bluuebunny/crossref_metadata_2025 huggingface dataset:
Central and territorial governmental institutions involved in health promotion for older people in European Union countries
Authors: Domagala Alicja
Published: April 2023

Defining, planning and achieving health goals including health promotion and health promotion for older people (HP4OP) are always the responsibility of the public authority. In European countries the public health and health promotion strategic framework, including HP4OP is provided by the ministry of health or others national public health organisations, which are responsible for defining of legal regulations on the different aspects of health promotion.

The goal of this article is the analysis of the central and territorial government (CTG) sector’s involvement in the issue of HP4OP, their functions, activities and responsibilities in this area. The analysis is focused on the main differences and similarities between CTG’s institutions.

The authors triangulated data collected using varied methods: literature review, questionnaire research (conducted in European Pro-Health 65+ project’s countries) and in-depth interviews with national experts from selected countries.

In the majority of analysed countries, the central government and municipalities are the main stakeholders responsible for providing funding for these programs. The operational level for the implementation of majority HP4OP is the local level. Research countries have been identified as strongly varying in institutional, legal and political specificity. The analysis shows the increasing position of HP4OP in public health policy.  Many of the identified problems come from the implementation of a fragmented approach, the duplication of efforts undertaken by different stakeholders and the lack of a co-ordinated strategy and dedicated legal regulations at both the national and regional/local levels.
Workplace health promotion programs in different areas of Europe
Authors: Magnavita Nicola , Capitanelli Ilaria , Falvo Roberto , La Milia Daniele I. , Borghini Alice , Moscato Umberto , Poscia Andrea , Ricciardi Walter
Published: April 2023

Background

Aging of the workforce challenges European countries. Keeping aged workers healthy and productive, through health promotion, is a key goal of European labour policy. The aim of the present study was to collect experiences of workplace health promotion for older workers (WHPOW) conducted in 10 representative countries of Central Europe, Eastern Europe and the Mediterranean.

Methods

A literature review of activities of WHPOW was conducted through a comprehensive search of major scientific databases and on the website of the major European Agencies on worker health promotion. The search was restricted to papers published in English from 2000 to 2015. Companies were asked for additional documentation about WHPOW programmes in a survey conducted with SurveyMonkey.

Results

A total of 756 initiatives regarding WHPOW were identified. 134 of these were guidelines, regulations, or review studies. The remaining 622 activities were intervention studies performed or promoted in the workplace and targeted at older workers or at the aging of the workforce. Most of the programs were carried out in Central Europe (295, 47.4%), less in East Europe (193, 31.0%) and in Mediterranean countries (134, 21.6%).

Conclusion

Our study shows that there are only a limited number of WHPOW actions throughout the 10 selected European Countries. While in Central Europe widespread interest in issues of aging workforce has resulted in national policies to encourage WHPO, not all the countries of Eastern Europe are equally well equipped. Lastly, in Southern Europe health promotion activities are largely inadequate compared to needs.
Health promotion for the oldest seniors in the social sector. Examples of policies and programmes from Poland and the Czech Republic
Authors: Sowa-Kofta Agnieszka , Szetela Anna , Golinowska Stanisława
Published: April 2023

The article identifies health promotion activities for the oldest people, who often become users of social services due to loss of capabilities, solitude and raising care needs related to worsening health status. The analysis is  based on the literature overview, experts’ consultations and interviews on the role of the social sector institutions in health promotion in selected countries. Examples of best practices in health promotion for older people in the social sector are presented. These include programmes of health information and campaigns on health risks avoidance, stimulation of physical activity, healthy eating for the oldest seniors, promotion of mental health and support of cognitive abilities, primary prevention activities and stimulation of social and cultural participation. The article concludes that health promotion activities for the oldest population, although on the side of main activities of the social sector, are an important element of activities of public and non-public institutions in providing care to dependent populations. Good practices identified typically involve numerous health promotion activities and require cooperation at the national – policy setting – level and within community.

The article identifies health promotion activities for the oldest people, who often become users of social services due to loss of capabilities, solitude and raising care needs related to worsening health status. The analysis is  based on the literature overview, experts’ consultations and interviews on the role of the social sector institutions in health promotion in selected countries. Examples of best practices in health promotion for older people in the social sector are presented. These include programmes of health information and campaigns on health risks avoidance, stimulation of physical activity, healthy eating for the oldest seniors, promotion of mental health and support of cognitive abilities, primary prevention activities and stimulation of social and cultural participation. The article concludes that health promotion activities for the oldest population, although on the side of main activities of the social sector, are an important element of activities of public and non-public institutions in providing care to dependent populations. Good practices identified typically involve numerous health promotion activities and require cooperation at the national – policy setting – level and within community.
Poisson mixture distribution analysis for North Carolina SIDS counts using information criteria
Authors: Massaro Tyler
Published: April 2023

