Polio and measles: reasons of missed vaccination in Italy, 2015-2017.

BACKGROUND: Also in Italy, a flourishing evidence confirms the recent spread of vaccine hesitancy movements resulting in approximately 4-7% of the paediatric population not immunised every year against polio and approximately 9-15% against measles in the last few years. The aim of this paper is to describe the reasons of polio and measles missed vaccination in Italy, in the period 2015-2017, and to analyse any potential effect of the 2017 mandatory vaccination law. METHODS: Number of missed vaccinations in children younger than 24 months, stratified by reason, were collected separately for measles and polio with a regional level of detail. Data were collected using an electronic form developed using Microsoft Excel®. RESULTS: The most frequent reason for missed polio vaccination was "definitive informed dissent" with a mean value 1.5%, followed by "found/contacted, but did not attend the appointment" with a mean value 1.3%. Inversely, "acquired immunity subsequent to previous disease or vaccination performed elsewhere" and "excused in a permanent way for health conditions" were the less frequent with a mean value 0.03% for both. For measles vaccination the reason "found/contacted, but did not attend the appointment" was the most frequent (mean value 3.2%), followed by "definitive informed dissent" (mean value 2.9%). CONCLUSIONS: Percentage of missed vaccination showed a remarkable reduction in 2017. This decrease is likely due to the introduction of mandatory vaccination law. In point of fact, "Dissent" decreased for both polio and measles during the study period. While, "Delay" increased during the 3-years. It seems that hesitant parents prefer to postpone vaccinations instead of refusing them. Counselling, parents' empowerment and vaccine education are central to contrast vaccination postponing. Thus, for parents who refuse vaccines ("Dissent"), monitoring the trend is important as well as trying to understand their reasons.

Fake news, influencers and health-related professional participation on the Web: A pilot study on a social-network of people with Multiple Sclerosis.

BACKGROUND: Over the last few decades, patients have increasingly been searching for health information on the Internet. This aspect of information seeking is important, especially for people affected by chronic pathologies and require lifelong treatment and management. These people are usually very well informed about the disease but are nonetheless vulnerable to hopes of being cured or saved, often amplified by misinformation, myths, legends, and therapies that are not always scientifically proven. Many studies suggest that some individuals prefer to rely on the Internet as their main source of information, often hindering the patient-doctor relationship. A professional approach is imperative to maintain confidentiality, honesty, and trust in the medical profession. OBJECTIVE: we aimed to examine, in a medically supervised Italian web community (SMsocialnetwotk.com) dedicated to people with Multiple Sclerosis (pwMS), the posts shared by users and to verify the reliability of contents of posts shared by users pinpointed as Influencers through an online questionnaire. METHODS: we grouped the posts published on SMsocialnetwork from April to June 2015 into those with medical content (scientifically correct or fake news), and those related to social interactions. Later, we gave a questionnaire to the community asking to identify the three users/Influencers providing the most reliable advice for everyday life with MS and the three users/Influencers providing the most useful information about MS treatments. RESULTS: 308 posts reported scientific and relevant medical information, whereas 72 posts included pieces of fake news. 1420 posts were of general interest. Four out of the 6 Influencers had written only posts with correct medical information (3 were pwMS, 1 was a Neurologist) and never any fake news. The remaining 2 appointed Influencers (2 pwMS) had written only posts about general interests. CONCLUSION: the identification of fake news and their authors has shown that the latter are never appointed as Influencers. SMsocialnetwork.com acted as a "web safe environment" where the Influencers contributed by sharing only correct medical information and never fake news. We speculate that the presence of neurologists and psychologists supervising the information flow might have contributed to reduce the risk of fake news spreading and to avoid their acquisition of authoritative meaning.

Caspase-8 expression and its Src-dependent phosphorylation on Tyr380 promote cancer cell neoplastic transformation and resistance to anoikis.

