bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimating the budget impact of innovative pharmacological treatments for patients with type 2 diabetes mellitus in Italy: the case of liraglutide (GLP-1).
Authors: Stefano Capri  , Barbieri Marco
Published: April 2023

Background

Diabetes is among the most common chronic illnesses worldwide, with escalating rates around the world.  Four years after the launch of liraglutide (a human GLP-1 analogue for type 2 diabetes) we aimed to evaluate the impact of its use in terms of resources consumption and also in terms of some clinical outcomes.

 Methods

A budget impact model (BIM) has been developed. The model was used to assess the financial impact for the Italian NHS caused by an increased use of liraglutide in patients with type 2 diabetes (T2DM). The analysis was conducted in a 3-year time horizon considering year 2013 as baseline. We used real data of market consumption, reflecting the budget holder’s perspective, and not just a hypothetical cohort of patients.

 Results

Increasing the percentage of patients receiving liraglutide over the next 3 years, would lead to an increase of costs, ranging from €2.1 million in the first year to €6.7 million in the third year for a total of €13.7 million. However, for these additional costs, the Italian NHS would get more patients with glycaemic control.

 Conclusions

This study has shown that an increase in the use of liraglutide would determine a relatively low extra cost per patient with T2DM in the Italian NHS. The results could be considered conservative since we did not include savings associated to a reduction of hypoglycaemic events. More comprehensive assessments, considering total costs of treatment and expected health benefits, can help decision-makers analyse whether higher acquisition costs may be offset by higher therapeutic results, leading to future projected savings for the healthcare system.
Knowledge, attitudes and behaviour about Sexually Transmitted Infections: a survey among Italian university female students
Authors: De Waure Chiara , Mannocci Alice , Cadeddu Chiara , Gualano Maria Rosaria , Chiaradia Giacomina , Vincitorio Daniela , Di Stanislao Francesco , De Vito Elisabetta , Langiano Elisa , Boccia Antonio , Ricciardi Walter , La Torre Giuseppe
Published: April 2023

Aims: Improvements have been made in terms of STIs mortality, but young women still have a lack of attention to the STIs prevention.

We investigated the knowledge and attitudes about STIs and their prevention among a sample of Italian university female students.

Methods: We designed a questionnaire about knowledge and attitudes toward STIs, Papanicolau test (Pap test) and Human Papilloma Virus (HPV) and had it filled out by 285 young women. Chi-square test, Mann-Whitney test and a multivariable analysis were performed in order to identify associated factors.  

Results: Knowledge about STIs seems weak, oppositely to knowledge about preventive measures. In line with the results of the univariate analyses, the multivariable one confirmed a higher probability to answer rightly for women who knew the effective behaviours for preventing STIs, women who took information about STIs from Internet, books and TV and those using natural methods (OR 2.77 - 95%CI 1.47-5.23, OR 2.99 - 95%CI 1.62-5.53 and OR 2.55 - 95%CI 1.05-6.18, respectively) and a lower one for students from Cassino and those who knew is possible to recover from STIs (OR 0.38, 95%CI 0.17-0.87 and 0.42, 95%CI 0.20-0.88, respectively). Furthermore, about Pap test it also confirmed the role of a medium-high STIs level of knowledge (OR 2.11, 95%CI 1.02-4.37) and a lower probability to know about it for women from Cassino (OR 0.25, 95%CI 0.09-0.73).

Conclusions: Young women are not completely aware of STIs risks and preventive measures. Informational and educational campaigns should be implemented to reach this target group and lighten the current and future burden of STIs.
A multistate model to evaluate COPD progression integrating drugs consumption data and hospital databases
Authors: Bartolomeo Nicola , Trerotoli Paolo
Published: April 2023

Background

The increase in costs related to the diagnosis and treatment of chronic-degenerative diseases requires a better knowledge of the true care pathway of patients. The study objective was to explore, using multi-state modeling, how analyses of drug prescriptions and data obtained from hospital discharge sheets can be used in combination to build a model of patients health care pathway in a non experimental setting. The model was applied to Chronic Obstructive Pulmonary Disease (COPD).

Methods

Based on the GOLD guidelines, access to hospitalization for COPD and prescription pharmaceuticals were awarded to seven transients states theoretically progressive. The intensity of transition were estimated with the non-parametric method proposed by Aalen and Johansen for multi-state Markov models non-homogeneous in time.

Results

The COPD patients included in the study are 111190. Patients admitted with a diagnosis of non acute COPD had a growing probability over time of needing prescriptions for inhaled corticosteroids (ICS) or the set combination of long-acting beta-agonists (LABA) and ICS; they also had a rising probability of an exacerbation. The use of ICS alone or in combination with LABA delays a hospital admission for acute respiratory failure by about 6 months, as compared to short-acting beta-agonists or anticholinergics.

Conclusion

The probabilities of a transition and their distribution in relation to time, sex, age and clinical status can be a helpful tool for those operating in the health care sector, who are called upon to carry out decisions from the standpoints of both efficacious clinical management and an efficient use of resources.
Smoke & Thriving: an ecological study
Authors: La Torre Giuseppe , Mipatrini Daniele , Grassi Maria Caterina
Published: April 2023

Studies suggest a possible inverse correlation between smoking attitude and happiness levels.