Mixture distribution analysis provides us with a tool for identifying unlabeled clusters that naturally arise in a data set.  In this paper, we demonstrate how to use the information criteria AIC and BIC to choose the optimal number of clusters for a given set of univariate Poisson data.  We give an empirical comparison between minimum Hellinger distance (MHD) estimation and EM estimation for finding parameters in a mixture of Poisson distributions with artificial data.  In addition, we discuss Bayes error in the context of classification problems with mixture of 2, 3, 4, and 5 Poisson models.  Finally, we provide an example with real data, taken from a study that looked at sudden infant death syndrome (SIDS) count data from 100 North Carolina counties (Symons et al., 1983).  This gives us an opportunity to demonstrate the advantages of the proposed model framework in comparison with the original analysis.
Childhood vaccinations. Validation of a tool for measuring knowledge, attitudes and vaccine hesitancy in pregnant women
Authors: Massimi Azzurra , Rosso Annalisa , Marzuillo Carolina , Prencipe Grazia Pia , De Soccio Pasquale , Adamo Giovanna , Sturabotti Giulia , De Vito Corrado , Villari Paolo
Published: April 2023

Background. The objective of this pilot study was to test a questionnaire aimed at assessing knowledge of and attitudes towards vaccination, as well as intention to vaccinate, among pregnant women.

Methods. The questionnaire was self-administered by 49 pregnant women attending antenatal classes at three Family Centers in Rome.

Results. Poor knowledge of vaccinations, inadequate attention from healthcare professionals, recurrent consultation of unreliable sources of information, and misconceptions about the side effects of vaccines, all contribute to vaccine hesitancy. Where appropriate, questionnaire sections were shown to be internally consistent.

Conclusion. The questionnaire proved reliable and is suitable for further studies.
A comparison of two approaches to implementing propensity score methods following multiple imputation
Authors: Penning de Vries Bas BL , Groenwold Rolf HH
Published: April 2023

Background. In observational research on causal effects, missing data and confounding are very common problems. Multiple imputation and propensity score methods have gained increasing interest as methods to deal with these, but despite their popularity methodologists have mainly focused on how they perform in isolation.

 

Methods. We studied two approaches to implementing propensity score methods following multiple imputation, both of which have been used in applied research, and compared their performance by way of Monte Carlo simulation for a continuous outcome and partially unobserved covariate, treatment or outcome data. In the first, so-called Within, approach, propensity score analysis is performed within each of m imputed datasets, and the resulting m effect estimates are averaged. In the Across approach, for each subject the m estimated propensity scores are averaged first, after which the propensity score method is implemented based on each subject’s average propensity score. Because of its common use, complete case analysis was also implemented. Five propensity score estimators were studied, including regression, matching, and inverse probability weighting.

 

Results. The Within approach was found to be superior to the Across approach in terms of bias as well as variance in settings with missing covariate data, when missing data were missing at random as well as when they were missing completely at random. In settings with incomplete treatment or outcome values only, the Within and Across approaches yielded similar results. Complete case analysis was generally least efficient and unbiased only in scenarios where missing data were missing completely at random.

 

Conclusion. We advise researchers not to use the Across approach as the default method, because even when data are missing completely at random, this may yield biased effect estimates. Instead, the Within is the preferred approach when implementing propensity score methods following multiple imputation.
A Bayesian approach to correct for unmeasured or semi-unmeasured confounding in survival data using multiple validation data sets
Authors: Chen Wencong , Zhang Xiang , Faries Douglas E. , Shen Wei , Seaman, Jr. John W. , Stamey James D.
Published: April 2023

Purpose: The existence of unmeasured confounding can clearly undermine the validity of an observational study. Methods of conducting sensitivity analyses to evaluate the impact of unmeasured confounding are well established. However, application of such methods to survival data (“time-to-event” outcomes) have received little attention in the literature. The purpose of this study is to propose a novel Bayesian method to account for unmeasured confounding for survival data.

 

Methods: The Bayesian method is proposed under an assumption that the supplementary information on unmeasured confounding in the form of internal validation data, external validation data or expert elicited prior distributions is available. The method for incorporating such information to Cox proportional hazard model is described.  Simulation studies are performed based on the recently published instrumental variable method to assess the impact of unmeasured confounding and to illustrate the improvement of the proposed method over the naïve model which ignores unmeasured confounding.

 

Results: Simulation studies illustrate the impact of ignoring the unmeasured confounding and the effectiveness of our Bayesian approach. The corrected model had significantly less bias and coverage of 95% intervals much closer to nominal.

 

Conclusion: The proposed Bayesian method provides a useful and flexible tool in incorporating different types of supplemental information on unmeasured confounding to adjust the treatment estimates when the outcome is survival data.  It out-performed the naïve model in simulation studies based on a real world study.
Application of random survival forest for competing risks in prediction of cumulative incidence function for progression to AIDS
Authors: Hamid Omid , Tapak Mahtab , Poorolajal Jalal , Amini Payam , Tapak Leili
Published: April 2023

Objective: There has remained a need to better understanding of prognostic factors that affect the survival or risk in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), particularly in developing countries. The aim of the present study aimed to identify the prognostic factors influencing AIDS progression in HIV positive patients in Hamadan province of Iran, using random survival forest in the presence of competing risks (death from causes not related to AIDS). This method considers all interactions between variables and their nonlinear effects.

