"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.

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.

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.

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.

Evaluation of drinking patterns and their impact on alcohol-related aggression: a national survey of adolescent behaviours.

BACKGROUND: Although there have been a wide range of epidemiological studies examining the impact of patterns of alcohol consumption among adolescents, there remains considerable variability in both defining these patterns and the ability to comprehensively evaluate their relationship to behavioural patterns. This study explores a new procedure for defining and evaluating drinking patterns and integrating well-established indicators. The composite measure is then used to estimate the impact of these patterns on alcohol-related aggressive behaviour among Italian adolescents. METHODS: Data were collected as part of the 2011 European School Survey Project on Alcohol and other Drugs (ESPAD). A national sample of 14,199 students aged 15-19 years was collected using an anonymous, self-administered questionnaire completed in a classroom setting. Drinking patterns were established using principal component analysis. Alcohol-related aggression was analysed as to its relationship to patterns of drinking, behaviour of friends towards alcohol use, substance use/abuse, school performance, family relationships and leisure activities. RESULTS: Several specific drinking patterns were identified: "Drinking to Excess" (DE), "Drinking with Intoxication" (DI) and "Drinking but Not to Excess" (DNE). A higher percentage of males were involved in alcohol-related aggression compared with females. In males, the DE and DI patterns significantly increased the likelihood of alcohol-related aggression, whereas the DNE pattern was negatively associated. Similar results were found in females, although the DI pattern was not significantly associated with alcohol-related aggression. Overall, cigarette smoking, illegal drug use, truancy, limited parental monitoring, frequent evenings spent outside of the home and peer influence associated strongly with alcohol-related aggression. CONCLUSIONS: Our findings suggest that drinking patterns, as uniquely monitored with an integrated metric, can: 1) explain drinking habits better than commonly used indicators of alcohol use and 2) provide a better understanding of behavioural risks such as alcohol-related aggression. Environmental background also appears to strongly associate with this type of aggressive behaviour.

An assessment of the psychometric properties of Italian version of CPGI.

The aim of this study was to adapt to the Italian context a very commonly used international instrument to detect problem gambling, the canadian problem gambling index (CPGI), and assess its psychometric properties. Cross-cultural adaptation of CPGI was performed in several steps and the questionnaire was administered as a survey among Italian general population (n = 5,292). Cronbach's alpha reliability coefficient was 0.87 and can be considered to be highly reliable. Construct validity was assessed first by means of a principal component analysis and then by means of confirmatory factor analysis, showing that only one factor, problem gambling, was extracted from the CPGI questionnaire (an eigenvalues of 4,684 with percentage of variance 52 %). As far as convergent validity is concerned, CPGI was compared with Lie/Bet questionnaire, a two-item screening tool for detecting problem gamblers, and with both depression and stress scales. A short form DSM-IV CIDI questionnaire was used for depression and VRS scale, a rating scale, was used for rapid stress evaluation. A strong convergent validity with these instruments was found and these findings are consistent with past research on problem gambling, where another way to confirm the validity is to determine the extent to which it correlates with other qualities or measures known to be directly related to problem gambling. In sum, despite the lack of a direct comparison with a classic gold-standard such as DSM-IV, the Italian version of CPGI exhibits good psychometric properties and can be used among the Italian general population to identify at-risk problem gamblers.

Complex factors and behaviors in the gambling population of Italy.

Gambling has seen significant growth globally, and particularly in Italy: it has rapidly evolved from a simple recreational activity to represent 4% of Italian GDP in 2010.A sample of 4.494 gamblers was drawn from IPSAD-Italia(®)2007-2008 (Italian Population Survey on Alcohol and Drugs) in order to examine different gambling patterns (assessed using the Canadian Problem Gambling Index Short form scale).Separate analysis was performed on young adults, age 15-24 (n = 1,241; male 56.2%), and adults, age 25-64 (n = 3,253; male 53.8%): compared with adults, Italian youth, although they gambled less (35.7% vs. 45.3%), appeared to have higher prevalence of low risk gambling (6.9% vs. 5.8%) and moderate risk or problem gambling (2.3% vs. 2.2%). Males are more likely to be moderate-risk or problem gamblers. Those with only a primary education are more likely to be moderate-risk or problem gamblers (young adults: RRR = 5.22; adults: RRR = 3.23) than those with a university education, just like those youth who use depressants, but only among younger (RRR = 3.38).A fundamental issue, "do not disapprove of gambling", seems to relate to problematic gambling: a specific Italian legislation, the Abruzzi Decree Law, could have influenced the perception that gambling may contribute positively to provide additional funds to the government for social good as well as to add needed jobs. Regardless of such potential social benefits, gambling is a social epidemic and if this association should be confirmed by more focused studies, policy makers should evaluate ways to affect this perception as soon as possible.