The present paper investigates the relation between males and females smoking prevalence and thriving levels in 155 countries worldwide. Analyses, after adjusting for socio-economic factors, reveal a different relationship between happiness and prevalence of tobacco smoking in the two genders. Countries with highest prevalence of males smoking show the lowest wellbeing levels (Beta coefficient: -0.350; P Value <0.001) while countries with highest prevalence of females smoking show the highest levels of wellbeing (Beta coefficient: 0.144; P Value: 0.030).

The countries with the highest prevalence of people thriving are those with the highest prevalence of women smoking and the lowest prevalence of males smoking.
Characteristics of drug demand reduction structures in Britain and Iran
Authors: Narenjiha Hooman , Noori Roya , Ghiabi Maziyar , Khoddami-Vishteh Hamid-Reza
Published: April 2023

Administrative structure of drug demand reduction and the way in which involved organizations interact with each other has been neglected by researchers, policy makers, and administrators at the national level and even in international institutions in this field. Studying such structures in different countries can reveal their attributes and features. 

In this study, key experts from the addictive behavior department of St George’s University of London and a group of Iranian specialists in the field of drug demand reduction first wrote on a sheet the name of organizations that are in charge of drug demand reduction. Then, via teamwork, they drew the connections between the organizations and compared the two charts to assess the relations between the member organizations. 

In total, 17 features of efficient structure were obtained as follow: multi-institutional nature, collaborative inter-institutional activities, clear and relevant inter-institutional and intra-institutional job description, the ability to share the experiences, virtual institutions activity, community-based associations activity, mutual relationships, the existence of feedback sys-tems, evaluation, changeability, the ability to collect data rapidly, being rooted in community, flexibility at the local and regional levels, connection with research centers, updated policymaking, empowering the local level, and seeking the maximum benefit and the minimum resources. 

Recognizing the characteristics of substance related organizations in various countries could help policy makers to improve drug demand reduction structures and to manage the wide-spread use of psychoactive substances more effectively.
Drug related harm reduction in the eu and candidate countries - success and gaps
Authors: Busch Martin , Grabenhofer-Eggerth Alexander , Klein Charlotte , Weigl Di Marion
Published: April 2023

Background: Evaluation of the state of play of the 2003 Council Recommendation on the prevention and reduction of health-related harms, associated with drug dependence, in the EU and candidate countries and elaboration of proposals for new recommendations.

Methods: Analysis of epidemiological data available at the European Monitoring Center for Drugs and Drug Addiction (EMCDDA) using statistical modeling, a general literature review on harm reduction measures, four systematic literature reviews (one on peer naloxone pro-grams) and surveys among decision makers in the field of drug policy and among harm reduc-tion providers (“stakeholders”) using online questionnaires and a gap survey among the na-tional focal points of EMCDDA in EU-countries and candidate countries.

Results: It was possible to decrease the number of HIV-infections among drug users substan-tially in most EU countries and candidate countries during the last decade; unfortunately for the numbers of deaths due to overdoses this effect could not be reached. Stakeholders (harm reduction providers) name improvement of needle and syringe exchange and harm reduction in prison as main priorities in order to reduce drug related infectious diseases. Concerning re-duction of mortality they prioritise peer naloxone programs, drug consumption rooms and first aid training of drug users.

 Conclusions : The increase of coverage of substitution treatment and of the availability of nee-dle exchange programs in most countries can be seen as successes of harm reduction policy although the coverage especially of the latter still needs improvement. Peer naloxone pro-grams and improvement of harm reduction in (and after) prison are two of 13 recommended actions to improve the situation concerning mortality of opioid users. Continuous political strengthening of harm reduction is necessary.
Hospitalization for drug-related disorders in Italy: trends and comorbidity
Authors: Burgio Alessandra , Grippo Francesco , Pappagallo Marilena , Crialesi Roberta
Published: April 2023

Background: The drug abuse has several health, social and economic effects. Hospital discharge records(HDR) collected by the Ministry of Health represent a major source of epidemiological data. In this paper we used this source in order to assess drug abuse hospitalization patterns and trends in Italy by means of the study of comorbidity at discharge.

Methods: Analysis are based on the National HDR Register and refers to data from 1999 to 2011 for the Ital-ian resident population. Two approaches have been followed: the main diagnosisand the comorbidity approach based on the analysis of all diagnoses reported on the HDR. As a measure of the association between drug-related disorders and specific conditions reported, an estimation of age-standardised relative risk (RR) has been used.

Results: The number of hospitalizations for drug-related diagnosis declined from 10,968 cases in 1999 to 6,180 in 2011.Using the comorbidity approach we found that in the period 2009-2011 the number of HDR with a mention of drug use is 2.8 times higher than the number based only on the main diagnosis.The conditions more strongly associated to the group of drug users are mental disorders, alcohol abuseand infectious diseases such as HIV disease and viral hepatitis.

