bluuebunny/crossref_metadata_2025 huggingface dataset:
Voluntary (NGO) Sector’s Involvement in Health Promotion for Older Population in Europe
Authors: Zabdyr-Jamróz Michał
Published: April 2023

Background and objective: The NGO’s (non-governmental organisations’) role in health promotion is very much praised and encouraged. The basic features of this sector, namely social participation, voluntary activity and self-help, are by default considered as beneficial for health promotion for older people. New policy approaches stimulate NGOs involvement in it. This makes questions about this involvement – its role, context and success – increasingly relevant.

Method: The research is based on narrative literature review as well as interviews and consultations with informers (practitioners and experts) in selected European countries.

Results: Voluntary/NGO sector increases its role as a complimentary or alternative source of health promotion for older people in Europe. Its involvement, roles and functions as well as actual significance, however, depends on a number of factors. It depends on the sustainability of funding, stability of employment, elderly participation rate and recognized availability of services. Those factors are determined by socio-economic and systemic conditions: a country-specific model of third sector, overall social attitudes towards participation and system of governance in health promotion.

Conclusion: The sector’s significance is widely acknowledged, however, its impact is often only assumed rather that sufficiently assessed and proven. By its voluntary nature, the sector might not be able to address the problem of health inequalities. Also, various political and economic changes across Europe result in the change of the sector’s performance.
Health Promotion for Older People Performed in Health Sector
Authors: Mokrzycka Anna S.
Published: April 2023

Background

Health sector plays important role in health promotion for older population (HP4OP). The institutions involved constitute a very differentiated sphere: variety of models, structures, financing methods, different forms of providers and payers. HP4OP requires engagement of health sector and medical/public health professionals.

Methods

Literature review was used: systematic reviews for English-language papers on HP4OP and sectorial institutions activities (incl.PubMed and the healthPROelderly database). Questionnaires, individual interviews and templates were provided for collecting information from country experts. Due to the low feedback for template distribution personal interviews and desk research methods were used.

Results

Health sector institutions have been indicated and analysed proving the importance of primary care role, institutional and inter-sectorial cooperation, specifically with local governments and NGOs. The important results showed that the medical professional’s approach has to be changed. Moreover, innovations, new technologies used by professionals and patients may significantly improve activities of health sector oriented on effective and long lasting HP4OP.

Conclusions: The research performed provided a set of information for the description of the sectorial role in HP4OP, including barriers and limitations, the prerequisites for the cooperation, good practices regarding health promotion projects/  programs focused on old population. The paper, based on EU project, presents the overall picture of health sector involvement in HP4OP and the statement that various institutional arrangements in EU do not contravene the idea of good practices applicability and importance for the effective implementation of HP4OP programs.
Predictors of HIV prevention knowledge and sexual behaviors among students at Makerere University Kampala, Uganda
Authors: Nuwasiima Afra , Onyango Nelson Owuor , Navvuga Patricia , Nuwamaya Elly , Nyabigambo Agnes , Lubinga Solomon J. , Babigumira Joseph B.
Published: April 2023

Background: Prior reviews argue that unsafe sexual behaviors and poor HIV knowledge significantly increase the probability of acquiring HIV infections among adolescents. This study assessed the predictors of HIV prevention knowledge and sexual behaviors among Makerere university students in Uganda.

 

Methods: We performed a cross-sectional survey. We performed a normality test using Shapiro Wilk test on knowledge score. Results revealed that knowledge score was not normally distributed. The study used two sample Wilcoxon Rank Sum and Kruskal Wallis Rank tests to assess the effect of HIV knowledge on demographic characteristics and sexual behaviors. Post-hoc tests were conducted using Bonferroni correction. Spearman rank correlation test was used for continuous variables while Chi-square and Fisher’s tests were used for categorical variables to assess the relationship between demographic characteristics and sexual behaviors.  