The application of observational data in translational medicine: analyzing tobacco-use behaviors of adolescents.

BACKGROUND: Translational Medicine focuses on "bench to bedside", converting experimental results into clinical use. The "bedside to bench" transition remains challenging, requiring clinicians to define true clinical need for laboratory study. In this study, we show how observational data (an eleven-year data survey program on adolescent smoking behaviours), can identify knowledge gaps and research questions leading directly to clinical implementation and improved health care. We studied gender-specific trends (2000-2010) in Italian students to evaluate the specific impact of various anti-smoking programs, including evaluation of perceptions of access to cigarettes and health risk. METHODS: The study used, ESPAD-Italia® (European School Survey Project on Alcohol and other Drugs), is a nationally representative sample of high-school students. The permutation test for joinpoint regression was used to calculate the annual percent change in smoking. Changes in smoking habits by age, perceived availability and risk over a 11-year period were tested using a gender-specific logistic model and a multinomial model. RESULTS: Gender-stratified analysis showed 1) decrease of lifetime prevalence, then stabilization (both genders); 2) decrease in last month and occasional use (both genders); 3) reduction of moderate use (females); 4) no significant change in moderate use (males) and in heavy use (both genders). Perceived availability positively associates with prevalence, while perceived risk negatively associates, but interact with different effects depending on smoking patterns. In addition, government implementation of public policies concerning access to tobacco products in this age group during this period presented a unique background to examine their specific impact on behaviours. CONCLUSION: Large observational databases are a rich resource in support of translational research. From these observations, key clinically relevant issues can be identified and form the basis for further clinical studies. The ability to identify patterns of behaviour and gaps in available data translates into new experiments, but also impacts development of public policy and reveals patterns of clinical reality. The observed global decrease in use is countered by stabilization in number of heavy smokers. Increased cigarette cost has not reduced use. While perceived risk of smoking may prevent initial experimentation, how government policies impact the perception of risk is not easily quantifiable.

Right ventricular ischemic injury in patients with acute ST-segment elevation myocardial infarction: characterization with cardiovascular magnetic resonance.

BACKGROUND: Experimental data show that the right ventricle (RV) is more resistant to ischemia than the left ventricle. To date, limited data are available in humans because of the difficulty of discriminating reversible from irreversible ischemic damage. We sought to characterize RV ischemic injury in patients with reperfused myocardial infarction using cardiovascular magnetic resonance. METHODS AND RESULTS: In 3 tertiary centers, 242 consecutive patients with reperfused acute ST-segment elevation myocardial infarction were studied with cardiovascular magnetic resonance at 1 week and 4 months after myocardial infarction. T2-weighted and postcontrast cardiovascular magnetic resonance scans were used to depict myocardial edema and late gadolinium enhancement, respectively. Early after infarction, RV edema was common (51% of patients), often associated with late gadolinium enhancement (31% of patients). Remarkably, RV edema and late gadolinium enhancement were found in 33% and 12% of anterior left ventricular infarcts, respectively. Baseline regional and global RV functions were inversely related to the presence and extent of RV edema and RV late gadolinium enhancement. At follow-up, a significant decrease in frequency (25/242 patients; 10%) and extent of RV late gadolinium enhancement was observed (P<0.001). With the use of multivariable analysis, the presence of RV edema was an independent predictor of RV global function improvement during follow-up (ß-coefficient=0.221, P=0.003). CONCLUSIONS: Early postinfarction RV ischemic injury is common and is characterized by the presence of myocardial edema, late gadolinium enhancement, and functional abnormalities. RV injury is not limited to inferior infarcts but is commonly found in anterior infarcts as well. Cardiovascular magnetic resonance findings suggest reversibility of acute RV dysfunction with limited permanent myocardial damage at 4-month follow-up.

Impact of Postprandial Hypoglycemia on Weight Loss After Bariatric Surgery.