Conclusions : These data can provide important information about the epidemiology of drug problems and the impact of drug policies.In addition the strong evidence of association of drug abuse and mental health provides a solid underpinning for planning more coordinated interventions of prevention and public health.
Molecular characterization of methicillin resistant Staphylococcus aureus isolated from hospitals environments and patients in Northern Palestine
Authors: Adwan Ghaleb , Shaheen Hala , Adwan Kamel , Barakat Ali
Published: April 2023

BACKGROUND: Staphylococcus aureus (S. aureus) is considered one of the most common pathogen to humans. Infections caused by this mocroorganism can be acquired through both hospital and community settings. This study was carried out to investigate molecular characterization of MRSA strains isolated from the patients and their environment in two hospitals (Rafidia hospital and Thabet hospital) inNorthern Palestine, and to determine the clonal identity between these strains and their possible contribution to nosocomial infections.

METHODS: Two hundred sixty five swabbed samples were collected from these hospitals, S. aureus was isolated,  antibiotic resistant genes were Panton–Valentin leukocidin (PVL) gene were detected and SCCmec and spA were typed by PCR and/or sequencing.

RESULTS: The prevalence of MRSA among S. aureus isolates was 29% and 8.2% in Rafidia hospital and Thabet hospital, respectively. All strains resistant to oxacilllin disk were carried mecA gene. Majority of strains (84.6%) carried SCCmec type II (n = 11), type IVa and non-typeable were also detected. In addition, PVL was detected in 2 (14.3%) clinical strains. ERIC PCR patterns revealed that 2 strains recovered from patient bed and nasal swab isolated from Thabet Hospital were nontypeable, spA typing showed that they belonged to type t386 and have identical DNA sequences. Other 2 clinical isolates were spa typed, one belonged to clone t044, while the other is new clone not exist in database.

CONCLUSIONS: Results may give evidence that environmental contamination possibly contributing to nosocomial infections.
Introducing the Harmonic Mean Solving a Tourist’s Problem
Authors: Bossi Anna , Zolin Anna
Published: April 2023

This exercise can be given to a group of students with basic knowledge of mathematics and physics at the beginning of a lesson. We can imagine that there will be some students that will solve the exercise using the “common sense” solution recalling basic notions of physics and some students that will solve the exercise recalling basic notion of physics and computing a mean velocity using the arithmetic mean, the most common mean. At the end of the exercise, the teacher will compare the two solutions and will present the harmonic mean as the fastest solution for the students that solved the problem using the “common sense” solution and as the correct mean to be used for the students that solved the exercise computing a mean velocity
Health behaviour surveillance of Health Sciences students in Northern Germany: Design and first results
Authors: Tobisch Sandra , von Borczyskowski Annika , Reintjes Ralf
Published: April 2023

Background

Health of students have most often been neglected in recent studies, although students face a transition of life during their studies which has strong implications on health.  During that time, universities play a key role as a setting where future professionals develop independence and learn skills possibly affecting their development and health. Nevertheless, less in known about this group in society and consequently, the aim of this research project was to monitor health of Health Sciences students through a long-term health surveillance system.

Methods

Since 2014, an almost complete convenience sample of Health Sciences students is surveyed twice a year at Hamburg University of Applied Sciences. A paper-pencil questionnaire, which includes questions about socio-demographics, well-being, health-promoting and health-risk behaviours, is administered during courses.

Results

Our first surveys achieved response rates of more than 97%. Up to 83% of enrolled students were reached. Undergraduate Health Sciences students reported health-risk behaviours, e.g. binge-drinking on 1 to 2 days (33.9%), regular cannabis use (4.2%), regular cognitive-enhancement (4.0%). Moreover, unhealthy diet was prevalent but almost all students were physically active.

Conclusions

A short paper-pencil questionnaire administered during courses and conducted according to standardized processes provides complete data on students’ health with little effort. Trends can be determined, which assist in making decision whether to take action in prevention and/or to evaluate campaigns. These first results show the need for a more targeted health promotion action for students.
Can HIV/AIDS be fought by targeting youths in Zambia? Analysis of the Knowledge, Attitudes and Sexual Behaviour among youths aged 15 – 24 years.
Authors: Bwalya Bupe Bwalya , Banda Andrew , Jere Stanley , Amanzi Patrick , Funsani Peter
Published: April 2023

Background: Although people of any age are susceptible to HIV, youths aged 15 – 24 face disproportionate risk of contracting it because of challenges that they face with regard to correct HIV and AIDS related knowledge, attitudes and practices. This study was aimed at determining whether HIV and AIDS can be fought by targeting interventions at youths aged 15 – 24 years by assessing their current knowledge, attitudes and sexual behaviours in Zambia.  

Methods: The study utilised secondary data from a self-weighting nationally representative sample of the 2009 Zambia Sexual Behaviour Survey.

