Social determinants of Health and Google Trends: a worldwide infodemiological report.

OBJECTIVE: Several sociodemographic variables are essential to the complete comprehension of people's health conditions. Also, social determinants of health are decisive in influencing people's health and healthcare strategy outcomes. Nevertheless, the level of awareness of the general population about the social determinants of health still seems poorly investigated. In this scenario, using an infodemiological approach, Google Trends represents a handy tool for monitoring internet-related search activities concerning this specific topic. This study aimed to assess the general population's consciousness about social determinants of health, testing widespread knowledge of these items and evaluating the association of the results obtained through Google-specific search volumes. MATERIALS AND METHODS: Data were collected using the Google Trends tool using several search terms related to food, social problems, and economic issues, which are useful for defining some social determinants of health variables. Descriptive data analysis was performed to show the worldwide Relative Search Volume variations from 1 September 2013 to 31 August 2023. Pearson's correlation analysis tested Relative Search Volumes and later logarithmic transformation. The K-Nearest Neighbors analysis was used to define and assess Relative Search Volumes (RSV) associations. RESULTS: The results have shown that the general population was mainly interested in topics such as "social support" and "economic burden", showing frequent peaks during the 10 years of the study. According to Pearson's coefficients test, other specific interests and relative correlations emerged regarding social variables (i.e., social support and social problems), food, and financial distress. Moreover, the K-Nearest Neighbors analysis showed that searching activities for "social support", "lack of food", and "social problems" were highly related; for "economic burden", "financial burden", and "out of pocket" suggested the existence of financial distress. CONCLUSIONS: The results of this study underline that social determinants of health are significant barriers to health and well-being and that non-medical factors should be considered more. Healthcare professionals involved in public health should study and understand more about the social determinants of health in relation to health outcomes to provide patient-centered care. Finally, this research suggests that we should encourage and maintain a more comprehensive approach to addressing the health needs of patients and communities, also by an infodemiological assessment.

The Sapienza University of Rome network of automated external defibrillators: a prototype webMap developed to speed access to community defibrillators and increase survival from out-of-hospital cardiac arrest.

OBJECTIVE: In Italy, only around 10% of people who experience out-of-hospital cardiac arrest (OHCA) survive. A large portion of OHCA events in public settings are characterized by an initial shockable rhythm, which requires prompt defibrillation. We aimed to create a system to quickly locate nearby public access automated external defibrillators (AEDs) on the campus of Sapienza University of Rome, the largest public university in Europe. MATERIALS AND METHODS: We developed the AED webMap through a 6-step process involving the: 1) collection of information and geographical coordinates for each AED from the university management system; 2) development of a new geolocation database; 3) integration of information contained in the new database with data provided by university departments; 4) geolocation of AEDs in the Google MyMaps environment; 5) graphic representation of all AEDs on digital map templates using specific symbols, with pop-ups containing additional information for each AED; and 6) publication of the webMap on the university website. RESULTS: The AED webMap was published on the university website (https://www.uniroma1.it/it/pagina/defibrillatori-sapienza-in-rete) and facilitates prompt identification of nearby AEDs by providing: 1) detailed AED geolocalization with interactive pop-up information for each AED, including whether the AED is located internally or externally; 2) the option to use different base maps (e.g., digital street map); 3) calculation and display of the route to reach the chosen AED; and 4) the possibility to migrate towards multiple platforms. CONCLUSIONS: The webMap can help bystanders quickly identify, locate, and reach nearby AEDs present on the campus of the largest public university in Europe, a measure that could help speed defibrillation and maximize the life-saving potential of AEDs in the event of OHCA.

Investigating the synergistic effect of socio-demographic fac- tors on behaviors and attitudes concerning alcohol and illicit drug use among Italian students: a large cross-sectional study.

Background: Alcohol, drug consumption and polysubstance use are some of the most important causes of illnesses and mortality among adolescents, who have been identified as common users of these substances. Aim of this study was to assess and describe the current scenery of alcohol and other drugs consumption habits among a wide sample of Italian high school and university students. Methods: A cross-sectional study was carried out using an online survey. The questionnaire was developed and administered via an internet forum for middle school, high school and university students named "Skuola.net". The statistical analysis included descriptive statistics, univariate and multivariate analysis. Additive interactions were assessed by calculating the synergy index. Results: A total of 11,379 Italian students answered the questionnaire. The prevalence of alcohol drinkers was 34.2%; among these, 17.8% of the individuals showed unhealthy drinking behaviors (frequency of alcohol use of four times or more per week); 10.3% of individuals declared daily assumption of six or more glasses of alcohol. Concerning drugs, 15.7% of the responders classified themselves as illicit drug users, with cannabis getting the highest prevalence rates (6.9%). Finally, concerning alcohol, a synergistic effect was recorded for male and adult individuals (SI = 1.04); while concerning illicit drugs, a synergistic effect was found between male gender and older age (SI = 1.42), and between university students and male gender (SI = 1.10). Conclusions: This study gives an overview about the attitudes of a wide sample of Italian students concerning alcohol and drugs habits. These results are in line with evidences from the scientific literature and will be helpful for developing future prevention strategies towards this target population.