INTRODUCTION: Postprandial hypoglycemia (PPHG) is a well-known complication after bariatric surgery (BS). However, it is not known whether PPHG affects weight loss after BS. AIMS: To assess the impact of PPHG on weight loss after BS in subjects without and with type 2 diabetes mellitus (T2D). METHODS: Data from 338 subjects who had undergone gastric bypass (RYGB) or sleeve gastrectomy (LSG) and were followed up for at least 2 years were analyzed. At each follow-up visit, the patient's anthropometric and biochemical characteristics were recorded and the Edinburgh Questionnaire was performed to evaluate the presence of PPHG symptoms. RESULTS: Before surgery: younger age and lower BMI predicted PPHG after BS (p = 0.02 and p = 0.0008, respectively). Also, the baseline OGTT indicated that subjects who developed PPHG had an earlier glucose peak and more often had low glucose levels at 2 h compared with the no-PPHG group (p = 0.03 and p = 0.004, respectively). After surgery: Mild-to-moderate PPHG occurred equally after RYGB and LSG (38% vs 25%, p = ns when accounting for confounders), and in T2D who achieved remission and those who did not (29.5% vs 28.6%, ns). At the 2-year follow-up, occurrence of PPHG was independently associated with smaller weight loss (p = 0.0006). CONCLUSIONS: Mild-to-moderate PPHG is a frequent complication after bariatric surgery and results in smaller weight loss after 2 years. Age, baseline BMI, and an earlier glucose peak during OGTT predict PPHG after bariatric surgery.

The Role of Hysteroscopy in Evaluating Postmenopausal Asymptomatic Women with Thickened Endometrium.

BACKGROUNDS AND AIMS: This study aims to compare hysteroscopic and histological findings in asymptomatic postmenopausal patients with thickened endometrium. MATERIALS AND METHODS: A retrospective study involving case records of 295 asymptomatic postmenopausal women with a thickened endometrium >5 mm diagnosed at transvaginal ultrasound (TVS). Patients (women) underwent hysteroscopy with biopsy between 2009 and 2015, and they were followed up at National Cancer Institute of Bari and at University Hospital of Pisa. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of hysteroscopy were evaluated. RESULTS: Inclusion criteria were TVS, hysteroscopy, and endometrial biopsy. When the hysteroscopic findings were normal, a sensitivity of 100%, specificity of 98.6%, PPV of 95.2%, and NPV of 100% were achieved. For polyps and myomas, we found 100%, 98.7%, 99.5%, and 100%, respectively. In case of endometrial hyperplasia, a sensitivity of 66.7%, a specificity of 100%, a PPV of 100%, and a NPV of 98.1% were achieved. For endometrial cancer hysteroscopy, sensitivity, specificity, PPV, and NPV were 100%, 99.6%, 75%, and 100%, respectively. CONCLUSIONS: Hysteroscopy allows an accurate diagnosis in benign endometrial pathology and suspect of malignant endometrial pathology in postmenopausal women with thickened endometrium.

'Are The Times A-Changin'? Trends in adolescent substance use in Europe.

AIMS: To estimate temporal trends in adolescents' current cigarette, alcohol and cannabis use in Europe by gender and region, test for regional differences and evaluate regional convergence. DESIGN AND SETTING: Five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 28 countries between 1999 and 2015. Countries were grouped into five regions [northern (NE), southern (SE), western (WE), eastern Europe (EE) and the Balkans (BK)]. PARTICIPANTS: A total of 223 814 male and 211 712 female 15-16-year-old students. MEASUREMENTS: Daily cigarette use, weekly alcohol use, monthly heavy episodic drinking (HED) and monthly cannabis use. Linear and quadratic trends were tested using multi-level mixed-effects logistic regression; regional differences were tested using pairwise Wald tests; mean absolute differences (MD) of predicted prevalence were used for evaluating conversion. FINDINGS: Daily cigarette use among boys in EE showed a declining curvilinear trend, whereas in all other regions a declining linear trend was found. With the exception of BK, trends of weekly drinking decreased curvilinear in both genders in all regions. Among girls, trends in WE, EE and BK differed from trends in NE and SE. Monthly HED showed increasing curvilinear trends in all regions except in NE (both genders), WE and EE (boys each). In both genders, the trend in EE differed from the trend in SE. Trends of cannabis use increased in both genders in SE and BK; differences were found between the curvilinear trends in EE and BK. MD by substance and gender were generally somewhat stable over time. CONCLUSIONS: Despite regional differences in prevalence of substance use among European adolescents from 1999 to 2015, trends showed remarkable similarities, with strong decreasing trends in cigarette use and moderate decreasing trends in alcohol use. Trends of cannabis use only increased in southern Europe and the Balkans. Trends across all substance use indicators suggest no regional convergence.