Results: Generally correct comprehensive knowledge is very low among youths (43 percent). This is in spite having good command of general and full general knowledge and the ABCs of HIV and AIDS prevention. Attitudes towards PLHIV, Condom use and HIV counselling and testing were negative. About one third (58 percent) of youths in Zambia have a history of early sexual debut (sex before age 15) with more females (64 percent) than males (51 percent) having hard sex. Male youths were more likely to have used a condom with most recent sexual partner as compared to females (AOR=0.265, 95%CI: 0.160, 0.438; p<0.001). Youths in rural areas had reduced odds of using a condom during their first sexual intercourse compared with those in urban areas (AOR=0.530, 95%CI: 0.387, 0.726; p<0.001).

Conclusions: Therefore, it can be seen lack of comprehensive correct knowledge, gender disparities, poor educational levels, youth’s age and place of residence are some of the contributing factors that may hinder the fight against HIV/AIDS among youths in Zambia.
Distance learning training in genetics and genomics testing for Italian health professionals: results of a pre and post-test evaluation
Authors: Michelazzo Maria Benedetta , Pastorino Roberta , Mazzucco Walter , Boccia Stefania
Published: April 2023

Background

Progressive advances in technologies for DNA sequencing and decreasing costs are allowing an easier diffusion of genetic and genomic tests. Physicians’ knowledge and confidence on the topic is often low and not suitable for manage this challenge. Tailored educational programs are required to reach a more and more appropriate use of genetic technologies.

Methods

A distance learning course has been created by experts from different Italian medical associations with the support of the Italian Ministry of Health. The course was directed to professional figures involved in prescription and interpretation of genetic tests. A pretest-post-test study design was used to assess knowledge improvement. We analyzed the proportion of correct answers for each question pre and post-test, as well as the mean score difference stratified by gender, age, professional status and medical specialty.

Results

We reported an improvement in the proportion of correct answers for 12 over 15 questions of the test. The overall mean score to the questions significantly increased in the post-test, from 9.44 to 12.49 (p-value < 0.0001). In the stratified analysis we reported an improvement in the knowledge of all the groups except for geneticists; the pre-course mean score of this group was already very high and did not improve significantly.

Conclusion

Distance learning is effective in improving the level of genetic knowledge. In the future, it will be useful to analyze which specialists have more advantage from genetic education, in order to plan more tailored education for medical professionals.
The Prevalence of anemia among informal primary school children: a community based study in Rural Upper Egypt
Authors: Salama Rasha A , Labib Meray R
Published: April 2023

Background: Anemia has been recognized as a major public health problem in developing countries. The magnitude of anemia among school children has received less attention compared with that in preschoolers and pregnant women. This study aimed to estimate the prevalence of anemia and to assess its associated factors among informal school children in rural Upper Egypt.

Methods: A cross sectional descriptive study was conducted in a randomly selected Girls Education initiative schools in three Egyptian governorates for duration of 11 months. A structured questionnaire was used to collect sociodemographic data from 2826 children aged 6-19 years. Hemoglobin concentration and anthropometric indicators were assessed using the World Health Organization guidelines. Stool samples were examined for parasitic infestations, using the Kato Katz technique. The objective of the study was adequately explained to participants’ guardian and their consensus was obtained with assured confidentiality.

Results: the prevalence of anemia among these children was 59.3%, out of which, 82.5% had mild anemia and 17.4% of them had moderate anemia. It was significantly higher among 64% of children in age group 6-9years and 61.3% of females. The majority of underweight children (75.8%) and 66.4% of children with parasitic infestation were anemic.

Conclusions: Anemia remains a common problem among GEI School particularly the young children and girls of low income household. School children should be screened periodically and appropriate measures should be taken in order to promote health and guide effective education sector reform initiatives.
Colorectal Cancer, Socioeconomic Distribution and Behavior: A Comparative Analysis of Urban and Rural Counties in the USA
Authors: Nuhu Kaamel M , McDaniel Justin T , Ruiz Juan I
Published: April 2023

Background: Colorectal cancer (CRC) ranks second for all cancer related deaths among men and women together and third for either sex when considered separately. Disparities exist in CRC incidence and mortality between rural and urban counties in the USA. This study sought to explore socioeconomic and behavioral factors that may partly explain these observed differences.

Methods: Using educational and income levels as measures of socioeconomic status (SES), and average alcohol consumption and smoking frequency as behavioral factors, data from the Behavioral Risk Factor Surveillance System (BRFSS) and the Surveillance, Epidemiology, and End Results (SEER) program for analysis were coupled.

Results: Results showed statistically significant inequalities for CRC incidence (t = 2.678, p = 0.010) and mortality (t = 2.567, p = 0.013), as well as socioeconomic (i.e., poverty; t = 5.644, p < 0.001) and behavioral (i.e., smoking; t = 2.885, p = 0.006) factors between selected rural and urban counties. Regression analysis for colorectal cancer incidence and mortality rates at the rural, urban, and national levels yielded relative impacts of smoking frequency, alcohol consumption, and educational level.

Conclusions: Health policies aimed at reducing disparities between rural and urban populations in the USA must therefore adequately address SES and behavioral factors.

