Hasil untuk "Public aspects of medicine"

Haiting Jiang, Chengyu Wei

China, with the severe burden of hepatitis B, plays a significant role in the global efforts towards eliminating hepatitis B disease by 2030. Vaccination is recognized as the most effective measure to prevent infectious diseases. However, vaccine hesitancy remains a significant barrier to achieving herd immunity across diverse populations. To address this issue, the health ministries and public health authorities in China have implemented various measures to encourage hepatitis B vaccination. China’s National Hepatitis B Immunization Program, initiated in 1985, has been successful in controlling this vaccine-preventable disease. Given the challenges in eliminating hepatitis B, strengthening the National Hepatitis Immunization Program in China is of utmost importance. Through an analysis of policy documents, reports, and scientific papers, the history of the program was summarized, and effective approaches to address vaccine hesitancy were identified. This will help achieve universal health coverage of vaccines and effectively work towards meeting the goals set for 2030.

Ying Sha, Jianfen Zhu, Fangrong Shen

Abstract Objective Polycystic ovary syndrome (PCOS) is an endocrine gynecological disease affecting many women of reproductive age. Clomiphene is the first-line treatment for PCOS patients, but most individuals may be resistant to it. This study aims to assess the efficacy of dexamethasone and clomiphene in the treatment of PCOS patients, and to provide a theoretical basis for clinicians to study and treat PCOS. Methods Chinese and English databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang Medical Network, and VIP Information Chinese Journal Service Platform (VIP) were searched from the inception to January 2023. Review Manager and Stata software were used for meta- analysis. The risk of bias of eligible studies were assessed using Cochrane’s risk of bias tool. Publication bias was assessed by funnel plots, Begg’s and Egger’s tests. Results A total of 12 literatures were finally included, with a total of 1270 PCOS patients. Compared with the control group, dexamethasone combined with clomiphene could significantly improve pregnancy (RR = 1.71, P < 0.00001), ovulation (RR = 1.30, P < 0.00001), luteinizing hormone level (SMD = -0.94, P < 0.00001), estradiol level (SMD = 0.99, P = 0.05), progesterone level (SMD = 5.08, P = 0.002) and testosterone level (SMD = -1.59, P < 0.00001). However, there were no significant effects on ovulation-stimulating hormone level (SMD = 0.15, P = 0.37), adverse reactions (RR = 1.30, P = 0.30), dizziness (RR = 1.50, P = 0.45), and vomiting (RR = 1.67, P = 0.48). Conclusion The treatment of dexamethasone combined with clomiphene is helpful to improve the ovulation and pregnancy rate in patients with PCOS, and improve the hormone levels of patients.

Sainan Duan, Dongxu Chen, Jinping Wang et al.

BackgroundCognition disorders not only lead to adverse health consequences but also contribute to a range of socioeconomic challenges and diminished capacity for performing routine daily activities. In the digital era, understanding the impact of digital exclusion on cognitive function is crucial, especially in developing countries. ObjectiveThis study aimed to evaluate the association between digital exclusion and cognitive function among elderly populations in developing countries. MethodsUsing data from CHARLS (China Health and Retirement Longitudinal Study) from 2011 to 2020 and MHAS (Mexican Health & Aging Study) from 2012 to 2021, we defined digital exclusion as self-reported absence from the internet. Cognitive function was assessed through 5 tests: orientation, immediate verbal recall, delayed verbal recall, serial 7s, and figure recall. Cognitive function was assessed in 2 categories: worse cognition (a categorical variable that classifies cognition as either better or worse compared to the entire cohort population) and cognitive scores (a continuous variable representing raw cognitive scores across multiple follow-up waves). Logistic regression analyses and generalized estimating equation (GEE) analyses were used to examine the relationship between cognitive function and digital exclusion, adjusting for potential confounders, including demographics, lifestyle factors, history of chronic diseases, basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and basic cognitive abilities. ResultsAfter excluding participants with probable cognitive impairment at baseline and those who did not have a complete cognitive assessment in any given year (ie, all tests in the cognitive assessment must be completed in any follow-up wave), a total of 24,065 participants in CHARLS (n=11,505, 47.81%) and MHAS (n=12,560, 52.19%) were included. Of these, 96.78% (n=11,135) participants in CHARLS and 70.02% (n=8795) in MHAS experienced digital exclusion. Adjusted logistic regression analyses revealed that individuals with digital exclusion were more likely to exhibit worse cognitive performance in both CHARLS (odds ratio [OR] 2.04, 95% CI 1.42-2.99; P<.001) and MHAS (OR 1.40, 95% CI 1.26-1.55; P<.001). Gender and age did not significantly modify the relationship between digital exclusion and worse cognition (intervention P>.05). The fully adjusted mean differences in global cognitive scores between the 2 groups were 0.98 (95% CI 0.70-1.28; P<.001) in CHARLS and 0.50 (95% CI 0.40-0.59; P<.001) in MHAS. ConclusionsA substantial proportion of older adults, particularly in China, remain excluded from internet access. Our study examined longitudinal changes in cognitive scores and performed cross-sectional comparisons using Z-score standardization. The findings suggest that digital exclusion is linked to an increased risk of cognitive decline among older adults in developing countries. Promoting internet access may help mitigate this risk and support better cognitive health in these populations.