Inhibiting proliferation in KB cancer cells by RNA interference-mediated knockdown of nicotinamide N-methyltransferase expression.

The enzyme Nicotinamide N-methyltransferase (NNMT) catalyzes the methylation of nicotinamide and other pyridines, playing a pivotal role in the biotransformation and detoxification of many drugs and xenobiotic compounds. Several tumours have been associated with abnormal NNMT expression, however its role in tumour development remains largely unknown. In this study we investigated expression levels of Nicotinamide N-methyltransferase in a cancer cell line and we evaluated the effect of shRNA-mediated silencing of NNMT on cell proliferation. Cancer cells were examined for NNMT expression by semiquantitative RT-PCR and Western blot analysis. A HPLC-based catalytic assay was performed to assess enzyme activity. Cells were transfected with four shRNA plasmids against NNMT and control cells were treated with transfection reagent only (mock). The efficiency of gene silencing was detected by Real-Time PCR and Western blot analysis. MTT cell proliferation assay and the soft agar colony formation assay were then applied to investigate the functional changes in cancerous cell. NNMT mRNA was detected in cancer cells, showing a very high expression level. In keeping with the results of RT-PCR analysis, the protein level and NNMT enzyme activity were particularly high in KB cells. ShRNA vectors targeted against NNMT efficiently suppressed gene expression, showing inhibition observed at both the mRNA and protein levels. Down-regulation of NNMT significantly inhibited cell proliferation and decreased colony formation ability on soft agar. The present data support the hypothesis that the enzyme plays a role in tumour expansion and its inhibition could represent a possible molecular approach to the treatment of cancer.

Life of a droplet: Buoyant vortex dynamics drives the fate of micro-particle expiratory ejecta.

We show that the dynamics of the expiratory cloud ejected during human respiratory events can be modeled by extending the theory of buoyant vortex rings with an initial momentum. We embed the integral conservation laws that govern the cloud's motion into the model of an expanding vortex to determine the velocity field inside and outside the cloud. We then apply a Lagrangian particle-tracking model to calculate the trajectories of the mucosalivary droplets suspended within the cloud. Our results show very good agreement with the available experimental data. The vortex is shown to have a significant effect on suspending the droplets present in the cloud, increasing the time they remain airborne and extending their range further than predicted by the existing models. We also study the role that initial conditions have on the maximum streamwise range of the droplets, finding that decreasing the angle of projection can reduce the spread of the droplets by an order of meters. Finally, we discuss the importance of these findings in the context of informing public health policies and global information campaigns to slow down the spread of respiratory viruses.

Effectiveness of clinical simulation on nursing student's improving critical care knowledge: a pretest-posttest study.

AIM: To evaluate the effectiveness of Human Patient Simulation method, as an additional method to theoretical lectures, on improving critical care knowledge of third course nursing students compared to only theoretical lectures. It was hypothesised that, the greater cognitive abilities used and trained around a specific subject, more strengthening of the subject contents is done by the students. METHODS: A non-experimental pretest-post test study was carried out with a questionnaire created ad hoc specifically for this study. Pretest questionnaire was administered after students received five weeks of theoretical lectures on critical care subjects. Post test was administered after students performed the theoretical classes and the simulation based learning activity on critical care subjects. RESULTS: 60 nursing students of the Campus Docent Sant Joan de Déu, attending to critical care subjects, were enrolled in the study. The statistical analyses performed showed a significance of the intervention in the post-test: p value 0.01 and the students improved on average by 1 point after the intervention, passing from 11.94 in the pre-test to 12.94 in the post-test. Results of this study suggest that use of Human Patient Simulation method of zone two made a positive difference in nursing students' ability to answer questions about critical care when there was need to apply their cognitives abilities. CONCLUSIONS: We evidenced that is crucial to direct cognitive resources appropriately toward each section of the simulation activity. Choosing the quantity and the kind of cognitive abilities that will be used by a specific group of students in a simulation activity, facilitators can upgrade the student knowledges and avoid impaired learning.