Energy Drink and Alcohol mixed Energy Drink use among high school adolescents: Association with risk taking behavior, social characteristics.

PURPOSE: The aims of the study were to: a) examine the prevalence of energy drink (ED) and alcohol mixed with energy drink (AmED) consumption; b) investigate the relationships between ED and AmED with alcohol, binge drinking and drugs accounting for at risk behaviors among a representative sample of Italian adolescents. METHODS: A representative sample of 30,588 Italian high school students, aged 15-19years, was studied. Binary and multivariate logistic regression analyses were performed to determine the independent association of the potential predictors' characteristics with the ED and AmED drinking during the last year. RESULTS: Respectively 41.4% and 23.2% of respondents reported drinking EDs and AmEDs in the last year. Multivariate analysis revealed that consumption of EDs and AmEDs during the last year were significantly associated with daily smoking, binge drinking, use of cannabis and other psychotropic drugs. Among life habits and risky behaviors the following were positively associated: going out with friends for fun, participating in sports, experiencing physical fights/accidents or injury, engaging in sexual intercourse without protection and being involved in accidents while driving. CONCLUSIONS: This study demonstrates the popularity of ED and AmED consumption among the Italian school population aged 15-19years old: 4 out of 10 students consumed EDs in the last year and 2 out of 10 AmED. Multivariate analysis highlighted the association with illicit drug consumption and harming behaviors, confirming that consumption of EDs and AmEDs is a compelling issue especially during adolescence, as it can effect health as well as risk taking behaviors.

Drinking and driving among Italian adolescents: Trends over seven years (2007-2013).

In recent years, increasing attention has been paid to the issue of driving under the influence of alcohol (DUI), especially among young people. The aims of the present study were (1) to analyse the trends of DUI, riding with a driver under influence of alcohol (RWDUI) and alcohol-related road crashes (A-rC) in a nationally representative sample of students in the period 2007-2013, (2) to assess how different drinking patterns were associated with DUI and RWDUI, (3) to evaluate other influential factors (such as gender, older siblings' and friends' behaviour with alcohol) on DUI and RWDUI. Data were drawn from the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) carried out annually in Italy. The sample size ranged from 25,555 to 40,390 students (15-19 years old). Results were stratified for students <18 years and ≥18 years old. Although a significant decreasing trend for alcohol consumption was observed only in the younger group, a significant decrease in DUI [APC (annual percent change) -9.7 in the younger and -6.4 in the older group] and in RWDUI (APC -6.7 in the younger and -4.8 in the older group) was detected. A significant decreasing trend of A-rC was observed only in the older group (APC -3.4). Three specific drinking patterns were identified: "Drinking to Excess" (DE), "Drinking with Intoxication" (DI) and "Drinking but Not to Excess" (DNE). In both age groups, the DE pattern significantly increased the likelihood of DUI, whereas the DI pattern was negatively associated, and the DNE pattern was not associated. Different results were found for RWDUI: the DE and DI patterns where significantly associated with RWDUI, whereas the DNE pattern was negatively associated. Overall, illegal substance use, parental monitoring, peers' and siblings' influence were associated with DUI and RWDUI. The change in behaviour towards DUI and RWDUI suggests a cumulative effectiveness of current alcohol policies, although further actions (greater attention to social context, law enforcement, and promotion of good practice) are needed to substantially reduce alcohol-related crashes.

Left ventricular dysfunction in repaired tetralogy of Fallot: incidence and impact on atrial arrhythmias at long term-follow up.

