University of Rome Tor Vergata

Abstract Objective To map the existing literature on decision regret among patients with non-communicable diseases (NCDs) and develop an integrated framework to understand its impact on patient outcomes and healthcare processes. Methods A systematic search of PubMed, Embase, CINAHL, Cochrane Library, Google Scholar, and Scopus databases was conducted until January 2024 using the “Population, Concept, Context” framework. The review identified and analyzed 28 studies published between 2005 and 2023 in North America and Europe. Results Decision regret primarily arises from mismatches between expected and actual treatment outcomes and is strongly influenced by patient-clinician communication quality. The need for improved informed consent processes and enhanced communication strategies to mitigate regret emerged as prevalent themes. A hypothetical theoretical path was developed to define the relationship between patient expectations, medical outcomes, and emotional responses. Conclusion Enhanced communication and personalized treatment plans are crucial for addressing the multifaceted nature of regret in healthcare. Improved patient-clinician communication and informed consent processes can significantly reduce decision regret. Practice Implications Healthcare providers should focus on effective communication and education to personalize care strategies and align treatment decisions with patient expectations. This could ultimately reduce decision regret and improve patient outcomes.

This paper investigates households’ financial fragility in twelve European countries to assess whether international differences are a matter of household characteristics and/or of country features. Financial fragility is characterized by not having income constraints, but by holding insufficient liquid assets to face unexpected expenses. The estimation results show that this metric is able to capture difficulties other than those related to debt and income and highlight the relevance of accounting for household portfolio decisions. Specifically, an illiquid portfolio increases the likelihood of financial fragility, while indebtedness not always does. Relevant differences among countries are observed in terms of both the estimated average likelihood of financial fragility and its main determinants. A decomposition exercise carried out by means of counterfactual methods shows that most of each country’s difference in financial fragility with respect to Germany arises predominantly from household characteristics rather than from its economic-institutional setup, even if in two countries the latter is found to more than compensate for the former.

Genital herpes is one of the most common sexually transmitted infections worldwide. Using the best available evidence, this guideline recommends strategies for diagnosis, management and follow‐up of the condition as well as for minimizing transmission. Early recognition and initiation of therapy is key and may reduce the duration of illness or avoid hospitalization with complications, including urinary retention, meningism or severe systemic illness. The guideline covers a range of common clinical scenarios, such as recurrent genital herpes, infection during pregnancy and coinfection with human immunodeficiency virus.

Several large longitudinal studies have found that blood biomarkers are able to efficiently detect Aβ and tau pathology and estimate the degree of neurodegeneration. When combined, blood AD biomarkers can reliably and effectively predict brain pathology in individuals with mild cognitive impairment and clinical progression to AD dementia and distinguish AD dementia from other types of dementia. Interpreting results of blood candidate biomarkers simultaneously in a clinical context in the single individual with cognitive complaints is challenging due to high individual variability, lack of clear cut-offs, and differential diagnosis. A decision algorithm could aid in the interpretation, tailored to the following clinically relevant questions. Although blood-based AD biomarkers have great potential in the diagnostic workup for AD, evidence of their utility in terms of patient clinical outcome is not yet available, hampering their widespread clinical implementation.

According to the World Health Organization (WHO), gender is one of the main determinants of health. Thus, there is an urgent need to understand and eliminate gender disparities in mental health, as gender equality is fundamental in science, medicine, and global health. Gender is a variable that influences several aspects of mental health, including the prevalence of mental disorders, clinical expression, disease course, response to treatment, and help-seeking attitudes. Depression is three times more frequent in women than in men, anxiety and panic disorders are twice as frequent in women than in men, bulimia three times, and anorexia nervosa 13 times. On the other hand, early-onset schizophrenia, substance use disorders, and neurodevelopmental disorders such as autism spectrum disorder and attention-deficit/hyperactivity disorder, are more prevalent in males. Gender differences in the pharmacokinetics and pharmacodynamics of drugs are responsible for their different efficacy and possible side effects. However, women are underrepresented in biomedical clinical studies. Indeed, an individual may respond to stimuli such as drugs based on circulating levels of sex hormones that fluctuate during the female reproductive cycle and are different in men and in people taking hormone treatments. A neglected problem is paternal and maternal perinatal depression. The perinatal period is an extremely delicate passage in a woman’s life. There is clear evidence that one in five women suffer from maternal mental disorders in the perinatal period and that relapses of major depressive disorder and bipolar episodes can frequently occur. It is also important to focus on the emotional well-being of co-parents in the perinatal period as it affects both of them and the mother and baby. Many screening programs and interventions are developing to promote healthy parenting and family bonding, targeting mental health, medication counseling, and reducing neurodevelopmental risk factors in offspring. Addressing gender inequality and incorporating gender differences into mental health and pharmacology are essential to establishing an effective and safer treatment strategy.