Method(s): A data set of 585 HIV-infected patients extracted from 1997 to 2011 was utilized. The effect of several prognostic factors on cumulative incidence function (probability) of AIDS progression and death were investigated.

Result: The used model indicated that using antiretroviral therapy tuberculosis co-infection are two top most important variables in predicting cumulative incidence function for AIDS progression in the presence of competing risks, respectively. The patients with tuberculosis had much higher predicted cumulative incidence probability. Predicted cumulative incidence probability of AIDS progression was also higher for mother to child mode of HIV transmission. Moreover, transmission type and gender were two top most important variables for the competing event. Men and those patients with IDUS transmission mode had higher predicted risk compared to others.

Conclusion: Considering nonlinear effects and interaction between variables, confection with tuberculosis was the most important variable in prediction of cumulative incidence probability of AIDS progression.
Factor associated with health-related quality of life among population in Northern Jordan
Authors: Matalqah Laila Mahmoud , Radaideh Khaldoon M. Radaideh , Khatatbeh Moawia M , Omari Omar Al
Published: April 2023

Objective: This study aimed to assess health-related quality of life among Jordanians. 

Design: A cross-sectional design study was conducted at three shopping centers in Northern Jordan. Measures: Respondents were invited to fill a questionnaire assessed quality of life (QoL) using the SF-36 health survey.

Results: Data was obtained from 915 Jordanian adults from the public with a mean age of 33.8 years (SD= 28.2). The total SF-36 score for the whole population was 71.2. Significantly, females reported lower SF-36 scores in both physical and emotional health domains (P= <0.001). Furthermore, elderly reported the lowest mean score in physical health scores (P=0.05). Physical health was dramatically affected by having health problems such as rheumatoid arthritis, obesity, back pain and asthma (P=0.05). On the other hand, emotional health domain was adversely affected only by monthly income (P<0.001).

Conclusions: Quality of life among Jordanian populations is considered fine. Young adults need more concern about their emotional health, which is highly affected by their economic level.
The economic burden of tuberculosis in Cyprus. A probabilistic cost of illness study.
Authors: Zannetos Savvas , Zachariadou Theodora , Adamidi Tonia , Georgiou Andreas
Published: April 2023

Background: Tuberculosis remains a major public health problem with considerable economic burden worldwide. The aim of this study was to estimate the economic burden of tuberculosis in Cyprus during 2009. 

Methods: A retrospective probabilistic incidence-based cost of illness model was developed to calculate, from the societal perspective, the economic burden of the disease including direct medical costs, direct non-medical costs and indirect costs. The bottom-up approach (person-based data) was used for the calculation of direct costs while for the calculation of indirect costs the approach of human capital was employed. In addition, probabilistic sensitivity analysis with 1000 Monte Carlo simulations was performed in order to calculate a 95% Confidence Interval (CI).

Results: Mean per patient cost of tuberculosis in Cyprus in 2009 was estimated at €12,882 (95% CI: €12,747.35 – €12,964.32). Direct medical costs accounted for 83.07% of the overall expenses, €10,675 per patient (95% CI: €10,462.07 – €10,780.59). Total direct non-medical costs of €355 (95% CI: €353.04 – 364.29) accounted for 2.77% of the overall expenses whereas 14.16% of the overall expenses were associated with the indirect cost of €1,820 (95% CI: €1,815.20 – €1,873.65).

Conclusion: For the first time in Cyprus, the cost of tuberculosis was estimated using a probabilistic incidence-based cost of illness model.  Our study confirms that tuberculosis is an expensive disease for the society. In addition, it provides important information to policy makers for the comprehension of the economic consequences of tuberculosis so as they can draft the national health policy accordingly and strengthen surveillance of the disease.
Differential item functioning analysis using the SF-36 in patients with lumbar disc herniation: A quality of life research
Authors: Dehesh Tania , Mahmoodi Marzieh , Iranmanesh Farhad , Dehesh Paria , Farvahari Arash
Published: April 2023

Background: Differential item functioning (DIF) presents when individuals from different groups perceive the meaning of items differently in health-related quality of life (HRQoL) questionnaires. The aim of this study is to distinguish DIF in the SF-36 questionnaire and to determine its effect on comparison of HRQoL scores of lumbar disc herniation (LHD) patients and a healthy population.

Methods: A total of 137 patients with LHD and 691 healthy individuals filled out the Persian version of the SF-36 questionnaire. The Rasch model was used to assess DIF for patients with LDH and a healthy population.

Results:  The presence of DIF was determined in 6 of 8 (75%) domain scores between patients with LDH and healthy individuals. Although half of the DIF was categorized as either negligible (3 out of 8; 37.5%), high DIF was observed in 3 out of 8 domains (37.5%). Gender was not flagged as important to DIF, with only 3 of 8 (37.5%) categorized as negligible.