 

Results: We report results for 1337 students. The mean age was 21.2SD (1.6) and more than half 700(52.4%) were male students. The median HIV prevention knowledge score of students was 13 IQR (11-15) in the range of 0 to 18. Males significantly scored higher than females (13.0 IQR (12-15) vs. 12.0 IQR (10-14) p=0.000), an increase in age was associated with higher knowledge scores (Rho = 0.101, p = 0.000).   Students in the third year of study significantly scored higher than those in the first year, and government-sponsored students scored higher than the privately sponsored students. HIV knowledge was also significantly associated with sexual experience, and condom use at univariate level but insignificant at multiple level analysis. Males were more likely to have ever had sex (31.7% vs. 12.7%) and ever used a condom (63% vs. 55%) than females respectively

 

Conclusion: Our findings suggest that Makerere University students possessed good knowledge on HIV. There is evidence of an association between student’s knowledge, and demographic characteristics and a few sexual behaviors. Future behavioral and educational programs that target both sexually and non-sexually experienced students should address the gender differences.
Occupational exposures and genetic susceptibility to lung cancer and pleural mesothelioma: a systematic review
Authors: Milovanovic Sonja , Stojanovic Jovana , Pastorino Roberta , Iavicoli Ivo Iavicoli , Boccia Stefania
Published: April 2023

Background

The risk of occupationally related lung cancer, as well as pleural mesothelioma, in association with genetic polymorphisms, has been investigated with contradictory results.

This systematic review aims to summarize the current knowledge on the relationship between genetic polymorphisms, occupational exposures, and lung cancer and pleural mesothelioma.

Methods

We searched MEDLINE, ISI Web of science, and SCOPUS online databases for all articles published in English language up to September 2016. Studies were considered eligible if they had assessed the association between occupational exposures and lung cancer/pleural mesothelioma in relation to genetic polymorphisms.

Results

Sixteen studies were included, of which eleven on lung cancer and six on mesothelioma, of which one was in common. NAT2 slow acetylator genotype confers an increased risk of pleural mesothelioma in subjects exposed to asbestos (OR=2.10; 95% CI=1.10-4.10), especially in combination with the GSTM1 null genotype (OR=3.60; 95% CI=1.30-9.60). GSTT1 null and CYP1A1 Msp1 T6235C (T/C+C/C) genotype carriers exposed to arsenic, uranium, asbestos and other chemical agents have an increased risk of lung cancer respect to not exposed wild type genotypes (OR=1.33; 95% CI=0.67-2.64, OR=2.20; 95% CI=1.11-4.35, respectively).

Conclusion

Genetic polymorphisms might modulate individual susceptibility to lung cancer and pleural mesothelioma in occupationally exposed subjects.
Joinpoint regression analysis with time-on-study as time-scale. Application to three Italian population-based cohort studies
Authors: Rea Federico , Pagan Eleonora , Monzio Compagnoni Matteo , Cantarutti Anna , Pugni Pietro , Bagnardi Vincenzo , Corrao Giovanni
Published: April 2023

Background: Joinpoint regression analysis is usually applied to study varying trends over time in order to identify the time point(s) in which the trend significantly changes. We illustrate three epidemiological investigations in which this methodology was applied with time-on-study as time-scale.

Methods: Data were retrieved from the healthcare utilization databases of Lombardy Region (Italy). We investigated the trend of the: (1) mortality rate among centenarians hospitalized for hip fracture (2004-2011); (2) proportion of persistent patients after the initial prescription of antihypertensive drugs during the first year of treatment according to gender (2005); prescription rate of statins in the year before and after the hospital admission among patients hospitalized for a transient ischemic attack (2008-2009).

Results: The following results were obtained: (1) a joinpoint was identified in the fourth month, showing an increased risk of death during the three months after hip fracture hospitalization; (2) the proportion of patients still under antihypertensive treatment falls until the fifth month, remaining stable afterwards; there was evidence that the prevalence of patients who discontinued the treatment was significantly higher among women than men; (3) during the year after the transient ischemic attack episode, monthly rate of available statins was double than the previous year with a significant decrease in the first four months.

Conclusions: The joinpoint regression analysis can be a useful tool in epidemiologic framework when a temporal trend is the objective of the investigation since it allows to make inference by means of a quantitative method rather than a qualitative evaluation.
Methodological issues in the observational studies conducted in older population: a narrative review
Authors: Poscia Andrea , Collamati Agnese , Milovanovic Sonja , Liborio Vetrano Davide , Liotta Giuseppe , Petitti Tommasangelo , Di Pietro Maria Luisa , Magnavita Nicola , Ricciardi Walter , Cherubini Antonio , Onder Graziano
Published: April 2023

Introduction

Well-conducted observational studies may represent valuable tools for getting insight to disease etiology, detecting the effect of age-related changes, and providing an important perspective on health risk factors and disabilities in an aging population. Nevertheless, this kind of research poses several challenges for researchers. The main aim of this narrative review was to address the potential methodological issues in performing the observational studies in the elderly, the factors that influence their participation, and the possible solutions for overcoming the barriers to research in this population.