Left ventricle (LV) systolic dysfunction in repaired tetralogy of Fallot (TOF) has been identified as a risk factor for functional status and adverse outcome. The aims of this cross-sectional followed by a prospective study were: (1) to evaluate the prevalence of LV systolic dysfunction in a large cohort of adults with repaired tetralogy of Fallot, (2) to test the relationship between LV systolic dysfunction and other known risk factors and (3) to evaluate the impact of LV systolic dysfunction on adverse cardiac events. In a multicenter study, 237 adults repaired TOF (58 % males, age 30 ± 10 years) were evaluated by cardiac magnetic resonance (CMR). Demographics, surgical history, ECG, Echo-Color Doppler and follow-up data were recorded. LV was dilated (Z value >2) in 16 patients (6 %), however 56 patients (23.6 %) had a reduced LV systolic function left ventricle ejection fraction (LVEF) (Z value <-2). Patients with LV systolic dysfunction were mainly males (82 %), had reduced right ventricle ejection fraction (RVEF), and higher right and left Late Gadolinium Enhanced scores. In a multivariate regression analysis male gender and RVEF resulted to be independent factors associated to LV systolic dysfunction. Atrial arrhythmias were the main adverse cardiac event at the follow-up and were associated to higher biventricular volumes and lower biventricular ejection fraction (EF); however multivariable analysis identified age, right ventricle end-diastolic volume (RVEDVi) and tricuspid regurgitation as independents factors associated to atrial arrhythmias. At long term follow-up at least » of repaired TOF has LV dysfunction. Lower LVEF is associated to male gender and lower RVEF.

Right ventricular dysfunction: an independent and incremental predictor of cardiac deaths late after acute myocardial infarction.

Prognostic implication of right ventricular dysfunction and infarction scar in the chronic phase of the myocardial infarction has been little analyzed. In 299 consecutive patients (age 63 ± 11 years) with >3 months old myocardial infarction, we quantified right and left ventricular volumes and ejection fractions by cine cardiac magnetic resonance, and right and left ventricular scar tissue by late gadolinium enhancement. During follow-up (median, 2.4 years) cardiac events (cardiac-related deaths or appropriate intra-cardiac defibrillator shocks) occurred in 21 patients. Right ventricular systolic dysfunction (ejection fraction lower the reference mean values-2 SD) was present in 67 patients (22 %), right ventricular late gadolinium enhancement was observed in 15 patients (5 %). After adjustment for left ventricular end-diastolic volume, wall motion score index, and global extent of late gadolinium enhancement, right ventricular dysfunction was an independent and incremental predictor of cardiac events (p = 0.0053), while right ventricular scar tissue extent was not. Right ventricular dysfunction is an independent and incremental predictor of cardiac events also in the chronic phase of the myocardial infarction. In these patients, right ventricular dysfunction does not necessarily mean right ventricular infarction scar, but likely reflects the effects of hemodynamic and biohumoral factors.

Country- and individual-level determinants of probable problematic gambling in adolescence: a multi-level cross-national comparison.

AIMS: To estimate the role of family and socio-economic indicators of welfare state in accounting for probable problem gambling during adolescence in a representative sample of students living in nine European countries. DESIGN: Data from the 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD) Study were used for cross-sectional analyses of adolescent probable problem gambling. SETTING: Representative surveys in nine European countries. PARTICIPANTS: A total of 31 236 16-year-old students. MEASUREMENTS: Respondents' probable problem gambling, socio-demographic characteristics and parenting (regulation, monitoring and caring) were measured individually. Indicators of wealth (gross domestic product per capita, GDP), expenditure on public health (% GDP) and benefit in kind for families/children (% GDP) were obtained from national public databases. FINDINGS: Students who perceived more parental caring [odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.85-0.98] and monitoring (OR = 0.57, 95% CI = 0.53-0.62) reported less involvement in probable problem gambling. Moreover, students who perceived stronger parental regulation (OR = 1.16, 95% CI = 1.09-1.23) were more likely to be possible problematic gamblers. At the country level, expenditure on public health was associated negatively with probable problem gambling (OR = 0.87, 95% CI = 0.78-0.97), whereas GDP per capita (OR = 1, 95% CI = 1.00-1.00) and the benefits in kind for families/children (OR = 1.16, 95% CI = 0.89-1.51) showed no association with probable problem gambling. CONCLUSIONS: Family characteristics and expenditure on public health may play a key role in explaining probable problem gambling among adolescents in Europe.

Role of stress echocardiography in operated fallot: feasibility and detection of right ventricular response.