Conclusion: Because the use of the SF-36 questionnaire in HRQoL assessment between groups may not be invariant, caution should be used during comparison of HRQoL scores between heterogeneous groups.
Analysing outcome variables with floor effects due to censoring: a simulation study with longitudinal trial data
Authors: Spriensma Alette . , Eekhout Iris , De Boer Michiel R. , Luime Jolanda J. , De Jong Pascal H. , Bahçecitapar Melike Kaya , Heymans Martijn W. , Twisk Jos W.R.
Published: April 2023

ackground: Randomised controlled trials (RCTs) are the gold standard to estimate treatment effects. When patients receive effective treatment over time they may reach the limit of a certain measurement scale. This phenomenon is known as censoring and lead to skewed distributions of the outcome variable with an excess of either low (floor effect) or high values (ceiling effect). Applying traditional methods such as linear mixed models to analyse this kind of longitudinal RCT data may result in bias of the regression parameters. To deal with floor effects due to censoring,  a tobit mixed model can be used. The objective of this study was to compare the results of longitudinal linear mixed model analyses with longitudinal tobit mixed model analyses.Methods: First, a simulation study was performed in which several situations of RCTs with floor effects were simulated. Second, data from an empirical RCT was analysed with both methods.Results: Although all analyses underestimated the intervention effects, the tobit mixed model performed much better than the linear mixed model in handling floor effects. However, with an increasing number of follow-up measurements in combination with a strong floor effect estimates from the tobit mixed model were also not accurate.Conclusion: tobit mixed model analysis should be used to estimate treatments effects in longitudinal RCTs with floor effects due to censoring.
Intermediate care units in progressive patient care model: a systematic literature review
Authors: Colamesta Vittoria , Dugo Valentina , La Milia Daniele Ignazio , Sommella Lorenzo , Orsi Giovanni Battista , Bucci Roberto , De Vito Corrado , La Torre Giuseppe , Laurenti Patrizia , Mancinelli Sandro , Maurici Massimo , Damiani Gianfranco , Palombi Leonardo , Villari Paolo , De Vito Elisabetta , Ricciardi Walter
Published: April 2023

Background: Progressive patient care (PPC) has been defined as a systematic classification and segregation of patients based on their medical and nursing needs. Aim of the present research was to perform a systematic literature review about existing medical intermediate care unit organizational models and their performance strengths and weaknesses with a specific focus on Italian implementation, respect to US model.

Methods: Databases PubMed, Cinahl, Google and Google Scholar were searched until September 2017. The search was limited to Italian and English studies. All study design are included in the review.

Results: Ten studies were included in the review. The American studies showed, after the PPC reorganization, an increase in level of satisfaction and nursing care, a reduction in average length of stay, costs and tensions between nurses and an improvement in nurse-physician communication. An Italian study reported the results of a project carried out in three case studies (Forlì, Foligno and Pontedera hospital), redesigning hospital patient flow logistics around the concept of intensity of care: in all three cases, after the reorganization, an increase in bed occupancy rate (before: 71%,81%,65%; after: 78%,84%,82%, respectively) and in hospital case-mix complexity (average DRG weight - before: 0.99,1.07,1.12; after: 1.19,1.09,1.61, respectively) and a reduction in turn-over ratio (before: 2.5,1.4,2.8; after: 1.5,1.2,1.7, respectively) was recorded. Considering Italian healthcare professionals’ point of view, majority of internists supported a hospital remodeling according to PPC model.

Conclusions: The PPC model, theorized in US, has found several applications in Italian regional realities. Improvements in quality of care, appropriateness and productivity in healthcare facilities, that adopted the PPC program, were observed.
Effect of the Irish Civil War 1922-1923 on suicide rates in Ireland: a retrospective investigation of the archives of the registrar-general for Saorstát Éireann
Authors: Osman Mugtaba , Parnell Andrew C , McCauley MacDara
Published: April 2023

Introduction: Emile Durkheim differentiated between two types of wars: National and Civil Wars in terms of effect on suicide mortality. This study investigates Durkheim’s assertion by examining the effect of Irish Civil War on the 1882-1928 suicide rates trend.

Method: We used Auto-Regressive Integrated Moving Average with Explanatory variables (ARIMAX) design adopting Bayesian approach.

Results: The odds for death by suicide for the total Irish population during the civil war period were calculated as 0.932 (95% CI: 0.753 to 1.125). This translates to a reduction in the suicide rates by 6.7% (95% CI: 24.7% to -12.5%). The odds for death by suicide for the total Irish population during the First World War period were calculated as 0.872 (95% CI: 0.754 to 0.997). This indicates to a reduction in the suicide rates by 12.8% (95% CI: 24.6% to 0.3%).

Conclusion: Evidence from this study support a significant drop in terms of the intensity of suicidal behaviour in the Irish population during World War I more so than during the Irish Civil War.

Conflict of interest: none
Predictors of medication use during pregnancy: a cohort study
Authors: Pisa Federica , Romanese Federico , Palese Francesca , Barbone Fabio
Published: April 2023

Background

Sociodemographic characteristics and health behaviours are associated with medication use in pregnancy, but it is unclear if they are independent predictors because women´s health status has hardly been accounted for. We aimed to identify predictors of use of medications and of iron/folic acid.