Methods

Comprehensive search for the papers published in the period from January 1st 1980 until 31st July 2016 in English or Italian was conducted through MEDLINE, Scopus and Web of Science electronic databases. Findings from the included papers were finally summarized.

Results

In cohort studies, the following barriers were addressed: sample size calculation, ascertainment of the target population, frequency of data collection, exposure determination, multifactorial loss to follow-up (drop-outs), cognitive impairment, definition of confounders, and ethical aspects. Case-control studies were reported to be prone to the issues like ascertainment of cases and controls, willingness to participate, data accuracy, recall bias, issues related to patients’ multimorbidity, and cognitive impairment.

Conclusions

Important factors to consider in research in elderly people include: precise definition of the study population, well conducted recruitment process, engagement with family and home care staff, cognitive impairment assessment and the consequent relevant ethical and legal issues, relief of participant burden in order to minimize withdrawal, and engagement with the media.
Obsessive Compulsive Tic Disorder: appropriate diagnosis and treatment as key elements to improve health and rationalize use of resources
Authors: Scalone Luciana , D’Angiolella Lucia Sara , Mantovani Lorenzo Giovanni , Galentino Roberta , Servello Domenico , Dell’Osso Bernardo , Zanaboni Dina Carlotta , Porta Mauro
Published: April 2023

Background: Obsessive Compulsive Tic Disorder (OCTD) has been described recently as an early onset and highly disabling endophenotype of Tic Disorder and Obsessive Compulsive Disorder. OCTD has a relevant but largely unknown clinical, social and economic burden for patients and their families. Our paper aimed to explore relevant aspects of the burden of OCTD. Methods: we conducted a literature review and a pilot study using retrospective demographic, clinical and economic data of patients with OCTD accessing the Galeazzi Hospital in Milan. Results: the literature review shows the absence of information on OCTD. From the pilot study we analysed data of 30 patients (80.0% male, 36.7% aged from 7 to 13 years, 63.3% aged from 15 to 48 years), 83.0% declared that obsessions and/or compulsions were the most important factors determining their social impairment. Adult patients refractory to drug treatment underwent Deep Brain Stimulation plus drugs. The mean clinical scores at the time of diagnosis indicated a severe condition for both tics and obsessive compulsive components. The mean time elapsed from symptoms onset to diagnosis of OCTD was 5.6 years, reaching up to 11 years in one case. Before reaching the correct diagnosis, different specialists visited the patients several times, 93.3% underwent diagnostic examinations and 86.7% took 2 or 3 different drugs. Ten patients were hospitalised and 8 had received psychotherapy. Discussion: Albeit preliminary, these results show that attention is mandatory for establishing correct diagnosis and treatment guidelines to improve health and rationally spend resources for OCTD.
An algorithm to identify patients with type 2 diabetes among undocumented migrants using data on drug dispensation by charities
Authors: Fiorini Gianfrancesco , Cerri Cesare , Rigamonti Antonello E. , Bini Silvia , Marazzi Nicoletta , Sartorio Alessandro , G. Cella Silvano
Published: April 2023

An algorithm to identify patients with type 2 diabetes among undocumented migrants using data on drug dispensation by charities.

Gianfrancesco Fiorini, Cesare Cerri, Antonello E Rigamonti, Silvia Bini, Nicoletta Marazzi, Alessandro Sartorio, Silvano G. Cella
 

Abstract

Background. Electronic databases of chronic diseases are available in many countries. Health data of residents, natives and documented migrants, are thus easily accessible. This does not happen for the growing population of undocumented migrants.
Methods. We analysed the databases of two Italian non-governmental organisations (NGOs) containing the records of all drug dispensations to 12,386 undocumented migrants from January 1st, 2013 to December 31st, 2016, with the aim to identify treated for type 2 diabetes (T2D) on the basis of demographic data and dispensed medicines.
Medications were identified according to the Anatomical Chemical Therapeutic (ATC) classification. All the patients with at least one dispensation per year of any A10 (antidiabetic) drug were selected. An algorithm to match this observation with the diagnosis of type 2 diabetes mellitus (T2D), on the basis of demographic data and use or not of insulin, was developed. The algorithm was validated in 400 diabetic and 400 non-diabetic patients randomly selected.
Results. The algorithm correctly identified all patients (N=660) with T2D. When our patients were grouped according to ethnicity, we found that all ethnic groups contributed a comparable percentage of patients with T2D. Also, no difference was seen between the group of EU citizens living in poverty cared for by the NGOs and any of the ethnic groups.
Conclusions. This algorithm can be used to identify patients treated for T2D when no diagnostic codes are available, as is frequently the case with undocumented migrants. Therefore it can be useful for many aspects of public health.
Households' food expenditures in urban areas of Iran: An application of small area estimation
Authors: Soltani-Kermanshahi Mojtaba , Mehrabi Yadollah , Kavousi Amir , Baghestani Ahmad-Reza , Mohammadi-Nasrabadi Fatemeh , Aliakbari-Saba Roshanak
Published: April 2023