Risk of medication errors and nurses' quality of sleep: a national cross-sectional web survey study.

OBJECTIVE: We aimed to evaluate quality of sleep and self-perception risk of medication errors, in a significantly-sized sample of nurses in Italy, using a web survey. SUBJECTS AND METHODS: An anonymous questionnaire about self-perception of quality of sleep (Pittsburgh Sleep Quality Index - PSQI) and risk of medication errors (based on the 7 R-rule), was made up and delivered by social media, i.e., Facebook and Instagram. Risk of medication errors was intended as near misses, i.e., accidents that do not cause the patient harm. RESULTS: A poor quality of sleep stated by PSQI score >5, was present in 87.9% of subjects and the risk of medication errors during the last shift was reported in 76% of them. However, more than half of nurses' sample (60.1%) reported a good or excellent self-perception quality of sleep. Risk of medication errors was associated with poor quality of sleep and it was independently associated with short resting time after night shift and bad self-perception quality of sleep (OR 3.165, 95% CI 1.468-6.827, p=0.003). CONCLUSIONS: Absence of proper resting is crucial on performance even if nurses perceived a good quality sleep. The relationship between shift work, poor sleep quality, and risk of medication errors represents crucial point for all health professionals' community, and web-survey represents a valuable information in order to capture the risk of medication errors. Health care organizations should encourage such a type of research in order to show a more proactive approach towards patient safety.

Measuring knowledge, attitudes and behavior of nurses in medication management: cross-cultural comparisons in Italy and Malta.

OBJECTIVE: Medication errors are one of the most common causes of negative events affecting patient safety all over the world.  Scientific literature divides the factors that contribute to the occurrence of harmful events into factors related to the characteristics of the healthcare workers and factors related to the organization of the drug management process. The aim of the study was to examine the knowledge, attitudes and behaviours related to medication errors among Italian and Maltese nurses. SUBJECTS AND METHODS: Cross-sectional survey of nurses working in Intensive Care settings in Italian and Maltese hospitals was conducted. A valid and reliable questionnaire used in previous studies was adapted for online use. Despite improved reporting, The Strengthening the Reporting of Observational Studies in Epidemiology was used. RESULTS: Findings showed good psychometric properties and reliability. MANOVA demonstrated significant differences in nurses' perception of the pharmacist presence during medication process and of the use of computerized provider order entry. MANOVA also demonstrated significant differences in the control of vital parameters and the application of the 8 right. CONCLUSIONS: These findings support the contention that knowledge, attitude and behaviour of nurses is similar across different contexts in different countries wherein nurse training is harmonised and regulated through a transnational directive.

The DREAM model's effectiveness in health promotion of AIDS patients in Africa.

This study evaluates the effectiveness of a holistic model for treating people living with AIDS in Africa; the model aims to improve knowledge about AIDS prevention and care, increase trust in the health centre, impact behaviour, and promote a high level of adherence to HAART. The study took place in the context of the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) programme in Mozambique, designed by the Community of Sant'Egidio to treat HIV patients in Africa. It provides patients with free anti-retroviral drugs, laboratory tests (including viral load), home care and nutritional support. This is a prospective study involving 531 patients over a 12-month period. The patients, predominantly poor and with a low level of education, demonstrated a good level of knowledge about AIDS (more than 90% know how it is transmitted) and trust in the treatment, with a relatively small percentage turning to traditional healers. Overall the patients had a low level of engaging in risky sexual behaviour and a very good level of adherence to HAART (69.5% of the 531 subjects had a pill count higher than 95%). The positive results of the programme's educational initiatives were confirmed with the patients' good clinical results.

Imitating gestures. A quantitative approach to ideomotor apraxia.

The ability to carry out movements on imitation was assessed with a 24-item test in uniterally hemisphere-damaged patients. On the basis of a cutoff score derived from the performances of 100 control patients, 20% of the right brain-damaged patients were calssified as apraxic. Most right brain-damaged patients were only mildly defective, but a few showed a striking impairment. In left brain-damaged patients apraxia was not only more frequent, but also much more severe and was nearly always associated with aphasia. However, the correlation between the motor and the language disorder was not particularly high, and the link between the two symptoms was thought to be dependent on the contiguity of the underlying nervous structures.

Conjugate gaze paresis in stroke patients with unilateral damage. An unexpected instance of hemispheric asymmetry.