This chapter gives an overview of the current state of knowledge regarding the non-native species Chara fibrosa. It presents a full morphological description of some exceptional finds in Europe including herbarium materials of the 19th century and recent finds in the Mediterranean area. The rare occurrences in Europe appeared in regions where rice farming is traditional and suggest that the species was accidentally introduced. Its ecological requirements are briefly described in order to attract the attention for investigations in the respective habitats.

Purpose Evaluating menstrual blood loss (MBL) in primary healthcare is challenging. Our study aimed to assess MBL using two methods: self-perception and pictograms (Pictorial Blood Assessment Chart—PBAC and Menstrual Pictogram superabsorbent polymer-c version—MP) in women undergoing transvaginal ultrasound (TVS). Methods We enrolled 221 premenopausal women with spontaneous menstruation, no hormonal therapy, and no ongoing pregnancy. They were divided into four age groups (12–20, 21–30, 31–40, and 41–55 years). Women self-reported normal (NMB) or heavy menstrual bleeding (HMB) and filled out PBAC and MP. A PBAC score ≥ 150 and MP score ≥ 80 ml indicated HMB. TVS was conducted on all patients, recording any pelvic pathologies. We compared self-perception with pictograms across the cohort, age groups, and ultrasound findings. Results Of the cohort, 50.2% reported normal periods and 49.8% heavy periods. No significant differences were found between self-perception and pictograms in identifying NMB and HMB across all groups. However, significant differences were observed between PBAC and MP scores for NMB (56.1% vs 41.2%, p = 0.001) and HMB (43.9% vs 58.8%, p = 0.001), particularly in the 31–40 age group. Significant differences in PBAC and MP scores were noted between age groups 12–20 and 41–55, and 31–40 and 41–55. No significant differences were found between self-perception and pictograms regarding ultrasound findings like adenomyosis, fibroids, endometrial pathology, and uterine congenital malformations. Conclusion Self-perception could be a reliable method for describing MBL across all age groups and ultrasound findings. Given the complexity and potential errors in using pictograms, clinicians should consider relying on self-perception for assessing menstrual cycle quantity.

Background Sacubitril/valsartan (S/V) is a cornerstone treatment for heart failure (HF). Beneficial effects on hospitalization rates, mortality, and left ventricular remodeling have been observed in patients with heart failure and reduced ejection fraction (HFrEF). Despite the positive results, the influence of S/V on renal function during long-term follow-up has received little attention. Aims We investigated the long-term effects of S/V therapy on renal function in a large cohort of patients with HFrEF. Additionally, we examined the effects of the drug in patients with chronic kidney disease (CKD) compared to those with preserved renal function and identified primary risk characteristics Methods We studied 776 outpatients with HFrEF and left ventricular ejection fraction (LVEF) <40% from an observational registry of the Italian Society of Cardiology, all receiving optimized standard-of-care therapy with S/V. The patients were included in a multicentric open-label registry from 11 Italian academic hospitals. Kidney function was evaluated at baseline, after 6 months of S/V, and at 4 years. Patients were followed-up through periodic clinical visits. Results During a 48-month follow-up period, 591 patients remained stable and 185 patients (24%) experienced adverse events (85 deaths and 126 hospitalizations). S/V therapy marginally affects renal function during the follow-up period (estimated glomerular filtration rate (eGFR) at baseline 72.01 vs eGFR at follow-up 70.38 ml/min/m², p = 0.01; and creatinine was 1.06 at baseline vs 1.10 at follow-up, p < 0.04). Among patients who maintained preserved renal function, 35% were in Dose 3 and 10% dropped out of S/V therapy (p < 0.006). Univariate analysis showed that Drop-out of S/V (HR 2.73 [2.01, 3.71], p < 0.001), history of previous HF hospitalization (HR 1.75 [1.30, 2.36], p < 0.001), advanced NYHA class (HR 2.14 [1.60, 2.86], p < 0.001), NT-proBNP values >1000 pg/ml (HR 1.95[1.38, 2.77], p < 0.001), furosemide dose >50 mg (HR 2.04 [1.48, 2.82], p < 0.001), and creatinine values >1.5 mg/dl occurred during follow-up (HR 1.74 [1.24, 2.43], p < 0.001) were linked to increased risk. At multivariable analysis, increased doses of loop diuretics, advanced NYHA class, creatinine >1.5 mg/dl, and atrial fibrillation were independent predictors of adverse events. Conclusion Long-term S/V therapy is associated with improved outcomes and renal protection in patients with HFrEF. This effect is more pronounced in patients who tolerate escalating doses. The positive effects of the drug are maintained in both CKD and preserved renal function. Future research may study the safety and underlying causes of current protection.