Background: A fundamental factor for human development is food, and inequalities in nutrition have been related to inequalities in health .The purpose of this study was to estimate Household Food Expenditure (HFE) in urban areas of Iran at district-level using small area estimation (SAE) methods.

 

Design and Methods: We used the Fay-Herriot model, the well-known area-level model of SAE. The main data was urban data of HFE collected by Statistical Centre of Iran at 2013. The environment of our study was urban area of Iran and study unit was household.

Results: Findings showed that average number of room at each household, migration rate, proportion of male headed households(PMH) and Proportion of the active population`s employed at district level had a significant effect on HFE. Comparison between aggregated province estimates and estimates reported by SCI was not significant (P=0.609). The lowest and the highest HFE belong respectively to Pishva district with 27,067 thousand rials(TRs) and to Boyer-Ahmad district  with 85,175 TRs.

Conclusions: Small-area estimation is advantageous for surveillance of HFE at the district level. This method allows documentation of geographic disparities and improves our understanding of the spatial distribution of HFE in urban areas of Iran.
Comparison between adenosine triphosphate bioluminescence and aerobic colony count to assess surface sanitation in the hospital environment
Authors: Raia Daniele Domenico , Cannova Lucia , Provenzano Sandro , Santangelo Omar Enzo , Piazza Dario , Alagna Enrico , Bonanno Valentina , Aprea Luigi , Firenze Alberto
Published: April 2023

Background: Adenosine triphosphate bioluminescence produced by the firefly luciferase has been successfullyintroduced to verify cleaning procedures in the food industry according to the Hazard Analysis Critical Control Pointprogram.Our aim was to evaluate the reliability of bioluminescence as a tool to monitor the effectiveness of sanitation in healthcaresettings, in comparison with the microbiological gold standard.Methods: 614 surfaces of various material were randomly sampled in Policlinico University Hospital units in Palermo,Italy, to detect adenosine triphosphate bioluminescence and aerobic colony count. Linear regression model andPearson correlation coefficient were used to estimate the relationship between the two variables of the study.Results: Aerobic colony count median was 1.71 colony forming units/cm2 (interquartile range = 3.8), whereasadenosine triphosphate median was 59.9 relative light units/cm2 (interquartile range = 128.3). Pearson coefficientR2 was 0.09. Sensitivity and specificity of bioluminescence test with respect to microbiology were 46% and 71%,whereas positive predictive value and negative predictive value were 53% and 65%, respectively.Conclusion: According to our results, there seemed to be no linear correlation between aerobic colony countand adenosine triphosphate values, suggesting that current bioluminescence technology has not any proportionalrelationships with culturable microbes contaminating environmental surfaces in health-care settings.
Real-world assessment of healthcare provided by the National Health Service: The network of regional Beaver research platforms
Authors: Rea Federico , Pugni Pietro , Pescini Dario , Palmieri Luigi , Giampaoli Simona , Carle Flavia , Corrao Giovanni
Published: April 2023

Real-world evidence can provide answers on healthcare utilization and appropriateness, post-marketing drugs safety and comparative effectiveness, and cost-effectiveness profiles of healthcare pathways. Healthcare utilization databases, possibly integrated with drug and disease registries, electronic medical records, survey and cohort data (i.e. real-world data), allow to trace healthcare ‘footprints’ left from beneficiaries of National Health Service.

Beaver is a research platform available on demand to Italian regions which we developed for computing indicators of healthcare utilization and clinical outcomes, as well as for generating evidence on effectiveness and cost-effectiveness profile. Two distinct solutions may be adopted. One, the so-called Beaver Light front-end allows to automatically compute health indicators of adherence to official guidelines. Two, the so-called Beaver Full front-end involves an eight-step procedure entirely driven by the study protocol.

In order to fulfil the directives recently issued by the European Parliament and Council and the Italian Authority for the protection of individual data, the platform resides in each region’s infrastructure, so limiting the free movement of electronic health data. Indeed, regional authorities should be responsible for data safety and for allowing data accessibility. The use of standardized and validated algorithms enables to obtain regional estimates that, being obtained by employing regional platforms containing data extracted with standardized procedure, may be compared and possibly summarized by using common meta-analytic techniques.