Dyah Wijayanti, Siti Nur Kholifah, Dinarwiyata Dinarwiyata

The fulfillment of the psychological needs of neglected children in shelters is important. However, only the physical need has been fulfilled, resulting in a feeling of dissatisfaction and hampers a positive attitude towards the social environment. Therefore, this study aimed to present a significant nursing intervention model to meet the psychological needs of neglected children. The model integrates behavioral (Lawrence Green), Caring (Jean Watson), and psychogenic needs theory (Murray) to explain the influence of predisposing, enabling, and supporting factors on behavior. This study adopted a cross-sectional design and observational analytic method with a population of 240 neglected children in Surabaya city shelters. The cluster sampling rule of thumb was used in SEM to select 110 (5x22 observe variables) respondents. The result showed that the unique aspects of the group nursing intervention model fulfilled the psychological needs of adolescents in shelters. Furthermore, interpersonal human caring behavior was influenced by predisposing factors and care values with a coefficient value of 0.203. Supporting factors and environmental caring had a coefficient of 0.220 while driving was 0.332. In conclusion, this study showed that the group nursing intervention model fulfilled the psychological needs of adolescents in shelters by integrating the theories of goal attainment, caring (Jean Watson), and psychosocial (Murray). These theories increased adolescent parenting actions, thereby enhancing self-confidence within shelters.

Maria Izabel Sanches Costa, Gabriela Lotta, Juliana Rocha Miranda et al.

RESUMO A temática do HIV ainda é permeada de estigmas e culpabilização de indivíduos por seus comportamentos. Políticas públicas, incluindo a de HIV/Aids, são baseadas em categorias políticas que geram efeitos simbólicos, reproduzindo ou enfrentando estigmas. A literatura afirma que Trabalhadores da Linha de Frente (TLF) mobilizam valores pessoais e profissionais nas interações com os usuários, que podem incluir categorias sociais ou políticas. Este artigo objetivou compreender como TLF operam tais categorias em contextos institucionais de ambiguidade, bem como analisar se suas percepções com relação às categorias de comportamento de risco e juventude estão em consonância com as políticas públicas. Foram analisadas 8 normativas e entrevistados 42 trabalhadores de 6 serviços de saúde. Os materiais foram codificados, as categorias oficiais foram comparadas, e as práticas, identificadas. As conclusões sugerem que as categorias sociais e políticas têm influência mútua. As categorias políticas ainda são legitimadas por meio de percepções sociais de normalidade e risco, especialmente ao lidar com populações prioritárias. As categorias sociais, operadas na implementação reforçam estigmas e julgamentos morais sobre alguns jovens, como os negros e pobres, as mães solteiras e a comunidade LGBTQIA+. Os serviços especializados utilizam mais as categorias políticas do que os serviços de atenção primária.

Sudhan Rackimuthu, Kapil Narain, Arush Lal et al.