Methods

This cohort included pregnant women recruited in a prenatal clinic in Trieste, Italy, from 2007 to 2009. Dispensations were obtained from the regional outpatient dispensation database through record linkage. We calculated the Odds Ratio (OR), with 95% confidence interval (95%CI), of ≥ 1 dispensation of (a) any medication and (b) iron/folic acid, using unconditional logistic regression. The final model adjusted for age, partner education, housing size, comorbidities.

 

Findings

Of 767 women, 70.5% had ≥ 1 dispensation of any medication and 46.1% of iron/folic acid. Use of any medication was predicted by immigrant status of the woman (OR 1.21; 95%CI 0.57–2.53) or of her partner (1.51; 0.67–3.40), ≤ high school degree of the woman (1.11; 0.61–2.03) or of her partner (1.21; 0.75–1.95), unemployment (1.47; 0.72–2.98), smoking (1.25; 0.65–2.40), alcohol consumption (≥5 drinks/week: 2.78; 1.78–4.34), and obesity (1.33; 0.59–2.99). Use of iron and/or folic acid was predicted by ≤ high school degree (0.65; 0.40–1.08), smoking (0.80: 0.47–1.37), and obesity (0.62; 0.31–1.25).

Discussion

In this cohort, characteristics including education, immigrant and employment status, smoking, alcohol consumption, and obesity independently predicted medication use. Interventions to promote safe use of medications should carefully consider women´s characteristics.
Handling missing continuous outcome data in a Bayesian network meta-analysis
Authors: Azzolina Danila , Baldi Ileana , Minto Clara , Bottigliengo Daniele , Lorenzoni Giulia , Gregori Dario
Published: April 2023

Background: A Bayesian network meta-analysis (NMA) model is a statistical method aimed at estimating the relative effects of multiple interventions against the same disease. The method has recently gained prominence, leading to the synthesis of the evidence regarding rank probabilities for each treatment. In several cases, an NMA is performed excluding incomplete data of studies retrieved through a systematic review, resulting in a loss of precision and power. 

Methods: There are several methods for handling missing or incomplete data in an NMA framework, especially for continuous outcomes. In certain cases, only baseline and follow-up measurements are available; in this framework, to obtain data regarding mean changes, it is necessary to consider the pre-post study correlation. In this context, in a Bayesian setting, several authors suggest imputation strategies for pre-post correlation. In other cases, a variability measure associated with a mean change score might be unavailable. Different imputation methods have been suggested, such as those based on maximum standard deviation imputation. The purpose of this study is to verify the robustness of Bayesian NMA models concerning different imputation strategies through simulations. 

Results: Simulation results show that the bias is notably small for every scenario, confirming that rankings provided by models are robust concerning different imputation methods in several heterogeneity-correlation settings. 

Conclusions: This NMA method seems to be more robust to missing data imputation when data reported in different studies are generated in a low-heterogeneity scenario. The NMA method seems to be more robust to missing value imputation if the expectation of the prior distribution, defined on the heterogeneity parameter, approaches the true value of the variability across studies.
A framework for assessing the impact of health research from a broad population perspective
Authors: Buja Alessandra , Bertoncello Chiara , Claus Mirko , Demiraj Kreald , Castoro Massimo , Baldovin Tatjana , Baldo Vincenzo , Damiani Gianfranco , Cocchio Silvia
Published: April 2023

Abstract

 

Background: research in the health sector is an activity associated with an uncertain return on investment. This study aims to outline a multidimensional framework for assessing the imact of research funded by public (or mixed public and private) sponsors. 

Methods: a focus group representing different stakeholders was created to develop a sense of purpose that would be shared by the intended beneficiaries of the research assessment process, and others with a direct or indirect interest in a program’s implementation. 

Results: a framework was designed that takes a holistic approach to the impact of research in which not only technical, but also economic, social and political dimensions are interrelated with the results achieved for the population and health services. 

Conclusions: the framework reflected the views of different stakeholders, favoring the development of the positive, proactive relationships essential to orienting the process of transforming the evidence emerging from research into action for health.
Accreditation and Quality in the Italian National Health Care System: a 10 years long review
Authors: Lazzeri Giacomo , Troiano Gianmarco , Centauri Federica , Mezzatesta Vincenzo , Presicce Giorgio , Porchia Barbara , Matarrese Daniela , Dori Fabrizio , Gusinu Roberto
Published: April 2023

Background: Italian accreditation and OECI accreditation are recognized as tools to ensure an adequate level of quality in healthcare setting. The aim of our study was to review the scientific literature about these topics looking for original experiences of accreditation. 

Methods: In March-April 2019 we conducted a search on original peer-reviewed papers in the electronic database PubMed (MEDLINE). The key search terms were “accreditation AND Italy”, “hospital accreditation AND Italy”. We looked for studies published between 2009 and 2019, reporting information about Accreditation experiences. 13. 