Background Recent real-world studies revealed high proportions of patients with metastatic urothelial cancer (mUC) do not receive any systemic therapy. This study describes the demographics, clinical characteristics, treatment rate and related predictive factors, healthcare resource utilization, and direct medical costs of patients with mUC receiving systemic therapy (or not) in the inpatient setting in Italy. Methods This retrospective observational study used the national hospital discharge database (Scheda di Dimissione Ospedaliera) to describe incident adult (≥ 18 years) patients with a first hospitalization for mUC (index) from 2017-2018, identified by a combination of ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), medical procedure, and diagnosis-related group codes. A model was fitted to identify factors associated with receiving inpatient chemotherapy and/or radiotherapy. Results Of 3674 patients with mUC identified, 1014 (27.6%) were treated with inpatient chemotherapy and/or radiotherapy and 2660 (72.4%) were not treated. The median age at index was 71 and 78 years for treated and untreated patients, and the mean (SD) Charlson Comorbidity Index (CCI) score was 0.3 (0.8) and 0.6 (1.1), respectively. Primary tumor location was the bladder in 87.2% of patients. Cardiovascular disease and renal function impairment were more prevalent in untreated (22.6% and 13.2%) vs treated (16.7% and 7.8%) patients. Older age (odds ratio [p-value]) (0.94 [< 0.001]), female sex (0.82 [0.035]), and higher CCI score (0.82 [< 0.001]) were all associated with a lower likelihood of receiving inpatient systemic treatment. The first year was the costliest: estimated national projected costs during the 36-month follow-up from first hospitalization for mUC were €34.3 million (95% CI, €30.3-€60.0 million) and €31.8 million (95% CI, €28.1-€56.0 million) when estimated after 1 year. Conclusions Our findings indicate a low rate of inpatient systemic therapy for patients with mUC in Italy (driven by older age, female sex, and high comorbidity burden), with a large economic burden despite a high nontreatment rate. Although this study provides a partial capture of the treatment pathway in Italy, the results are consistent with other European studies with similar designs and highlight the need to better identify the reasons for not administering inpatient systemic chemotherapy and/or radiotherapy.

The composition of human gut microbiota is dominated by bacteria which have been extensively studied. The role of intestinal eukaryote microorganisms like Blastocystis, however, remains under investigation. Moreover, the potential impact on gut health related to Blastocystis presence was primarily investigated in symptomatic individuals mainly from industrialized countries, and appears to be mostly beneficial to the host microbiota. Data from surveys conducted in underdeveloped countries with higher prevalence and from asymptomatic individuals could therefore be valuable. The aim of this preliminary study was to analyze the composition of the gut microbiota in relation to the protozoa Blastocystis ST1 and ST2 and Entamoeba hartmanni carriage in asymptomatic subjects living in a semi-urban area of Côte d’Ivoire to add data into the ongoing debate on the role of Blastocystis in host health. The amplification of the V3 and V4 regions of bacterial 16S rDNA genes was performed to obtain the gut microbiota composition, and differential analyses on alpha and beta diversity were performed from the phylum to genus taxonomic level. The analysis revealed that individuals positive for both protozoa exhibited higher alpha and beta diversity compared to those who tested negative. Additionally, their bacterial composition showed a reduction in Bacteroides and an increase in Prevotella 9. Relative abundances of some OTUs, particularly Faecalibacterium, observed in individuals who tested positive for protozoa, were correlated with a good state of health of the gut microbiota. Blastocystis ST1 and ST2 associated with E. hartmanni thus appeared to be related to a state of intestinal eubiosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13099-024-00661-5.