Abstract Background With large swathes of the world’s population—majority clustered in low- and middle-income countries—still yet to receive the minimum of two doses of the COVID-19 vaccine; The need to address the failures of international solidarity to equitably distribute COVID-19 vaccines is now more urgent than ever to help curb the pandemic and prevent future variants. However, many high-income countries have adopted a “me first” approach, proceeding to offer COVID-19 booster doses to their entire populations, including those at least risk of severe illness, whilst the rest of the world is left unvaccinated or partially vaccinated with one dose for even their most vulnerable communities. Main body COVID-19 vaccine inequity places the health of the global population at risk and exacerbates socio-economic repercussions, especially in low- and middle-income countries. Initiatives launched to combat vaccine inequity such as the Fair Allocation Framework for the COVID-19 Vaccines (COVAX) have been unsuccessful as several governments, primarily from high-income countries, have scaled down their contributions to the initiative. Furthermore, COVAX has not seriously engaged with the Access to COVID-19 Tools (ACT) Health Systems Connector, as was originally intended, leading to crucial health systems components critical to vaccine delivery to be overlooked. Several strategies can be employed to help achieve the desired global immunization goals, such as Intellectual Property waivers, increased donations, and activation of new COVID-19 vaccine manufacturing hubs. In addition, continued advocacy for vaccine equity by all involved and affected stakeholders, as well as critical amendments to existing or upcoming legislation and funding mechanisms will help address the shortcomings of current inequitable vaccine distribution. Conclusions Global solidarity and collective action through pandemic governance mechanisms are urgently needed to ensure vaccine equity. These interventions are vital to rapidly mitigate ongoing health and humanitarian crises and ultimately curb the pandemic, sooner rather than later.

Bhardwaj A

Anish Bhardwaj Departments of Neurology, Neurosurgery, and Neurobiology, University of Texas Medical Branch (UTMB), Galveston, TX, 77555, USACorrespondence: Anish Bhardwaj, University of Texas Medical Branch (UTMB), 9.128 John Sealy Annex, Route 0539, 301 University Blvd, Galveston, TX, 77555, USA, Tel +1-409-772-8068, Email anbhardw@UTMB.EDUAbstract: Medical professionalism is critical toward provision of safe, effective, patient-centered, timely, efficient, and equitable clinical care delivery. The basic tenets of medical professionalism are deeply embedded in the historical context via oaths and expectations. However, standardization of professional conduct and its integration by providers have been a challenge due to the evolving complexity of healthcare organizations (HCOs) and academic medical institutions (AMIs). Increasing heterogeneity of the workforce leads to greater complexity in collaborative teamwork. In this evolving landscape, violations of professional conduct demand closer scrutiny along professional and personal lines. Likewise, actions among minority groups pose challenges between integration and inclusion of certain professional interactions and conduct. Recently, in American HCOs and AMIs, there has been a renewed emphasis on accountability and managing unprofessional behaviors in the delivery of clinical care. This descriptive literature-based treatise explicates the professionalism construct in its historical milieu, underscores key facets of professionalism, highlights principal drivers of unprofessional behaviors, and posits solutions for enhancing and nurturing professionalism in the delivery of clinical care in HCOs and AMIs by a diverse workforce of healthcare providers.Keywords: professionalism, workforce, healthcare, diversity, inclusion

Yuan Wang, Yueqi Zhu, Caiyun Qi et al.

BackgroundChina has launched a large “toilet revolution” in rural areas, but the results show that sanitation has not always been markedly improved. Few scholars have paid attention to this issue, and the list of the reasons is scattered and incomplete.MethodUsing the qualitative research method, this study interviewed seven village cadres and 39 villagers in three villages of Jiaozuo City to examine the implementation barriers to rural toilet retrofitting (RTR) projects in China.ResultsUsing the Van Meter and Van Horn policy implementation approach, the research has found that: (a) unreasonable standards and objectives fail to incorporate local conditions and improve the actual quality; (b) lack of capital and human resources cannot renovate new toilets; (c) uncoordinated inter-organizational communication and enforcement activities by top-down mechanism lead to policy implementers and target groups' dissatisfaction with the policy; (d) weak and unenthusiastic, inadequate implementing agencies, reduce their working ability; (e) inappropriate economic, social and political conditions impede the villagers' acceptance; and (f) an attitude of passive acceptance by the implementers reduce the working motivation.ConclusionTo improve sanitation in rural China, it is necessary to solve the six barriers. The findings of this study can provide recommendations and guidance for implementing the RTR and related public health policies.

Monica Boen, K. Jerdan

Social media has exponentially grown in the past 15 years, and the recent increase in the use of social media platforms in medicine is undeniable. In aesthetic medicine, having a social media presence can help to educate patients, the public, and colleagues on medical knowledge and procedures, while also dispelling the overcrowded misinformation from nonmedical influencers. Social media has many positive aspects that can be incorporated into aesthetic medicine to make the field stronger as well as negative aspects that should be avoided. We review the overall impact of social media in aesthetic medicine.

