL/m(2))] and mostly changed in the controls, showing a decreased distensibility coefficient (peak: 40.6 ± 15.1 × 10(-3)/kPa) and an increased elastance index [peak: 5.9 ± 2.8 mm Hg/(mL/m(2))]. CONCLUSIONS: In older patients with multiple cardiovascular risk factors or established coronary artery disease, an abnormal carotid-ventricular adaptation to exercise was observed when compared to young healthy individuals.

Adolescent Gambling-Oriented Attitudes Mediate the Relationship Between Perceived Parental Knowledge and Adolescent Gambling: Implications for Prevention.

Although substantial research has provided support for the association between parental practices and adolescent gambling, less is known about the role of adolescent attitudes in this relationship. The primary purpose of this study was to test an integrative model linking perceived parental knowledge (children's perceptions of their parents' knowledge of their whereabouts and companions) with adolescent gambling while evaluating the mediating effects of adolescents' own gambling approval, risk perception of gambling, and descriptive norms on gambling shared with friends. The data were drawn from the ESPAD® Italia 2012 (European School Survey Project on Alcohol and Other Drugs) study, which is based on a nationally representative sample of Italian adolescent students aged 15-19. The analysis was carried out on a subsample of 19,573 subjects (average age 17.11, 54 % girls). Self-completed questionnaires were administered in the classroom setting. The results revealed that adolescents who perceived higher levels of parental knowledge were more likely to disapprove of gambling and show higher awareness of its harmfulness, which were in turn negatively related to gambling frequency. They were also less likely to perceive their friends as gamblers, which was also negatively related to gambling frequency. These findings suggest that gambling prevention efforts should consider perceived parental knowledge and gambling-oriented attitudes (self-approval, risk perception, and descriptive norms) as factors that may buffer adolescent gambling behavior in various situations.

Association of Problem Gambling with Type of Gambling Among Italian General Population.

The origin of gambling disorders is uncertain; however, research has shown a tendency to focus on specific types of games as a potential important risk factor. The principal aim of this study is to examine the relationships between types of gambling practices and gambling disorder. The data were extracted from IPSAD-Italia(®) 2010-2011 (Italian Population Survey on Alcohol and other Drugs), a survey among the Italian general population which collects socio-cultural information, information about the use of drugs, legal substances and gambling habits. In order to identify the "problem gambler" we used the Problem Gambling Severity Index. Three groups are considered in this analysis: no-risk gamblers, low-risk gamblers, moderate-risk/problem gamblers. Type of gambling practice was considered among two types of gambler: one-game players and multi-games players. 1.9 % of multi-game players were considered problem gamblers, only 0.6 % of one-game players were problem gamblers (p < 0.001). The percentage of players who were low and moderate-risk gamblers was approximately double among multi-game players, with 14.4 % low-risk and 5.8 % moderate-risk; compared with 7.7 % low-risk and 2.5 % moderate risk among one-game players. Results of ordinal logistic regression analysis confirmed that higher level of gambling severity was associated with multi-game players (OR = 2.23, p < 0.0001). Video-poker/slot-machines show the highest association with gambling severity among both one-game players and multi-game players, with scores of OR equal to 4.3 and 4.5 respectively. These findings suggest a popular perception of risk associated with this type of gambling for the development of gambling problems.

Clustering eating habits: frequent consumption of different dietary patterns among the Italian general population in the association with obesity, physical activity, sociocultural characteristics and psychological factors.

PURPOSE: (a) To identify clusters of eating patterns among the Italian population aged 15-64 years, focusing on typical Mediterranean diet (Med-diet) items consumption; (b) to examine the distribution of eating habits, as identified clusters, among age classes and genders; (c) evaluate the impact of: belonging to a specific eating cluster, level of physical activity (PA), sociocultural and psychological factors, as elements determining weight abnormalities. METHODS: Data for this cross-sectional study were collected using self-reporting questionnaires administered to a sample of 33,127 subjects participating in the Italian population survey on alcohol and other drugs (IPSAD(®)2011). The cluster analysis was performed on a subsample (n = 5278 subjects) which provided information on eating habits, and adapted to identify categories of eating patterns. Stepwise multinomial regression analysis was performed to evaluate the associations between weight categories and eating clusters, adjusted for the following background variables: PA levels, sociocultural and psychological factors. RESULTS: Three clusters were identified: "Mediterranean-like", "Western-like" and "low fruit/vegetables". Frequent consumption of Med-diet patterns was more common among females and elderly. The relationship between overweight/obesity and male gender, educational level, PA, depression and eating disorders (p < 0.05) was confirmed. Belonging to a cluster other than "Mediterranean-like" was significantly associated with obesity. CONCLUSION: The low consumption of Med-diet patterns among youth, and the frequent association of sociocultural, psychological issues and inappropriate lifestyle with overweight/obesity, highlight the need for an interdisciplinary approach including market policies, to promote a wider awareness of the Mediterranean eating habit benefits in combination with an appropriate lifestyle.