Background Rapid eye movement (REM) sleep behavior disorder (RBD) may precede motor symptoms in Parkinson's disease (PD) by years. According to a recent hypothesis, premotor RBD (pRBD) is a marker of the PD body‐first subtype, where synucleinopathy originates from the peripheral autonomic nervous system. Conversely, in the brain‐first subtype, pathology would arise in the brain. Functional connectivity (FC) could provide additional insight into the neurodegenerative process of these putative PD subtypes. Objectives We aim to analyze the possible FC differences between early‐stage PD patients with (PD pRBD+ ) and without (PD pRBD− ) pRBD using high‐density electroencephalography (EEG). Methods We enrolled 28 PD pRBD+ , 35 PD pRBD− , and 35 healthy controls (HC). Data were recorded with a 64‐channel EEG system, and a source‐reconstruction method was used to identify brain‐region activity. FC was calculated using the weighted phase‐lag index in θ, α, β, and low‐γ bands. Statistical analysis was conducted using network‐based statistic. Results We found a significant trend of decreased α‐FC across PD pRBD+ , PD pRBD− , and HC, mainly in prefrontal and temporal areas. The altered α‐FC correlated with Montreal Cognitive Assessment scores in PD pRBD+ and, to a lesser extent, PD pRBD− and with gait/postural disturbances in PD pRBD+ patients only. PD pRBD+ and PD pRBD− had similarly increased FC than HC in a β band network, predominantly involving sensorimotor and limbic areas. The increased β network FC was related to bradykinesia severity in both PD subgroups. Conclusions Compared to PD pRBD− (brain‐first subtype), PD pRBD+ group (body‐first subtype) demonstrates specific EEG‐FC dysfunctions in the α band, which may reflect early involvement of the cholinergic ascending system. © 2024 International Parkinson and Movement Disorder Society.

WDFY3 (MIM#617485) defects may manifest neurodevelopmental disorders (NDDs) and opposite effects on brain size based on allelic effect. This case highlights a heterozygous WDFY3 nonsense variant linked to mild‐to‐moderate NDDs, macrocephaly, and unique facial features. Findings emphasize the importance of exome sequencing in NDDs for accurate diagnosis and clinical management. image

The development of a stable, non‐toxic material that emits electrons following absorption of visible light may have a major impact on the solar photocatalysis of difficult reactions such as CO2 and N2 reduction, as well as for targeted chemical transformations in general. Diamond is a good candidate, however it is a wide bandgap material requiring deep UV photons ( λ ${{\rm{{\rm \lambda} }}}$ <227 nm) to promote electrons from the valence band into the conduction band. Embedding silver nanoparticles under the diamond surface allows the photoconductivity of the diamond in the spectral region of the surface plasmon resonance to be increased, while also leading to an enhancement of visible light photoemission. Considering the low intensity of the light sources used in this work and the spectral properties of the enhanced photoconductivity and photoemission a mechanism based on plasmonically enhanced photoconductivity which in turn allows surface states emptied by photoemission to be recharged thus leading to enhanced photoemission in the visible range is proposed.

Arrhythmogenic Cardiomyopathy (ACM) is a life-threatening, genetically determined disease primarily caused by mutations in desmosomal genes, such as PKP2 . Currently, there is no etiological therapy for ACM due to its complex and not fully elucidated pathogenesis. Various cardiac cell types affected by the genetic mutation, such as cardiomyocytes (CM) and cardiac mesenchymal stromal cells (cMSC), individually contribute to the ACM phenotype, driving functional abnormalities and fibro-fatty substitution, respectively. However, the relative importance of the CM and cMSC alterations, as well as their reciprocal influence in disease progression remain poorly understood. We hypothesised that ACM-dependent phenotypes are driven not only by alterations in individual cell types but also by the reciprocal interactions between CM and cMSC, which may further impact disease pathogenesis. We utilized a patient-specific, multicellular cardiac system composed of either control or PKP2 -mutated CM and cMSC to assess the mutation’s role in fibro-fatty phenotype by immunofluorescence, and contractile behaviour of co-cultures using cell motion detection software. Additionally, we investigated reciprocal interactions both in silico and via multi-targeted proteomics. We demonstrated that ACM CM can promote fibro-adipose differentiation of cMSC. Conversely, ACM cMSC contribute to increasing the rate of abnormal contractile events with likely arrhythmic significance. Furthermore, we showed that an ACM-causative mutation alters the CM-cMSC interaction pattern. We identified the CM-sourced DLK1 as a novel regulator of fibro-adipose remodelling in ACM. Our study challenges the paradigm of exclusive cell-specific mechanisms in ACM. A deeper understanding of the cell-cell influence is crucial for identifying novel therapeutic targets for ACM, and this concept is exploitable for other cardiomyopathies.

We build an asymmetric duopoly model featuring two polluting firms that are heterogeneous in terms of production efficiency. The less efficient firm performs abatement by buying an environmental good in exchange for a fixed fee, while the more efficient one engages directly in abatement. In this set-up, we compare two environmental policy settings: one where the regulator commits to policy before observing abatement investment, and one where such commitment is not credible (i.e. time consistency). We conclude that, in the latter setting, emission taxes are lower, whilst aggregate profits and consumers’ surplus are enhanced with respect to the case with commitment. The welfare ranking is not straightforward, as commitment may make society better off than under time consistency, depending on the degree of technological asymmetry in production. Moreover, policy makers might be “trapped” in a time-consistent policy scenario, due to the interest of involved stakeholders, at the expense of environmental policy effectiveness.