Caspase-8 expression is lost in a small percentage of tumors suggesting that the retention of its functionality may positively contribute to tumor progression. Consistently, several non-apoptotic functions of Caspase-8 have been identified and Caspase-8 has been shown to modulate cell adhesion, migration and to promote tumor progression. We have previously identified the Src-dependent phosphorylation of Caspase-8 on Tyr380 as a molecular mechanism to downregulate the proapoptotic function of Caspase-8; this phosphorylation occurs in colon cancer and may promote cell migration in neuroblastoma cell lines. However, the occurrence of Caspase-8 phosphorylation on Tyr380 and its significance in different carcinoma cellular models, have not been clarified yet. Here we show that Caspase-8 expression may promote cell transformation in glioblastoma and in hepatocarcinoma cell lines. In these systems Caspase-8 is phosphorylated on Tyr380 in a Src kinase dependent manner and this phosphorylation is required for transformation and it is enhanced by hypoxic conditions. Using a cancer cellular model characterized by Src constitutive activation engineered to express either Caspase-8-wt or Caspase-8-Y380F we could show that Caspase-8 expression and its phosphorylation on Tyr380, but not its enzymatic activity, promote in vitro cell transformation and resistance to anoikis. This work demonstrates a dual role for Caspase-8 in cancer, suggesting that Tyr380 phosphorylation may represent a molecular switch to hijack its activity from tumor suppressor to tumor promoter.

Narrative medicine and the personalisation of treatment for elderly patients.

Healthcare organisations, medical knowledge and clinical practice are among the contexts that have most strongly felt the impact of the over 75 population. This is a population of multimorbidity and polypharmacy patients. They are often seen as a conglomeration of juxtaposed guidelines resulting in the intake of more than 10 drugs a day, with absolutely no certainty of their efficacy. The scientific community is increasingly calling into question the current disease-focused approach. Narrative medicine can provide the tools for a treatment plan which is instead more patient-centred. Narrative medicine can promote the development of a systemic, integrated and multi-disciplinary approach to elderly patients. The stories of patients and caregivers, their representations, perceptions, experiences and preferences can reduce the risk of inappropriate tests and treatments. They can promote deprescribing procedures based on a careful analysis of a specific patient's needs. Narration time is treatment time which does not necessarily create a burden on organisations and caregivers. Quite the contrary since by facilitating adherence and team work, it can significantly reduce time and costs. Given their training and the importance of their relationship with elderly patients, internists, together with geriatricians, can play a key role in promoting and coordinating a narrative medicine approach.

Forecasting of the flowering time for wild species observed at Guidonia, central Italy.

It is well known that forecasting the flowering time of wild vegetation is useful for various sectors of human activity, particularly for all agricultural practices. Therefore, continuing previous work by Cenci et al., we will present here three new phenoclimatic models of the flowering time for a set of wild species, based on an original data sample of flowering dates for more than 500 species, observed at Guidonia (42 degrees N in central Italy) by Montelucci in the period 1960-1982. However, on applying the bootstrap technique to each species sample to check its basic statistical parameters, we found only about 200 to have data samples with an approximately Gaussian distribution. Eventually only 57 species (subdivided into eight monthly subsets from February to September) were used to formulate the models satisfactorily. The flowering date (represented by the z variable), is expressed in terms of two variables x and y by a nonlinear equation of the form z=axbeta+gammay. The x variable represents either the degree-day sum (in model 1), or the daily-maximum-temperature sum (in model 2), or the daily-global-insolation sum (in model 3), while y for all three models corresponds to the rainy-day sum. Note that all summations involved in the computation of the variables x and y take place over a certain period of time (preceding the flowering phase), which is a parameter to be determined by the fitting procedure. This parameter, together with the threshold temperature (needed to compute the degree-days in model 1), represents the two implicit parameters of the process, thus the total number of parameters (including these last two) becomes respectively, five for model 1, and four for the other two models. The preliminary results of this work were reported at the XVI International Botanical Congress (1-7 August 1999, St. Louis, Missouri USA).