Prognostic role of BNP in children undergoing surgery for congenital heart disease: analysis of prediction models incorporating standard risk factors.

BACKGROUND: The routine use of brain natriuretic peptide (BNP) in pediatric cardiac surgery remains controversial. Our aim was to test whether BNP adds information to predict risk in pediatric cardiac surgery. METHODS: In all, 587 children undergoing cardiac surgery (median age 6.3 months; 1.2-35.9 months) were prospectively enrolled at a single institution. BNP was measured pre-operatively, on every post-operative day in the intensive care unit, and before discharge. The primary outcome was major complications and length ventilator stay >15 days. A first risk prediction model was fitted using Cox proportional hazards model with age, body surface area and Aristotle score as continuous predictors. A second model was built adding cardiopulmonary bypass time and arterial lactate at the end of operation to the first model. Then, peak post-operative log-BNP was added to both models. Analysis to test discrimination, calibration, and reclassification were performed. RESULTS: BNP increased after surgery (p<0.001), peaking at a mean of 63.7 h (median 36 h, interquartile range 12-84 h) post-operatively and decreased thereafter. The hazard ratios (HR) for peak-BNP were highly significant (first model HR=1.40, p=0.006, second model HR=1.44, p=0.008), and the log-likelihood improved with the addition of BNP at 12 h (p=0.006; p=0.009). The adjunction of peak-BNP significantly improved the area under the ROC curve (first model p<0.001; second model p<0.001). The adjunction of peak-BNP also resulted in a net gain in reclassification proportion (first model NRI=0.089, p<0.001; second model NRI=0.139, p=0.003). CONCLUSIONS: Our data indicates that BNP may improve the risk prediction in pediatric cardiac surgery, supporting its routine use in this setting.

Relationship Between Gambling Severity and Attitudes in Adolescents: Findings from a Population-Based Study.

This study used a nationally representative sample of 14,910 high school adolescents, aged 15-19 years. The large sample size presents a unique opportunity to evaluate firstly the geographical distribution of gambling prevalence, secondly, on a subsample of 5,920 adolescents, we studied the association of "no-problem-gambling", "at-risk gambling" and a relatively rare condition, "problem gambling", with demographic, environmental and behavioral variables. It differs from other studies due to the broad sample, thus enabling the combined analysis of the above variables that typically have only been studied separately. This integrated analysis, involving multiple variables, individual and environmental, allows the control of important covariates. Multivariate analysis showed that at-risk/problem gamblers were more likely to be engaged in behaviors contrary to social rules/law including heavy episodic drinking, tranquillizer/sedatives use as well as to approve gambling and have friends who gamble. It's important to emphasize that risk-perception is not related to gambling. Furthermore, the great geographical variability of at-risk and problem-gambling rates suggest that social aspects have to be considered. Currently universal prevention specifically targeting gambling is lacking, thus an associative model such as social analysis have been implemented in this study, in order to construct the basis for the design of a future prevention program based on scientific results and thus having important implications for implementation within community based activities. Prevention is fundamental: 53.5% of underage individuals have engaged in gambling even though legislation attempts to restrict access.

Optimizing the balance between radiation dose and image quality in pediatric head CT: findings before and after intensive radiologic staff training.