Conjugate gaze paresis was investigated in 436 patients who had suffered a severe stroke and were consecutively hospitalized for unilateral hemispheric damage. Gaze paresis was found in 120 and was associated with a high mortality, severe neurological impairment, and was more frequent in women. However, conjugate gaze paresis was also dependent on the side and locus of the lesion. It was more frequent, severe, and long-lasting in patients with right-sided brain damage. Moreover, it was preponderantly associated with post-Rolandic lesions in patients with right-sided brain damage and with involvement of the entire territory of distribution of the Sylvian artery in those with left-sided brain damage. This suggests that oculomotor centers have an asymmetrical organization in the two hemispheres, diffuse on the left and focalized on the right. It also explains why visual neglect occurs more frequently following right-sided brain damage.

Eyelid movement disorders and motor impersistence in acute hemisphere disease.

The aim of this study was to evaluate, in an acutely brain-damaged population, the occurrence of motor impersistence and its relation to the side of lesion. All the patients hospitalized in a 10-month period for a stroke involving one hemisphere and able to cooperate were given, in the early days of illness, a motor impersistence battery requiring the maintenance of a position of eyelids, gaze, mouth, and limbs for 10 seconds. A control group of 50 patients without brain damage provided the basis for evaluating pathologic performance. Failure to keep eyes closed was the most common manifestation of motor impersistence. It sometimes affected the contralateral eye alone, lasted in a few patients for 3 months, and was significantly more frequent after right than left brain damage. Three right brain-damaged (RBD) patients showed a complete inability to initiate lid closure, and one RBD patient a complete inability to initiate lid opening. Impersistence in other somatic areas was more rare.

Prosopagnosia in two patients with CT scan evidence of damage confined to the right hemisphere.

Two patients developed a severe and long-lasting inability to recognize familiar faces (prosopagnosia) after a stroke, which was shown by CT scan to be confined to the right hemisphere. The area of softening involved the entire cortico-subcortical territory of distribution of the right posterior cerebral artery. These data suggest that in a few cases right occipito-temporal damage may be sufficient to produce prosopagnosia.

An experimental investigation on the nature of extinction.

Under conditions of bilateral simultaneous presentation a right brain-damaged patient consistently extinguished visual stimuli presented for 200 msec to the left visual field. He was submitted to a series of experiments aimed at assessing the variables that influence this phenomenon. Extinction persisted unmodified when stimulus presentation was lengthened to 500 msec, when the size of the left stimulus was four-fold that of the right stimulus and for whatever position the stimuli occupied on the two halves of the display. Single stimuli were always perceived, but their localization was transposed rightward. The only condition in which extinction was partially reduced was when the instructions called for total disregard of the right stimulus. The patient also extinguished the leftmost of two stimuli presented in the left space, while he always perceived both stimuli when they were presented in the right space. However, if attention was covertly moved to a point in the right space and two stimuli were displayed to either side of it, left stimuli were neglected 70% of the time. Though a left stimulus was never perceived, it slowed the RT to the identification of a right stimulus. These data are interpreted in the frame of the directional bias theory, which attributes extinction to a shift of attention towards the side ipsilateral to the lesion, caused by the imbalance between the opponent turning processors, controlled by the right and left hemisphere. However, the striking difference in the rate of extinction when both stimuli were presented to the left or to the right field implies a stepwise decrement in the deployment of attention by the damaged processor, when it enters in the opposite space.

Tactile morphagnosia secondary to spatial deficits.

A 73-year old man showed visual and tactile agnosia following bilateral haemorrhagic stroke. Tactile agnosia was present in both hands, as shown by his impaired recognition of objects, geometrical shapes, letters and nonsense shapes. Basic somatosensory functions and the appreciation of substance qualities (hylognosis) were preserved. The patient's inability to identify the stimulus shape (morphagnosia) was associated with a striking impairment in detecting the orientation of a line or a rod in two- and three-dimensional space. This spatial deficit was thought to underlie morphagnosia, since in the tactile modality form recognition is built upon the integration of the successive changes of orientation in space made by the hand as it explores the stimulus. Indirect support for this hypothesis was provided by the location of the lesions, which could not account for the severe impairment of both hands. Only those located in the right hemisphere encroached upon the posterior parietal cortex, which is the region assumed to be specialised in shape recognition. The left hemisphere damage spared the corresponding area and could not, therefore, be held responsible for the right hand tactile agnosia. We submit that tactile agnosia can result from the disruption of two discrete mechanisms and has different features. It may arise from a parietal lesion damaging the high level processing of somatosensory information that culminates in the structured description of the object. In this case, tactile recognition is impaired in the hand contralateral to the side of the lesion. Alternatively, it may be caused by a profound derangement of spatial skills, particularly those involved in detecting the orientation in space of lines, segments and complex patterns. This deficit results in morphagnosia, which affects both hands to the same degree.