Results: The literature search yielded 562 publications. Finally, we identified 16 manuscripts eligible for the review. The studies were published between 2010 and 2016; they were conducted from 2007 to 2015; they involved a minimum of 1 to a maximum of 183 centres located in different Italian regions and cities. They concerned different fields such as oncology, haematology, health physics, health direction, paediatrics, and surgery. Accreditation led to a general enhancement of quality, and offered suggestions for further improvement. 

Conclusion: Each healthcare system should achieve the best possible levels of quality and safety. 

Accreditation, combined with further strategies could ensure the highest level of quality.
Drug resistance patterns of Mycobacterium tuberculosis complex and risk factors associated with multidrug-resistant tuberculosis in the upper southern part of Thailand
Authors: Boonrod Tum , Ingsrisawang Lily , Pungrassami Petchawan , Sengsong Supattra , Bromnavej Arisa , Waseewiwat Pinkamon , Sreevijit Natthapakam , Bunsanong Bunrit , Bunsin Chusri
Published: April 2023

Background: this study aimed to assess the drug resistant pattern of Mycobacterium tuberculosis complex (MTBC) and the risk factors associated to multidrug-resistant tuberculosis cases (MDR-TB) in upper part of southern Thailand. 

Methods: a total of 3238 TB cases was retrieved from a database of the office of prevention and control disease region 11. Only 1008 cases were confirmed by culture growth for Mycobacterium tuberculosis and drug-susceptibility testing (DST) during a period of 4 years (January 2013 to December 2016). The risk factors, including gender, age group, residence place, and history of treatment were analysed using multivariate logistic regression to predict the MDR-TB cases. 

Results: among 1008 TB cases included in study, 77.4% of them were males, 31.5% lived in rural area with median age of 45.0 years (IQR = 23.0), 27.6% were retreatment for tuberculosis, 25.9%, 10.8%, 3.0%, 10.7% and 9.1 were determined to be resistant to isoniazid, rifampicin, ethambutol, streptomycin and MDR-TB, respectively. Adjusted odds ratios (95% confidence interval) of MDR-TB were 5.4 (2.68-11.03), and 4.2 (2.10, 8.45) for retreatment patients, and on treatment patients, respectively. 

Conclusions: drug resistance tuberculosis is considerable problem in upper part of southern Thailand. Major risk factors involved previous history of TB treatment. Thus, it emphasizes on patients who had a history of previous TB treatment.
Strategies to achieve HPV-related disease control in Italy: results from an integrative approach
Authors: Acampora Anna , Grossi Adriano , Barbara Andrea , Causio Francesco Andrea , Calabrò Giovanna Elisa , Cicchetti Americo , De Waure Chiara
Published: April 2023

Background: achieving Human Papilloma Virus (HPV) - related diseases control is an important challenge in public health. In Italy HPV vaccination uptake does not rise a sufficient level. The aim of this project is to identify strategies to promote HPV vaccination in Italy. 

Methods: an integrated approach consisting of a systematic review and a two-step panel consultation was used to identify strategies to increase vaccination uptake among adolescents, population target of the national vaccination program, and to promote vaccination in additional targets. Overall, ten experts in the fields of Gynecology, Public Health, General Practice and Pediatrics were involved along with Patients representatives. Recommendations were elaborated according to a set of criteria drawn from the Evidence to Decision (EtD) framework. 

Results: the systematic review led to the identification of three categories of strategies: reminds, education and multicomponent approaches respectively. A strong recommendation was formulated to use reminds tailored to vaccine recipients or their parents, and a moderate recommendation to use reminds directed to health professionals. A moderate recommendation was developed on the implementation of multicomponent interventions. A strong recommendation was yielded with respect to the promotion of HPV vaccination among women already treated for HPV-related diseases, fertile women not previously vaccinated and 25 year-old women undergoing cervical cancer screening. Lastly, a strong recommendation was formulated for catch-up initiatives targeted to women and men turning 18 years of age. 

Conclusion: this project led to the identification of several valuable strategies to improve HPV vaccination and strengthen HPV-related diseases control at national level.
Task shifting to enhanced physical therapy in musculoskeletal secondary care. An evidence-based narrative review
Authors: Pennestrì Federico , Banfi Giuseppe
Published: April 2023

Background: The World Health Organization defines task shifting as the rational redistribution of tasks among the healthcare workforce teams. The transfer of tasks to physical therapy is well suited for musculoskeletal conditions, either where exercise and physical activity are an important part of the treatment, or to sort the flow of emergency patients. 

Methods: What are the benefits, limits and implementation challenges associated to the employment of enhanced physical therapy in the redistribution of secondary healthcare workforce? The aim of this narrative review is to collect evidence from the most recent publications, in order to address clinical studies, policy making and further research. 

Results: A clear correlation between healthcare system and type of service was not found, supporting that task shifting can be employed to meet different needs. In emergency departments, enhanced physical therapists are employed to improve the flow of musculoskeletal patients, reduce waiting time, length of stay and free up professionals in support of more complex conditions. Otherwise, enhanced physical therapists are employed to sort the flow of chronic musculoskeletal patients, triaging to orthopaedic surgery, and performing follow-up. Clinical outcomes were equal or better than those achieved by other professionals. Appropriate diagnoses and referrals were also demonstrated, despite two studies show enhanced physical therapy to be effective but dependent by medical support. Specific training is therefore fundamental. 