Key words: colorectal cancer, rural health, social determinants of health, health behavior
General health status and its related socio-demographic factors: a population based cross-sectional study
Authors: Armanmehr Vajihe , Shahghasemi Zohreh , Alami Ali , Moradi Noorallah , Rezaeian Shahab
Published: April 2023

Background: There is still little information on health status in small communities and also according to the different cultural characteristics of people in different societies, the present study aimed to determine the rate of general health and its related socio-demographic factors in general population.

Methods: A population-based cross-sectional study was conducted in Gonabad city, the North-East of Iran, in 2013. We used the 28-item General Health Questionnaire (GHQ-28) to examine general health status with the cutoff point of 23. The association between general health and socio-demographic factors were reported in crude and adjusted odds ratios with 95% confidence interval.

Results: A total of 800 subjects were interviewed (Response rate=98%). The mean age was 35.5 (SD ± 10.6) years, 49.6% were female, 41.8% were aged 30 years or younger, and 65.9% did not have academic education. According to the GHQ-28, 24.7% of the participants were categorized as not healthy people. General health status was associated with age, sex, education level, family size, residency duration in neighborhood, and SES status.

Conclusion: General health status varied according to both the individual and socio-economic factors. Socio-economic status seems to play an important role in enhancing individual’s health and then lead to improve the health of community. These findings also suggest that mental health programs should be targeted in women and elderly population by the newly established family physician plan.
Environmental and Personal Factors Related to Asthma Severity among Children: Hospital Based Study, Egypt
Authors: Abo Elkheir Omaima Ibrahim , Hafez Manal Refaat , Mohamed Soheir Ibrahim
Published: April 2023

Background: Childhood asthma is a complex disorder in which many environmental and personal factors play a role. However, the contribution of these factors to asthma severity is poorly understood. This study aims to determine the relationship between environmental exposures, personal factors and asthma severity among asthmatic children.

Methods: This cross-sectional hospital based study was conducted on 180 asthmatic children; they were divided into mild, moderate and severe asthma according to forced expiratory volume in first second. Environmental factors (indoor and outdoor), food allergy, history of other allergic diseases, family history of allergic disorders, time trend of attacks as well as asthma outcome were reported.

Results: Children with severe asthma were younger than those with mild or moderate asthma. Severe asthma was significantly linked to family history of allergy, presence of co-morbid allergic diseases, fish, egg and milk allergy, as well as exposure to passive smoking (73.7%) and poor housing conditions. Also, it was significantly linked to presence of unauthorized factories in residential area (31.6 %, p=0.001). As well as, contact with pets (42.1%). Children with severe asthma had more limitations of physical activities (73.7%), missed school days (81.5%), with poor school performance (p=0.04) than those with mild moderate or asthma.

Conclusion: Severe asthma was linked to female gender and younger age, co-morbid allergic diseases, family history of atopy and food allergy. It was higher among children residing in places with unauthorized factories and living in substandard housing condition. Children with severe asthma had poor asthma outcome.
Prevalence of Dyslipidemia among Healthy University Students: Fayoum Governorate, Egypt.
Authors: Abdel Wahed Wafaa Y Y , El-Khashab Khalid , Hassan Safaa Khamis
Published: April 2023

Introduction:. Dyslipidemia is a well known and major modifiable risk factor for coronary heart disease (CHD). Increased prevalence of these abnormalities in young adulthood, increase the prevalence of CHD later on life.

Objectives: to estimate the prevalence and patterns of serum lipid profiles and associated factors among university students in Fayoum University students.

Methods: A descriptive cross-sectional study was conducted on a group of 384 Fayoum university students. Fasting blood samples were collected from all participants and assayed for fasting total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), and low density lipoprotein (LDL).

Results: According to the National Cholesterol Education Program-Adult Treatment Panel III criteria, the overall prevalence of dyslipidemia was 44.3% , hypercholesterolemia prevalence was 38.8%, hypertrigyceridemia 29.7%   low HDL-C 27.1% and high LDL-C 33.1%  Significant associated factors of dyslipidemia among study participants were urban residence, increasing age,  physical inactivity ,overweight&obesity, abdominal obesity frequent fast food consumption and Low fruit and vegetables consumption

Conclusion: The prevalence of dyslipidemia is high among Fayoum university students, important associated factors are obesity and overweight,  physical inactivity , unhealthy dietary habits  that need to be tackled through intervention programs.
Comparison among single-phase test, automated screening method and GC/MS for the traceability of ketamine in urine
Authors: Lagravinese Giovanni M. , De Vita Miriam , Visione Alice , Capomassi Angelica , Visconti Sara , Guglielmelli Emanuele
Published: April 2023