Right posterior brain-damaged patients are poor at assessing the age of a face.

The ability to order unknown faces by age was investigated in right and left brain-damaged patients, divided into posterior and non-posterior groups on the basis of CT scan findings. A face recognition test and a figure ground discrimination test were also given. All three tests were affected by brain damage, but their sensitivity to the locus and side of lesion varied. While no hemispheric difference was found on the figure ground discrimination test, the face age test significantly discriminated patients with right posterior injury from any other brain-damaged group. The face recognition test occupied an intermediate position, with right posterior patients significantly impaired in comparison with right non-posterior patients and marginally impaired with respect to left posterior patients. Aphasia did not affect the performance of left brain-damaged patients on any of the tests. The findings are interpreted as evidence that damage of the right posterior hemisphere areas disrupts the structural encoding of visual information. Four prosopagnosic patients were also tested. Only those showing signs of apperceptive agnosia failed on the face age test.

Auditory extinction following hemisphere damage.

Extinction to the simultaneous presentation of sounds to both ears was investigated in patients with acute cerebrovascular disease and found to be present in nearly half of the patients in the early stage of stroke. The occurrence of the symptom was not significantly different following damage to either hemisphere, but a higher percentage of right brain-damaged patients tended to show extinction for a longer time. However, this finding must be evaluated with caution since a greater number of left- than right-hemisphere patients had to be excluded from the investigation because aphasia precluded their understanding test instructions. The presence of auditory extinction was not related to that of visual extinction and there were patients with severe visual neglect who did not extinguish in the auditory modality. These findings and CT scan evidence, indicating that patients with long-lasting extinction had lesions encroaching upon the auditory pathways, suggest that in number of cases the phenomenon may have a sensory and not an attentional basis.

Is memory loss without anatomical damage tantamount to a psychogenic deficit? The case of pure retrograde amnesia.

Following a car accident, a patient remained unconscious for approximately 20 min and confused for a few hours. When he could be questioned, he was found to have lost all past memories. The retrograde amnesia covered his whole life and concerned autobiographic events as well as famous facts and encyclopaedic knowledge. It also partially involved the verbal and visual lexicon. Reading, writing and counting were no longer possible. The profound impairment of retrograde memory contrasted with the preservation of anterograde memory, which permitted the patient to reacquire some of the notions he had lost, without, however, recovering the feeling of a personal experience of autobiographical information. Four years later, the retrograde deficit was unmodified, except for what had been relearnt. The search for data in support of an organic or psychological aetiology was negative. No signs of brain damage were apparent at the neurological examination and on CT, MRI and SPECT. On the other hand, there was no evidence of a psychiatric history, psychological stress or emotional precipitants that could substantiate the hypothesis that the patient derived a primary or secondary gain from amnesia. We propose that cases of focal retrograde amnesia, similar to the present one, deserve to be classified separately from organic and psychogenic forms under the label of 'functional' retrograde amnesia, a syndrome in which the threshold of activation of premorbid memories is abnormally raised by the trauma, leaving the encoding and retrieval of new memories unaffected.

Prosopagnosia can be associated with damage confined to the right hemisphere--an MRI and PET study and a review of the literature.

The early position that prosopagnosia is predominantly associated with right hemisphere (RH) injury was challenged by the finding that in practically all cases that come to autopsy pathological data point to bilateral damage. Yet the rejection of the RH hypothesis may have been too hasty. We report three prosopagnosic patients in whom MRI and CT documented a lesion confined to the right occipito-temporal areas and PET confirmed that hypometabolism involved the RH only. A review of the literature brought out 27 cases with neuroimaging evidence that prosopagnosia was associated with RH damage plus four cases with surgical evidence. It remains, however, that the inability to recognize familiar faces is a rare disorder, not manifested by the majority of patients with right temporo-occipital injury. We submit that right-handers differ in the degree of their RH specialization in processing faces and that in only a minority of them is it so marked that it cannot be compensated for by the healthy left hemisphere.

Slowly progressive visual agnosia or apraxia without dementia.

Two patients manifested a progressive impairment of visuoperceptive abilities and one patient a progressive generalized apraxia, in the absence of dementia and oral language disorders. The disease started in the presenium and the follow-up was of five, two and half and two years, respectively. The relation of these clinical pictures to cases of generalized dementia and to cases with isolated, progressive aphasia is discussed.