BACKGROUND: Patients with repaired tetralogy of Fallot often present residual hemodynamic abnormalities leading to right ventricular (RV) burden. Semisupine exercise echocardiography (Ex-Echo) is a validated method for diagnosis and prognosis in ischemic and valvular heart diseases and has potential for the evaluation of RV burden, pressure, and function. The aims of this study were to assess the effect of exercise on the right ventricle in adults with repaired tetralogy of Fallot and to identify factors associated with decreased RV function at peak exercise in an observational study. METHODS: A total of 128 patients with repaired tetralogy of Fallot referred to an outpatient congenital heart disease unit were evaluated by Ex-Echo and conventional clinical and diagnostic examinations (i.e., electrocardiography, transthoracic echocardiography, cardiovascular magnetic resonance, cardiopulmonary exercise testing, and N-terminal pro-brain natriuretic peptide assay). The following Ex-Echo parameters were measured at rest and at peak exercise: tricuspid annular plane systolic excursion, RV pressure, and RV fractional area change (FAC). RESULTS: Interpretable images for RV FAC analysis were obtained in 123 of 128 patients. In 91 of 128 with detectable tricuspid valve regurgitation, RV systolic pressure during exercise was evaluated. According to positive or negative RV FAC variation during exercise, 74 patients were respectively defined as "responders" on stress echocardiography and 49 as "nonresponders"; the median percentage change between rest and stress was 13.8% (interquartile range, 5.9% to 26.9%) in responders and -13.5% (interquartile range, -25.4% to -7.4%) in nonresponders. Systolic RV systolic pressure increased in a similar manner in the two groups (65 ± 36% in responders vs 59 ± 39% in nonresponders, P = .45). Tricuspid annular plane systolic excursion increased significantly during peak exercise in responders from 17.2 ± 3.4 mm at rest to 19.7 ± 4.3 mm (P < .0001) but did not in nonresponders (from 16.9 ± 4.7 to 18.1 ± 4.6 mm, P = .20). Left ventricular end-diastolic volume at rest and left ventricular ejection fraction < 50% were related to the lack of increased RV FAC on exercise. CONCLUSIONS: Ex-Echo is feasible in patients with repaired tetralogy of Fallot and allows the integrated assessment of variation in RV systolic pressure, area, and function during exercise, which usefully complement more conventional indices of hemodynamic burden in these patients. Longitudinal follow-up is needed to better delineate the prognostic value of the results of Ex-Echo.

Conventional insulin vs insulin infusion therapy in acute coronary syndrome diabetic patients.

AIM: To evaluate the impact on glucose variability (GLUCV) of an nurse-implemented insulin infusion protocol when compared with a conventional insulin treatment during the day-to-day clinical activity. METHODS: We enrolled 44 type 2 diabetic patients (n = 32 males; n = 12 females) with acute coronary syndrome (ACS) and randomy assigned to standard a subcutaneous insulin treatment (n = 23) or a nurse-implemented continuous intravenous insulin infusion protocol (n = 21). We utilized some parameters of GLUCV representing well-known surrogate markers of prognosis, i.e., glucose standard deviation (SD), the mean daily δ glucose (mean of daily difference between maximum and minimum glucose), and the coefficient of variation (CV) of glucose, expressed as percent glucose (SD)/glucose (mean). RESULTS: At the admission, first fasting blood glucose, pharmacological treatments (insulin and/or anti-diabetic drugs) prior to entering the study and basal glycated hemoglobin (HbA1c) were observed in the two groups treated with subcutaneous or intravenous insulin infusion, respectively. When compared with patients submitted to standard therapy, insulin-infused patients showed both increased first 24-h (median 6.9 mmol/L vs 5.7 mmol/L P < 0.045) and overall hospitalization δ glucose (median 10.9 mmol/L vs 9.3 mmol/L, P < 0.028), with a tendency to a significant increase in first 24-h glycaemic CV (23.1% vs 19.6%, P < 0.053). Severe hypoglycaemia was rare (14.3%), and it was observed only in 3 patients receiving insulin infusion therapy. HbA1c values measured during hospitalization and 3 mo after discharge did not differ in the two groups of treatment. CONCLUSION: Our pilot data suggest that no real benefit in terms of GLUCV is observed when routinely managing blood glucose by insulin infusion therapy in type 2 diabetic ACS hospitalized patients in respect to conventional insulin treatment.