BACKGROUND

The use of ketamine, for non-medical purpose, results widespread also in Italy. This drug is not searched by institutional centers, charged of the responsibility to realize the execution of toxicological analysis based on the article 187 of The New Italian Highway Code. We evaluated the reliability of the single-phase test comparing it with an automated screening method and a gas chromatography-mass spectrometry to search the presence of ketamine on casualty patients involved in car accidents in Rome.METHODS The screening analysis were performed by a single-phase test (with a cut-off settled at 1000 ng/ml), and an automated immunoenzymatic assay (cut-off settled at 330 ng/ml). The confirmation tests have been realized by gas chromatography-mass spectrometry.RESULTSThe single-phase test highlighted ten positive samples out of 294. The automated instrument confirmed only six out of ten previous positive samples, meanwhile the instrument found further four positive samples, considered negative by the single-phase test. The presence of ketamine is confirmed by gas chromatography-mass spectrometry only in seven samples out of fourteen resulted positives from both screening analysis. Three samples out of seven confirmed by gas chromatography-mass spectrometry were positive only to ketamine.CONCLUSION Following the law indications, ketamine is not searched: this limit does not make the authorities able to apply the penalties expected for road laws violations. The automation is essential to guarantee the reliability of toxicological screening tests, especially to medico-legal significance. This results highlight the absolutely necessity of the execution of the confirmation test, successively to screening analysis.
Detecting Rates, Trends and Determinants of Cesarean Section Deliveries in Iran Using Generalized Additive Mixed Models
Authors: Mahmoodi Marzieh , Moghimbeigi Abbas , Faradmal Javad , Ghahramani Masoome
Published: April 2023

Background: The present study aimed to investigate the trend of cesarean section and its related factors through the recent years.

Methods: The study data containing delivery information from Hamadan hospitals and are recorded from 2001 to 2014. The data were analyzed through the generalized additive mixed models using R software (v. 3.2.2).

Results: cesarean rate in this study was about 42%. According to the results, the trend of cesarean deliveries almost increased in the recent years. A significant relationship was found between the average age and elective cesarean rate, but, the pregnancy rate didn’t have a significant effect on the elective cesarean rate.

Conclusion: Cesarean section rate was more than the allowed limit by world health organization (WHO) that is 15%. Although cesarean delivery is preferred to natural vaginal delivery in the case the mother’s or infant’s life is in danger, it should not replace natural delivery for any reason. Natural vaginal delivery can be promoted by providing the society with the knowledge about the advantages of natural delivery and complications of cesarean section.
Is vaccination good value for money? A review of cost-utility analyses of vaccination strategies in eight European countries
Authors: Barbieri Marco , Capri Stefano
Published: April 2023

Objective: The objective of this study is to review published cost-utility analyses of vaccination strategies in eight European countries and to assess whether there are differences in cost-effectiveness terms among countries and vaccinations.

Methods: A systematic search of the literature was conducted using the National Health Service Economic Evaluation Database and the PubMed database. Cost-utility analyses of any type of vaccination that used quality-adjusted life years (QALYs) as measure of benefit and conducted in Belgium, France, Germany, Italy, Spain, Sweden, the Netherlands or the UK were included.

Results: A total of 94 studies were identified. As a result of our search methodology, the vast majority of studies were conducted in the Netherlands or UK (33 and 30 studies, respectively). The most frequent vaccination types were against Human papillomavirus (HPV) with 23 studies, followed by vaccination against pneumococcal infections (19 studies). The analysed vaccinations were generally cost-effective but with high variability. Considering an incremental cost effectiveness ratio (ICER) of 40,000€/QALY, we noticed that the following vaccinations studies are below this threshold, i.e. all varicella and influenza (with one outlier) studies, 90% of the studies for HPV and 75% of the studies for pneumococcal vaccinations. Rotavirus vaccination was considered as not cost-effective, with only 30% of studies below the threshold of 40,000€/QALY. There was no clear trend for vaccinations being more cost-effective in some countries.

Conclusions: The published literature has shown that vaccination strategies are generally cost-effective in European countries. High heterogeneity in the results among studies and countries was found.
Inferential misconceptions and replication crisis
Authors: Hirschauer Norbert , Musshoff Oliver , Gruener Sven , Frey Ulrich , Theesfeld Insa , Wagner Peter
Published: April 2023

Misinterpretations of the p value and the introduction of bias through arbitrary analytical choices have been discussed in the literature for decades. Nonetheless, they seem to have persisted in empirical research, and criticisms of p value misuses have increased in the recent past due to the non-replicability of many studies. Unfortunately, the critical concerns that have been raised in the literature are scattered over many disciplines, often linguistically confusing, and differing in their main reasons for criticisms. Misuses and misinterpretations of the p value are currently being discussed intensely under the label “replication crisis” in many academic disciplines and journals, ranging from specialized scientific journals to Nature and Science. In a drastic response to the crisis, the editors of the journal Basic and Applied Social Psychology even decided to ban the use of p values from future publications at the beginning of 2015, a fact that has certainly added fuel to the discussions in the relevant scientific forums. Finally, in early March, the American Statistical Association released a brief formal statement on p values that explicitly addresses misuses and misinterpretations. In this context, we systematize the most serious flaws related to the p value and discuss suggestions of how to prevent them and reduce the rate of false discoveries in the future.
Statistical modeling of complex health outcomes and air pollution data: Application of air quality health indexing for asthma risk assessment
Authors: Weerasinghe Swarna
Published: April 2023

Background: Statistical models for complex health outcome data analyses with; zero inflation, autocorrelation, confounding, seasonality and delayed exposures, play an important role in accurately assessing air pollution risk, especially in public health warning using national air quality health indices (NAQHI). NAQHI assessment generalizes model estimates across all geographies and seasons and neglects area and season specific variations. The aim is to develop complex statistical models, specific to the complex data structures and to demonstrate effectiveness of the model estimates in public health massage delivery.