In conclusion, the Beaver regional platform is a promising tool which may contribute to stimulate healthcare research in Italy.
Quality Assessment of Healthcare Databases
Authors: Carle Flavia , Di Minco Lidia , Skrami Edlira , Gesuita Rosaria , Palmieri Luigi , Giampaoli Simona , Corrao Giovanni
Published: April 2023

The assessment of data quality and suitability plays an important role in improving the validity and generalisability of the results of studies based on secondary use of health databases. The availability of more and more updated and valid information on data quality and suitability provides data users and researchers an useful tool to optimize their activities.

In this paper, we have summarized and synthesized the main aspects of Data Quality Assessment (DQA) applied in the field of secondary use of healthcare databases, with the aim of drawing attention to the critical aspects having to be considered and developed for improving the correct and effective use of secondary sources.

Four developing features are identified: standardizing DQA methods, reporting DQA methods and results, synergy between data managers and data users, role of Institutions. Interdisciplinarity, multi-professionality and connection between government institutions, regulatory bodies, universities and the scientific community will provide the "toolbox" for i) developing standardized and shared DQA methods for health databases, ii) defining the best strategies for disseminating DQA information and results.
Socio-Economic Determinants of Household access to Health Services in Selected District of Punjab
Authors: Iftikhar Ayesha , Naqvi Syed Asif Ali
Published: April 2023

Background: Sound health is basic right of every individual and access to health care is necessary. The right to use health services (HS) is a multifarious idea. In Pakistan provision of basic health facilities of health are inadequate. Current study was aimed at highlighting the primary reasons behind it.

Methods: This study used cross sectional data from Pakistan Social and Living Standard Measurement (PSLM) to determine the social and economic determinants of health care services in selected districts of province Punjab. Logistic regression technique is used to measure the impact of selected variables on health access.

Results:  Results of the study showed that the health access services in the district of Faisalabad are greater as compared to the Rawalpindi and Layyah districts. Moreover, people were using private health facilities as compared to government health facilities.

Conclusion: The study indicated that the education level, household (HH) head gender, work status, region and place of residence, and economic situation, affect the health access services in selected regions. Measures should be taken to reduce the monopoly of private health sector by providing better government health facilities.
Non-parametric estimation of survival probabilities with a time-dependent exposure switch: application to (simulated) heart transplant data
Authors: Bernasconi Davide Paolo , Valsecchi Maria Grazia , Antolini Laura
Published: April 2023

Background: To summarize the survival experience of patients waiting for heart transplant and to compare it with the post-transplant survival it is not possible to use the Kaplan-Meier estimator considering the intervention status as fixed in time because of the well known "immortaltime bias" issue.Methods: We reviewed and applied to a simulated dataset the available methods to perform a non-parametric analysis accounting for the time-varying nature of the transplant status. Specifically we considered the Simon-Makuch estimator and the recently proposed "clock-back" estimator.Results: We showed that the Simon-Makuch estimator for the survival of patients on list is unbiased but the corresponding estimator of the post-transplant survival is not reliable for non-markov contexts like the one considered. Instead, if the semi-Markov assumption could be postulated (the post-transplant mortality depends mainly on the time since transplant and not on the waiting time to the intervention), the "clock-back" estimator produces valid results.Conclusion: We enlightened the importance of testing the process memory assumptions (e.g. Markov properties) in order to choose the approach more reliable. Moreover, we recommend the use of the Simon-Makuch method to study the survival of patients before the interventionand the use of the "clock back" estimator for the post-intervention survival in semi-markovian contexts.
Parents Knowledge, attitude and practice of antibiotic use for upper respiratory tract infections in children: a cross-sectional study in Ras Al khaimah, United Arab Emirates
Authors: Salama Rasha Aziz , Bader Kussai Nidam , Rahmen Abeer Sharmen , Hashmi Fatima
Published: April 2023

Background: Upper respiratory tract infections are common in children and represent a significant cause of antibiotic abuse. Parents’ knowledge and attitudes often contribute to inappropriate prescription of antibiotics and promoting antibiotics resistance. The study aimed at exploring parental knowledge, attitudes and practices towards antibiotic use in children with URTI along with identifying the reasons behind self-medication and abuse of antibiotics