E. Magnin

Neurodevelopmental and neurodegenerative disorders are both growing major public health topics with similarities and frequent complex interactions with each other. Taking these aspects into account can provide a new point of view on lifelong neurocognitive trajectories. Assessing both neurodevelopmental and neurodegenerative dimensions during cognitive and behavioral clinical assessments is challenging but might improve diagnostic accuracy and physiopathological understanding. It is therefore necessary to understand the lifelong specific neurocognitive trajectory of each patient in order to develop personalized precision cognitive medicine.

Chu, Cherry, Cram, Peter, Pang, Andrea et al.

BackgroundThe COVID-19 pandemic has led to a notable increase in telemedicine adoption. However, the impact of the pandemic on telemedicine use at a population level in rural and remote settings remains unclear. ObjectiveThis study aimed to evaluate changes in the rate of telemedicine use among rural populations and identify patient characteristics associated with telemedicine use prior to and during the pandemic. MethodsWe conducted a repeated cross-sectional study on all monthly and quarterly rural telemedicine visits from January 2012 to June 2020, using administrative data from Ontario, Canada. We compared the changes in telemedicine use among residents of rural and urban regions of Ontario prior to and during the pandemic. ResultsBefore the pandemic, telemedicine use was steadily low in 2012-2019 for both rural and urban populations but slightly higher overall for rural patients (11 visits per 1000 patients vs 7 visits per 1000 patients in December 2019, P<.001). The rate of telemedicine visits among rural patients significantly increased to 147 visits per 1000 patients in June 2020. A similar but steeper increase (P=.15) was observed among urban patients (220 visits per 1000 urban patients). Telemedicine use increased across all age groups, with the highest rates reported among older adults aged ≥65 years (77 visits per 100 patients in 2020). The proportions of patients with at least 1 telemedicine visit were similar across the adult age groups (n=82,246/290,401, 28.3% for patients aged 18-49 years, n=79,339/290,401, 27.3% for patients aged 50-64 years, and n=80,833/290,401, 27.8% for patients aged 65-79 years), but lower among younger patients <18 years (n=23,699/290,401, 8.2%) and older patients ≥80 years (n=24,284/290,401, 8.4%) in 2020 (P<.001). There were more female users than male users of telemedicine (n=158,643/290,401, 54.6% vs n=131,758/290,401, 45.4%, respectively, in 2020; P<.001). There was a significantly higher proportion of telemedicine users residing in relatively less rural than in more rural regions (n=261,814/290,401, 90.2% vs n=28,587/290,401, 9.8%, respectively, in 2020; P<.001). ConclusionsTelemedicine adoption increased in rural and remote areas during the COVID-19 pandemic, but its use increased in urban and less rural populations. Future studies should investigate the potential barriers to telemedicine use among rural patients and the impact of rural telemedicine on patient health care utilization and outcomes.

Erika A. Waters, Jennifer M. Taber, A. McQueen et al.

Cancer risk prediction models such as those published in Cancer Epidemiology, Biomarkers, and Prevention are a cornerstone of precision medicine and public health efforts to improve population health outcomes by tailoring preventive strategies and therapeutic treatments to the people who are most likely to benefit. However, there are several barriers to the effective translation, dissemination, and implementation of cancer risk prediction models into clinical and public health practice. In this commentary, we discuss two broad categories of barriers. Specifically, we assert that the successful use of risk-stratified cancer prevention and treatment strategies is particularly unlikely if risk prediction models are translated into risk assessment tools that (i) are difficult for the public to understand or (ii) are not structured in a way to engender the public's confidence that the results are accurate. We explain what aspects of a risk assessment tool's design and content may impede understanding and acceptance by the public. We also describe strategies for translating a cancer risk prediction model into a cancer risk assessment tool that is accessible, meaningful, and useful for the public and in clinical practice.

Ensieh Izadi, G. Afshan, R. Patel et al.