Methods: A time series model was fitted to asthma hospital admissions and ambient air pollution data from two sites, Halifax, an urban, traffic and industry polluted site and Sydney, a rural waste disposal polluted site, in the province of Nova Scotia, Canada. I fitted zero inflated, auto regressive, Poisson and Negative Binomial models with lagged effects for sparse asthma admissions and air pollution data and compared the model risk estimates with that of the NAQHI.

Results: NAQHI used three pollutants, Nitrogen Dioxide, Ozone and particulate matter. I found Carbon monoxide in the urban site and lead in the waste disposal site as prominent pollutants and there were seasonal differences. The findings demonstrated severe under-assessment of asthma relative risk by NAQHI, when prominent pollutants are neglected and also when auto correlation and zero inflation are ignored.    

Conclusion:  This study demonstrated the importance of complex statistical model use and the consequences of lack of such modelling that accounted for data structures in public health risk assessments.
Considering time-interaction terms using parametric survival models for interval-censoring data
Authors: Ghasemi Erfan , Baghban Alireza Akbarzadeh , Baghestani Ahmadreza , Asgary Saeed
Published: April 2023

Background: Many of the variables which are investigated in survival research are time-invariant, i.e. their values do not change over time. But their effects, may yet vary over time. Thus, the change in behavior that occurs over time needs to be included in the analysis. This can be done by adding time-interaction terms to the model.

Method: In this research, a parametric survival model, which is capable of evaluating the effects of time-dependent variables, was applied for interval-censored data such that the time to invariant variables interaction terms were considered as time-dependent variables.

Results: Using a practical example, the results of the study show that this model can alter the interpretations regarding the effects of exploratory variables.

Conclusion: when dealing with fixed variables whose effects change over time, the researcher can incorporate their interaction effect with time, and treat them as time-dependent variables and obtain appropriate inferences.
A systematic review of case-series studies on the effectiveness of interventions to reduce polypharmacy and its adverse consequences in the elderly
Authors: Michelazzo Maria Benedetta , Milovanovic Sonja , Boccia Stefania
Published: April 2023

Background. Aging is frequently accompanied by chronic diseases; as a consequence, older people are often exposed to polypharmacy that has been associated with negative health-consequences. The aim of this study is to conduct a systematic review of the literature reporting on the effectiveness of different approaches to reduce polypharmacy in the elderly.

Methods. We conducted a comprehensive literature search of MEDLINE, Scopus and ISI Web of Knowledge databases. Eligible studies were case-series reporting outcomes of interventions aimed at reducing polypharmacy and its consequences in the elderly. A quality appraisal of the studies included was performed.

Results. Nineteen studies were included, of which six conducted in community setting, seven in hospital setting, and six in nursing homes. Seventeen of them were judged as moderate quality, and two of them as poor quality. The majority of the interventions were carried out by pharmacists, alone (35%) or with other professionals (40%). Interventions consisted in pharmacotherapy reviews based on various tools and software; in some cases educational interventions were performed for review-performers and patients. Studies conducted in community-setting provided also a feedback to primary care physician. The outcomes included five categories: therapy’s characteristics (e.g. number of drugs, appropriate prescriptions), quality of life, health-related outcomes, costs, healthcare services’ utilization. Therapy-related outcomes were those more affected by all types of interventions.

Conclusion. Interventions aimed at reviewing patients’ therapy are effective in optimizing the use of drugs, and could be considered also  in improving quality of life, healthcare costs, services’ utilization, and health-related outcomes.
Pubertal maturation and health risk behaviors in adolescents: a systematic review
Authors: Morais de Azevedo Kesley Pablo , Dos Santos Isis Kelly , Silva Dantas Paulo Moreira , Knackfuss Maria Irany , Bento Teresa , De Leitão José Carlos , De Medeiros Humberto Jefferson
Published: April 2023

Objective: The objective of this academic work is to demonstrate evidences available in literature about the association among the pubertal maturation and health risk behavior in adolescents.

Methods: It was used the database from MEDLINE/Pubmed, Scopus, Lilacs and Web of Science. The terms used in the research, with its variations, were “puberty”, “maturation”, “maturity”, “risk behaviors”, “risk factors”, “adolescent” and “student”.

Results: Out of 838 manuscripts found in the databases, after the sorting and applied the eligibility criteria, remained in this systematic review 13 articles. Early maturation was associated significantly with the use of alcohol, cigarettes and illegal drugs, early sexual initiation, sedentary behaviors and involvement in fights, where girls showed higher prevalence.