Conclusion: Task shifting is a promising innovation which is worthy introducing in the management of chronic musculoskeletal conditions, when most of the treatments may be repeated under the supervision of medical consultants.
CD4 Count Progression of Adult HIV Patients Under Art Follow Up At Mekelle General Hospital, Tigray Region: A Longitudinal Data Analysis Approach
Authors: Gebre Meles Hagazi , Temesgen Haftom , Alemayehu Mussie
Published: April 2023

Background: The number of people receiving antiretroviral therapy (ART) in low- and middle-income countries continues to show encouraging growth, indicating that the global effort to scale up HIV treatment has exceeded 15 million people by the end of 2015. 

Methods: A retrospective cohort study, comprising of the quantitative method of data collection was conducted among randomly selected 210 adult ART users enrolled in the first 6 months of 2011 and followed up to mid-2016 which is a five year follow up. Data were analyzed using a linear mixed model to identify the determinant factors, which importantly incorporates the effect of factors over time. 

Results: Ninety-five (45%) were males and 115 (55%) were females. Composition of patients’ WHO clinical stage were; stage I (25 (11.8%)), stage II (30 (14.2%)), stage III (102 (48.8%)), and stage IV (52 (24.6%)). The mean CD4+ count at baseline was 218 cells. The progression of CD4+ count for males is lower than that of female over time (coef. =-0.0779, p-value=0.0062). There was a direct relationship between time in month and CD4+ count progression i.e., the CD4+ count progression of the adult HIV patients was increasing during the subsequent number of times measured or followed up under the ART clinic (coef. = 0.0435, p-value=0.0000). Patients with WHO stage II (coef. = -0.0982, p-value=0.0109) , stage III (coef. = -0.0884, p-value = 0.0010) and stage IV (coef. = 0.0859, p-value = 0.0095) had lower CD4+ count than the reference category WHO clinical stage I over time. 

Conclusion: In conclusion, we found that the WHO clinical stage, Time, Weight, Gender and the Interaction effects of Weight with Time were significantly associated with the progression of CD4+ counts over time.
Machine learning in clinical and epidemiological research: isn't it time for biostatisticians to work on it?
Authors: Azzolina Danila , Baldi (University of Padova) Ileana , Barbati Giulia , Berchialla Paola , Bottigliengo Daniele , Bucci Andrea , Calza Stefano , Dolce Pasquale , Edefonti Valeria , Faragalli ( Andrea , Fiorito Giovanni , Gandin Ilaria , Giudici Fabiola , Gregori Dario , Gregorio Caterina , Ieva Francesca , Lanera Corrado , Lorenzoni Giulia , Marchioni Michele , Milanese Alberto , Ricotti Andrea , Sciannameo Veronica , Solinas Giuliana , Vezzoli Marika
Published: April 2023

In recent years, there has been a widespread cross-fertilization between Medical Statistics and Machine Learning (ML) techniques.
New opportunities in Haemophilia treatment: Efmoroctocog Alfa for patients with Haemophilia A
Authors: Calabrò Giovanna Elisa , Castaman Giancarlo , Di Minno Giovanni , Coretti Silvia , Rumi Filippo , Stojanovic Jovana , Sacchini Dario , Favaretti Carlo , Cicchetti Americo
Published: April 2023

Recently new opportunities are emerging for improving the way patients with Haemophilia A are treated. Among these opportunities, efmoroctocog alfa is a first-in-class recombinant factor VIII-Fc fusion protein (rFVIIIFc) produced by recombinant DNA technology with an extended half-life compared with conventional FVIII preparations. The available evidence coming from an Italian HTA report indicates that efmoroctocog alfa provides an effective alternative to conventional FVIII preparations (including standard rFVIIIs) for the management of Haemophilia A. Moreover, by reducing the frequency of injections required, it has the potential to reduce treatment burden, and hence improve adherence to prophylaxis and patient Quality-of-Life.
Association Between Triglyceride-Glucose Index (TyG Index) and Type 2 Diabetes Mellitus: A Systematic Review
Authors: Liberty Iche Andriyani , Putri Naufal Karyna
Published: April 2023

Background: Insulin Resistance has a major role in the pathogenesis of diabetes mellitus where there is a decrease in sensitivity in peripheral tissues. The emergence of insulin resistance, 1-2 decades precedes before the diagnosis of type 2 diabetes mellitus is established. This theory is supported by the usefulness of insulin resistance as a marker of future diabetes or the prevention of type 2 diabetes by insulin-sensitizing agents. Recently, there is evidence that has been suggested to measure insulin resistance as surrogate marker by calculated the triglyceride and glucose which is so called as “Fasting triglyceride-glucose index” or can be shorten as “TyG index”. This study reported a systematic review of association between TyG index and type 2 diabetes mellitus from various literatures to make a conclusion as a basis for further research.