Counterfeit and substandard medicines are recognized as one of serious threats to public health. The product quality of antibacterial medicine will compromise patients’ recovery and increase the chance of antibacterial resistance. The review aims to provide a summary of low quality levofloxacin issues and the risk factors as well as suggesting the aspects of product quality that need to be regulated strictly. Quality of the active ingredient, levofloxacin, has an important role to contribute to successful therapy. The poor quality of raw material, directly and indirectly, causes treatment failure as the presence of insufficient dose, mislabeled content, and poor dissolution characteristics can lead to lower bioavailability. Identifying and reporting these factors can potentially help in improving the quality of drug marketed in various developing countries and may also reduce the incidences of treatment failure. Dissolution test is used for testing the dissolution profiles and the rate of drug release from solid formulation such as oral formulations, thus providing information regarding the in vivo performance of a formulation and its bioequivalence. On the other hand, quality-testing procedures are used for comparing the quality of products.

Marie N. Hanna, T. Speed, R. Shechter et al.

Zepeng Gong, Zepeng Gong, Ziqiang Han et al.

The cyberspace plays an important role in improving the quality, equity, and efficiency of health services. Studying people's adoption of online health services, such as online health consultation services (OHCS) can benefit both industry and policy in the health service sector. This paper investigates influencing factors and paths of people's intention of adopting OHCS by employing the extended valence framework, with our new contribution of integrating subjective norm and offline habit into the model. Five hundred forty-three university students participated in the survey. Structural equation models and Sobel-Goodman tests were applied to test the models. The results show that subjective norm (β = 0.077, p = 0.041), trust in providers (β = 0.194, p = 0.002) and perceived benefit (β = 0.463, p &lt; 0.001) positively affect the intention to adopt OHCS, while offline habit (β = −0.111, p = 0.026) has a negative effect. However, the association of perceived risk (β = −0.062, p = 0.315) and adoption is not supported. Moreover, trust in providers plays a mediating role between subjective norm and the intention of adopting, while perceived benefit mediates the relationship between trust in providers and the intention of adopting. This study highlights the importance of trust, subjective norm, perceived benefit, and persisting habits in promoting the adoption of OHCS.

Joel L N Barratt, Meredith Lane, Emir Talundzic et al.

Strongyloidiasis is a neglected tropical disease caused by the human infective nematodes Strongyloides stercoralis, Strongyloides fuelleborni fuelleborni and Strongyloides fuelleborni kellyi. Previous large-scale studies exploring the genetic diversity of this important genus have focused on Southeast Asia, with a small number of isolates from the USA, Switzerland, Australia and several African countries having been genotyped. Consequently, little is known about the global distribution of geographic sub-variants of these nematodes and the genetic diversity that exists within the genus Strongyloides generally. We extracted DNA from human, dog and primate feces containing Strongyloides, collected from several countries representing all inhabited continents. Using a genotyping assay adapted for deep amplicon sequencing on the Illumina MiSeq platform, we sequenced the hyper-variable I and hyper-variable IV regions of the Strongyloides 18S rRNA gene and a fragment of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene from these specimens. We report several novel findings including unique S. stercoralis and S. fuelleborni genotypes, and the first identifications of a previously unknown S. fuelleborni infecting humans within Australia. We expand on an existing Strongyloides genotyping scheme to accommodate S. fuelleborni and these novel genotypes. In doing so, we compare our data to all 18S and cox1 sequences of S. fuelleborni and S. stercoralis available in GenBank (to our knowledge), that overlap with the sequences generated using our approach. As this analysis represents more than 1,000 sequences collected from diverse hosts and locations, representing all inhabited continents, it allows a truly global understanding of the population genetic structure of the Strongyloides species infecting humans, non-human primates, and domestic dogs.

Germán Soprano

Hacia fines del siglo XIX y principios del siglo XX se inició la modernización, burocratización y profesionalización del Ejército Argentino. Como resultado de ese proceso se conformaron las divisiones del Ejército, esto es, organizaciones militares autónomas entre sí, compuestas por unidades de diferentes armas, elementos de apoyo de combate y de servicios. Entre estos últimos estaba el de sanidad militar, que actuaba en las unidades operativas de los distritos militares para el reconocimiento de los ciudadanos para el Servicio Militar Obligatorio y en los hospitales militares. Este artículo tiene por objetivos: 1) caracterizar ese proceso en sus relaciones con las concepciones de la defensa, organización, funciones y despliegue territorial del Ejército; 2) analizar, en ese marco, la conformación del servicio de sanidad militar entre 1888, con la sanción de la Ley Orgánica del Cuerpo de Sanidad del Ejército y la Armada, y 1938, con los cambios en el diseño orgánico del Ejército en vísperas de la Segunda Guerra Mundial.