Conclusions: Henceforth, the results from the current study indicates that the early maturation is associated with health risk behaviors in adolescents, especially with the use of alcohol and cigarettes.
Gaetano Pieraccini: Public Health giant who created Italian Social Medicine
Authors: Bucci Roberto , Colamesta Vittoria , Sernia Sabina , La Torre Giuseppe
Published: April 2023

It’s well known all over the world that Italy is the birthplace of Bernardino Ramazzini (1633 - 1714), the real founder of occupational medicine, and that Italian doctors had a great importance in scientific and cultural development in occupational medicine. One of the most celebrated of them was Luigi Devoto, Professor of Medical Pathology at Pavia in 1901, who undertook a free course of Occupational medicine, creating in the same year the fortnightly journal "Work" - that became "Occupational medicine" since 1925 - and opening a Labour Clinic in Milan in 1910. In 1907 the first two Italian schools of occupational medicine arose in Milan and in Naples. In 1901 Giulio Yule Giglioli wrote the first systematic treatise about workers’ diseases. In this cultural background Gaetano Pieraccini grew and developed his original cultural approach to the field of occupational medicine, which got from him a new dimension: the Social Medicine.
Essentials of Epidemiology in Public Health
Authors: Stadtlander Christian T. K.-H.
Published: April 2023

Review of: Essentials of Epidemiology in Public Health. Ann Aschengrau and George R. Seage III. Burlington, MA: Jones and Bartlett Learning, 2014, 534 pp., $111.95. ISBN: 978-1-284-02891-1
An editorial perspective on Barbieri and Capri article: Is vaccination good value for money? A review of cost-utility analyses of vaccination strategies in eight European countries
Authors: Toumi Mondher
Published: April 2023

An editorial perspective on Barbieri and Capri article: Is vaccination good value for money? A review of cost-utility analyses of vaccination strategies in eight European countries
Cut-off point estimation of Neck circumference to determine Overweight and Obesity among Asian Indian adults
Authors: Mondal Nitish , Timungpi Ruplin , Kathar Moniram , Hanse Sarlongki , Teronpi Siko , Timung Ajitsingh , Bose Kaushik , Sen Jaydip
Published: April 2023

Background: Neck circumference (NC) is a relatively new anthropometric measure of differentiating body fat distribution and considered as a marker of upper subcutaneous adiposity.

Aims and Objectives: The present study was undertaken to assess the suitability and cut-offs estimation of NC to determine overweight and obesity in Asian Indian adults.

Materials and Methods: The present cross-sectional study was carried out among 1830 adults (914 males; 916 females) aged 20-49 years of Karbi-Anglong, Northeast-India, using multistage-stratified sampling method. Height, weight, waist circumference (WC) and neck circumference (NC) were recorded using standard procedures. The body mass index (BMI kg m−2) was calculated and overweight and obesity were assessed using standard cut-offs. Results: Linear and binary logistic regression analyses showed that NC had a better predictive value of BMI (p<0.001). The ROC-AUC results showed that NC seems to have relatively better predictive value in greater adiposity (BMI≥30.00 kg m−2) among both males (AUC 0.83, 95% CI: 0.81-0.86) and females (AUC 0.88, 95%CI: 0.85-0.89) (p<0.01). The cut-offs of NC were observed to be 36.0 cm and 38.0 cm (in males) and 30.9 cm and 33.0 cm (in females) for BMI ≥25.00 kg m−2 and BMI 30 kg m−2, respectively.

Conclusion: Further studies should be undertaken to determine and validate the existing and/or newly proposed cut-offs among larger samples for pan-Indian cut-offs for the assessment of overweight and obesity and related risks of non-communicable diseases and metabolic disorders.
Health promotion actions in mass-media for seniors in selected European countries
Authors: Rogala Maciej Bartłomiej
Published: April 2023

Background

The paper consists results of research aimed at health promotion for older people (HP4OP) in mass-media in 10 selected European countries involved in project ProHealth 65+. Identification, describing and analysis of contemporary good practices sector in media allowed for review selected interventions, programmes and actions directed to seniors corresponding to health promotion. Research indicated main relationships that determine presence of media activities in health promotions focused on seniors.

Methods

The content of report has been focused on target group of elderly and prepared on ground of the literature review on public health and health promotion, analysis and evaluations of EU programmes and official reports, research studies focused on impact of mass-media for health, indications of experts and partners in project ProHealth 65+, documents describing realisations of mass-media initiatives, good practices in HP4OP and searches using PubMed, Web of Science, Google Scholar, Google and base CRODIS.

Results

The results of the research conducted that mass-media as sector can be one of a tool enabling promotion of health for older people through activities directed to HP4OP. Results of the studies  showed that mass-media engaged in health communication process apply all kind of health promotion functions. Research confirm significant role of media influencing knowledge, attitudes and behaviours about health related topics.

Conclusion

In the report was presented significance and important functions of media in societies not as a tool of information but additionally a source of  education and raising awareness in context of healthy and active ageing strategy in Europe. However potential of mass-media seems to be not completely appreciated and used in HP4OP process in 10 analysed countries. The conclusion can be substantial issue to further discussions and finding solutions how to strengthen engagement of mass-media in HP4OP.