OBJECTIVE: The purpose of this study was to assess the radiation dose and image quality of pediatric head CT examinations before and after radiologic staff training. MATERIALS AND METHODS: Outpatients 1 month to 14 years old underwent 215 unenhanced head CT examinations before and after intensive training of staff radiologists and technologists in optimization of CT technique. Patients were divided into three age groups (0-4, 5-9, and 10-14 years), and CT dose index, dose-length product, tube voltage, and tube current-rotation time product values before and after training were retrieved from the hospital PACS. Gray matter conspicuity and contrast-to-noise ratio before and after training were calculated, and subjective image quality in terms of artifacts, gray-white matter differentiation, noise, visualization of posterior fossa structures, and need for repeat CT examination was visually evaluated by three neuroradiologists. RESULTS: The median CT dose index and dose-length product values were significantly lower after than before training in all age groups (27 mGy and 338 mGy ∙ cm vs 107 mGy and 1444 mGy ∙ cm in the 0- to 4-year-old group, 41 mGy and 483 mGy ∙ cm vs 68 mGy and 976 mGy ∙ cm in the 5- to 9-year-old group, and 51 mGy and 679 mGy ∙ cm vs 107 mGy and 1480 mGy ∙ cm in the 10- to 14-year-old group; p < 0.001). The tube voltage and tube current-time values after training were significantly lower than the levels before training (p < 0.001). Subjective posttraining image quality was not inferior to pretraining levels for any item except noise (p < 0.05), which, however, was never diagnostically unacceptable. CONCLUSION: Radiologic staff training can be effective in reducing radiation dose while preserving diagnostic image quality in pediatric head CT examinations.

Prognostic implication of Doppler echocardiographic derived coronary flow reserve in patients with left bundle branch block.

AIMS: Myocardial ischaemia during pharmacological stress echocardiography is a strong prognostic predictor in patients with a left bundle branch block (LBBB). However, the additive value of Doppler-derived coronary flow reserve (CFR) during pharmacological stress testing remains to be investigated in this subset of patients. METHODS AND RESULTS: The study group consisted of 324 LBBB patients (187 men; age 68 ± 10 years) with known (n = 74) or suspected (n = 250) coronary artery disease who had undergone dipyridamole (up to 0.84 mg/kg over 6') stress echocardiography with CFR assessment of left anterior descending (LAD) by Doppler. A value of CFR ≤ 2.0 was considered abnormal. The median duration of follow-up was 15 months (first to third quartile: 8-34 months). Of the 324 patients, 52 (16%) had ischaemia at stress echo by wall motion criteria, and 139 (43%) had a CFR ≤ 2. During follow-up, 51 (16%) events occurred: 37 deaths and 14 myocardial infarctions (MIs). Age (HR: 1.09, 95% CI: 1.04-1.15, P < 0.0001), resting wall motion score index (HR: 5.29, 95% CI: 2.36-11.89, P < 0.0001), smoking habit (HR: 4.38, 95% CI: 1.93-9.91, P < 0.0001), and CFR ≤ 2 (4.69, 95% CI: 1.96-11.19, P = 0.001) were independently correlated with mortality, while CFR ≤ 2 (HR: 3.91, 95% CI: 1.90-8.04, P < 0.0001), age (HR: 1.06, 95% CI: 1.02-1.10, P = 0.001), smoking habit (HR: 2.25, 95% CI: 1.18-4.30, P = 0.01), ischaemia at stress echo (HR: 2.30, 95% CI: 1.11-4.77, P = 0.02), and resting wall motion score index (HR: 2.17, 95% CI: 1.11-4.25, P = 0.02) were independently correlated with death or MI. Four-year mortality and 4-year hard event rate were markedly higher in patients with CFR ≤ 2 than in those with CFR >2 (49 vs. 6% and 56 vs. 8%, respectively; P < 0.0001 for both). A CFR of ≤ 2 was associated with a significantly higher annual hard event rate independently of age, sex, ejection fraction, history of coronary artery disease, diabetes, and hypertension. Moreover, it was correlated with an increased (P < 0.0001) yearly mortality and event rate in patients with non-ischaemic stress echo conducted on therapy. At incremental analysis, a CFR of ≤ 2 added prognostic value to clinical findings, resting wall motion score index, ongoing anti-ischaemic therapy, and ischaemia at stress echo when both death and death or MI were the clinical endpoints. CONCLUSIONS: Abnormal CFR on LAD is a strong and independent indicator of mortality and death or MI in patients with LBBB, and is associated with markedly increased risk also in the subset of patients with stress echo negative for ischaemia on therapy.