Methods: A literature search in EBSCOhost, ProQuest, MEDLINE, and NCBI database was performed to retrieve and review studies reporting the association between TyG index and type 2 diabetes.

Results: All studies showed that higher TyG index were associated with higher type 2 diabetes (HR 4.36, 10.38, 9.54 for each).

Conclusion: This systematic review provides further evidence about higher TyG index is related to higher risk of development type 2 diabetes. It represents that TyG index can predicting the risk of incident T2DM.
Sample sizes for non-inferiority studies based on the difference between two proportions: a unified approach for difference, ratio and odds ratio models
Authors: Cesana Bruno Mario , Antonelli Paolo
Published: April 2023

Background: It is never easy to make sample size calculation for two-arm, non-inferiority studies with a primary proportion outcome not only because the different parameterisations involved in the difference, ratio, and odds ratio models lead to different non-inferiority margins and different sample size results, but also because of the different efficiency of the respective sample size formulae.

Methods: According to a formal statistical approach, we showed how to express the non-inferiority margins of the three models by keeping the probability (success or failure) of the standard treatment fixed (considered as “known” in the planning phase of a trail), and equal under the null and alternative hypotheses as the statistical basis for sample size calculation.

Results: We have obtained the sample size formulae and their respective power formulae for the three considered models both for success and failure probabilities. A sample size table for non-inferiority success studies is reported for illustrative purposes. In addition, we have compared the sample sizes from the three models by means of graphic and theoretical approaches and we have shown their asymptotic relationships. Furthermore, we have obtained the formulae for switching among the three considered models. Finally, we have correct some previously published formulae for sample size calculations.

Conclusion: The clearly separate approach to the probabilities of success and failure of the three considered models shown in this paper makes it possible to switch among them consistently and equivalently and to choose the probability formulation for the most parsimonious model.
The difference of free light chains as a predictor of kidney damage in patients with Multiple Myeloma
Authors: Mancuso Salvatrice , Carlisi Melania , Serra Nicola , Sardo Mariano , Bertuglia Giuseppe , Pappalardo Emanuela , Siragusa Sergio
Published: April 2023

Background: Multiple myeloma (MM) is a malignant neoplasm characterized by the clonal expansion of plasma cells that can release monoclonal immunoglobulins (monoclonal component) or part of theme. Since 2001, the k and λ serum free light chains (sFLC) evaluation and their ratio (rFLC) have made up the laboratory analysis more sensitive and precise in MM patients. The role of rFLC has been widely studied and discussed and now it is validated in the literature. Instead, the value of free light chains difference (dFLC), especially in MM is less known yet. The aim of this study is to evaluate the relationship between the dFLC and the kidney damage parameters in patients with MM, in comparison with the rFLC value.

Methods: We conducted a retrospective population-based study on 58 MM patients and we individuated two groups obtained considering the measures of dFLC and rFLC in relation to abnormal and normal values of some renal function markers, such us Bence-Jones proteinuria (BJ), albuminuria, proteinuria and serum creatinine. The Mann-Whitney test was used to test the difference between two independent samples.

Results: We observed a significant greater mean score of dFLC in patients with abnormal levels of BJ (2322.91>297.47, p=0.0001), albuminuria (2650.61>671.37, p=0.0016) and proteinuria (2327.19>593.14, p= 0.0025), while there was no significant difference for serum creatinine (1636.18<1870.85, p=0.994). Instead, no differences were observed for the rFLC parameter.

Conclusion: The data obtained allow us to conclude that dFLC can be considered a potential predictor of renal damage in MM patients, even better than rFLC.
Alcohol and the young: how does the press face the problem?
Authors: Concina Diego , Giubertoni Ailia , Spina Paolo , Allara Elias , Faggiano Fabrizio , Avogadro Alcohol Group
Published: April 2023

Background: alcohol is an important component of the Mediterranean diet and its moderate use is protective against cardiovascular risk. Binge drinking, i.e. the heavy consumption of alcohol over a short period of time, is the main consumption pattern of young people in Western countries and may lead to severe toxic effects in many organs. Mass media often address the issue by suggesting prevention measures; however, they may also have the unintended effect of encouraging alcohol misuse. This study aims to assess how the Italian press faces excessive alcohol consumption in young people, comparing the messages given by the press with scientific recommendations.

Methods: articles published by the 6 best-selling Italian newspapers and the 4 best-selling Italian magazines were collected from October 15th to November 14th 2009. Medline database, governmental and non-governmental sources were searched for scientific recommendations regarding primary prevention of alcohol misuse. Press articles were described and analysed by filling out a predefined form.

Results: fourteen newspaper articles regarding alcohol were found, 79% belonging to the news section. Six quotations of scientific recommendations were found: two about drink-driving, two about raising public awareness, one about Monitoring and Evaluation, and one about community and workplace action.

Conclusions: scientific recommendations were often inadequately reported by the Italian press. The most covered recommendations, designed driver and public educational intervention, are also the least effective according to international literature. Therefore, a further effort is needed to tackle this issue in a more scientifically sound way.