Yohannes Hailemichael, Charlotte Hanlon, Kebede Tirfessa et al.

Abstract Background There is a lack of high quality population-based studies from low- and middle-income countries examining the relative economic status of households with and without a member with a mental health problem. The aim of the study was to explore the socio-economic status of households with a person with severe mental disorder (SMD; psychosis or bipolar disorder) or depression compared to households without an affected person. Methods A population-based, comparative, cross-sectional household survey was conducted in Sodo district, south Ethiopia, between January and November 2015. Two samples were recruited, each with its own comparison group. Sample (1): households of 290 community-ascertained persons with a clinician-confirmed diagnosis of SMD and a comparison group of 289 households without a person with SMD. Sample (2): households of 128 people who attended the primary health care centre and who were identified by primary care staff as having a probable diagnosis of depressive disorder; and comparison households of 129 patients who attended for other reasons and who did not receive a diagnosis of depression. Household socioeconomic status (household income, consumption and asset-based wealth) was assessed using a contextualized version of theWorld Health Organization (WHO) Study on global Ageing and adult health (SAGE) questionnaire. Each disorder group (SMD and depression) was further divided into higher and lower disability groups on the basis of median score on the WHO Disability Assessment Schedule. Results Households of a person with SMD who had higher disability were more likely to have a poorer living standard (no toilet facility; p < 0.001). Having a reliable source of regular income was significantly lower in households of a person with SMD (p = 0.008) or depression (p = 0.046) with higher disability than the comparison group. Households of persons with SMD with higher disability earned less (p = 0.005) and owned significantly fewer assets (p < 0.001) than households without SMD. Households including persons with depression who had higher disability had lower income (p = 0.042) and reduced consumption (p = 0.048). Conclusions Households with a member who had either SMD or depression were socioeconomically disadvantaged compared to the general population. Moreover, higher disability was associated with worse socio-economic disadvantage. Prospective studies are needed to determine the direction of association. This study indicates a need to consider households of people with SMD or depression as a vulnerable group requiring economic support alongside access to evidence-based mental healthcare.

J Alves, J Perelman, E Ramos et al.

Introduction Educational inequalities in smoking start early in life but there still some uncertainty regarding the time they emerge, and what explains their trends. This article investigates whether and how educational inequalities in smoking evolve from pre-adolescence until young adulthood. Methods This study used data from the EPITeen Cohort, that recruited 13-year-old adolescents born in 1990 and enrolled at public and private schools of Porto, Portugal. For this analysis, we considered 1,038 participants, followed across four waves: 2003/2004, 2007/2008, 2011/2013, and 2014/2015. We modelled whether smoking behaviours were influenced by the educational attainment. We computed the odds ratio (OR) for smoking prevalence states (never smoking, experimenter, less than daily smoker, daily smoker and former smoker) and incidence transitions between these smoking states (never smoker to smoking experimenter; non-smoker, experimenter or less than daily smoker to daily smoker; non-smoker, experimenter or daily smoker to less than daily smoker; and daily or less than daily smoker to former smoker) as function of education, age, and adding interactions for age with education. These analysis were done separately for men and women. Results The results showed that men with lower academical achievement were more likely to experiment until 17 years old (OR=0.83 for the interaction with 13 years old, and OR=0.66 for the interaction with 17 years old). However, those with higher academical achievement were more likely to experiment later, at 21 and 24 years old (OR for the interaction was 1.07). The inequalities in the prevalence of daily smoking emerged at 17 years old (OR for interaction with 17 years old was 0.42). Less of participants with higher academical achievement became daily smokers (OR for high education was 0.22 between 13 and 17 years old). Among women, the inequalities followed the same trends observed among men. Conclusions Our results suggested that educational inequalities in daily smoking prevalence emerge at 17 years old and are formed in a cumulative way: by the risk of experimenting from 13 to 17 years old, and by the risk of becoming daily smoker from 17 to 21 years old. In order to tackle inequalities is essential to understand when they emerge across the life-course. These results really highlight that tobacco campaigns should focus not only the middle adolescence but also the late adolescence, from 13 to 21 years old.

V. Felitti