Scar extent, left ventricular end-diastolic volume, and wall motion abnormalities identify high-risk patients with previous myocardial infarction: a multiparametric approach for prognostic stratification.

AIMS: We sought to investigate whether combining left ventricular (LV) volumes, regional wall motion abnormalities, and scar tissue extent obtained by cardiac magnetic resonance (CMR) improves risk stratification of patients with previous myocardial infarction (MI). METHODS AND RESULTS: In 231 consecutive patients (age 64 ± 11 years, males 89%) with previous MI, we quantified LV volumes and regional wall motion abnormalities by cine CMR, and measured the extent of the infarction scar by late gadolinium enhancement (LGE). During follow-up (median, 3.2 years) cardiac events (cardiac death or appropriate intra-cardiac defibrillator shocks) occurred in 19 patients. After adjustment for age, an extent of LGE >12.7%, an LV end-diastolic volume >105 mL/m(2), and a wall motion score index >1.7 were independent associated with adverse cardiac events at multivariate analysis (P < 0.05, P < 0.001, and P < 0.01, respectively). The patients with none of these factors, and those with one or two factors, showed a lower risk of cardiac events [hazard ratio (HR) = 0.112, P < 0.01 and HR = 0.261, P < 0.05] than those with three factors. The cumulative event-rate estimated at 4 years was 29.6% in patients with all three factors, 7.7% in those with one or two factors, and 3.5% in patients with none of these factors. CONCLUSION: A multiparametric CMR approach, which includes the measure of scar tissue extent, LV end-diastolic volume and regional wall motion abnormalities, improves risk stratification of patients with previous MI.

Italian Adolescent Gambling Behaviour: Psychometric Evaluation of the South Oaks Gambling Screen: Revised for Adolescents (SOGS-RA) among a sample of Italian students.

Since no Italian validated instrument focuses specifically on the measurement of pathological gambling in very young people, with this study, we aim to adapt an international instrument (SOGS-RA) and assess its psychometric properties in a sample (n = 14.910) of young Italian students aged between 15 and 19 years. Cross-cultural adaptation of the instrument was performed through translation, synthesis of translation, back-translation, expert committee review, and pre-testing. The kappa statistic for test-retest concordance ranged from 0.53 to 0.80. Internal validity was assessed by the MCA that identified one principal component with eigenvalue equal to 3,875: the Divgi index and very simple structure analysis also pointed out one common factor, so uni-dimensionality of the SOGS-RA was accepted. Moreover the SOGS-RA was found to have acceptable internal consistency (α = 0.780). Cronbach's alpha was also assessed separately among males and females (respectively 0.786 and 0.707). The SOGS-RA was assessed in relation to gambling frequency, alcohol and drug use: Chi squared test revealed a strong association both for males and females with gambling frequency (p value ≤ 0.0001), frequent use of illicit drugs (for each drug p value ≤ 0.0001) and having had 3 or more occasions of binge drinking in the last month (p value ≤ 0.0001). At the end we can say that, the results of our study suggest that the SOGS-RA screen may be useful to assess at-risk or problem gambling for both genders in comprehensive youth surveys.

Cannabis reduction among adolescents as spillover from successful tobacco control.

BACKGROUND: National programs that reduce adolescent cannabis use warrant renewed attention in light of current discussions to reform cannabis legislation, including the possibility of legalization for recreational use. This study measures the size of a decrease in a country's prevalence of adolescent cannabis use that accompanies a decrease in its prevalence of adolescents who had ever smoked a cigarette. METHODS: Data are from the European School Survey Project on Alcohol and Other Drugs (ESPAD), which is a collaborative effort of more than 40 European countries to surveil adolescent substance use. This study uses data from the seven survey administrations in 1995, 1999, 2003, 2007, 2011, 2015, and 2019. The main analysis is a fixed-effect regression analysis of country-level, four-year changes in adolescent lifetime cannabis use prevalence on country-level, four-year changes in adolescent lifetime cigarette use prevalence. RESULTS: Decreases in the national prevalence of adolescents who had ever smoked a cigarette were accompanied by decreases half as large in national prevalence of adolescent lifetime cannabis use. CONCLUSION: For European countries considering the legalization of adult recreational cannabis use, tobacco control can offer a tool to help counter potential increases in cannabis use among adolescents.