Methods: A cross sectional survey was conducted at pediatric outpatient clinics of Saqr Hospital in the emirate of Ras Al Khaimah,United Arab Emirates A structured interview questionnaire was used to collect data from 239 parents of children aged less than7 years, between February to March 2016

Results: More than half (54.4%) of the respondents had a poor level of knowledge. About (66.1%) were not aware that antibiotics are indicated to treat bacterial infection. However, 67.2 % of the respondents incorrectly identified that antibiotics are used to treat viral infections. Nearly 44.5 % of the respondents were aware of antibiotic resistance in relation to its overuse. With regard to attitude, 68.2% of the respondents believed that they would be satisfied if physicians did not prescribe antibiotics for common cold. Yet, 63% would request it if physicians did not prescribefor frequent URTIs. Nearly 43.5% of respondents gave self-medication to their children mostly because of repeated similar attacks and over the counter acquisition of antibiotics. Most (82.2%) of them declared that, physicians did not provide sufficient information regarding diagnosis and therapy More than half (54.4%) of the respondents had a poor level of knowledge. About (66.1%) were not aware that antibiotics are indicated to treat bacterial infection. However, 67.2 % of the respondents incorrectly identified that antibiotics are used to treat viral infections. Nearly 44.5 % of the respondents were aware of antibiotic resistance in relation to its overuse. With regard to attitude, 68.2% of the respondents believed that they would be satisfied if physicians did not prescribe antibiotics for common cold. Yet, 63% would request it if physicians did not prescribe for frequent URTIs. Nearly 43.5% of respondents gave selfmedicationto their children mostly because of repeated similar attacks and over the counter acquisition of antibiotics. Most (82.2%) of them declared that, physicians did not provide sufficient information regarding diagnosis and therapy

Conclusions: Educational programs are needed to raise awareness and correct expectations about judicious use of antibiotics
An inverse probability weighting method for estimating the net benefit in survival analyses in observational studies
Authors: Chiba Yasutaka
Published: April 2023

Background: Recently, in the context of randomized trials, a measure on the difference scale called the net benefit was developed for survival analysis. As this measure does not require the assumption of proportional hazards, it is an attractive new measure of the treatment effect to apply instead of the hazard ratio calculated under this assumption. However, no method for estimating it has been presented in observational studies. Therefore, we describe a simple method to estimate the net benefit adjusted for confounding. 

Methods: We reviewed a method for estimating the net benefit in a randomized trial and extended it to a method that adjusts for confounding using inverse probability of treatment weights. 

Results: We performed Monte Carlo simulations to test the performance of our method. The results show that our method estimated adjusted net benefits in an unbiased manner regardless of whether the assumption of proportional hazards held. In addition, we illustrated our method using data from an observational study evaluating disease-free survival of Ewing’s sarcoma patients. Our method yielded an adjusted net benefit of –0.032, whereas an existing method, used to analyze data from randomized trials, yielded an unadjusted net benefit of 0.284. 

Conclusions: In observational studies with a time-to-event outcome, the net benefit adjusted for confounding can readily be estimated using inverse probability of treatment weights.
Correction for potentially inappropriate prescribing can increase specificity when using drug prescriptions as an adjunct to diagnostic codes to assess comorbidities in older patients
Authors: Fiorini Gianfrancesco , Castagna Alberto , Cerri Cesare , Rega Vincenzo , Rigamonti Antonello E. , Cella Silvano G.
Published: April 2023

Background: Comorbidities are a growing problem in older patients in many clinical settings, but electronic records may give an unsatisfactory picture of this complexity. Analysis of drug prescriptions can add further diagnostic information to that gathered from billing diagnostic codes, but the risk exhists that potentially inappropriate prescriptions may lead to over-estimating comorbidities.

Methods: We analysed the administrative records and drug prescriptions of the 304 patients discharged during 2016 from a neurological rehabilitation unit. International Classification of Diseases – 9th revision diagnostic codes were matched with prescriptions at discharge, coded according to the Anatomical Therapeutic Chemical classification. The codes of the prescriptions not explained by the diagnostic codes were recorded, grouped, corrected for potential inappropriate prescribing, and analysed.

Results: Of the 304 patients, 295 had at least one prescribed drug not inferable from their diagnostic codes. The mean number of these prescriptions was 3.5 ± 1.9 per patient, and that of prescriptions remaining after correction for potentially inappropriate prescribing was 2.0 ± 1.5. The more frequent groups of potentially inappropriate medications were anti-acids, psychotropic drugs, laxatives, potassium supplements, cardiovascular drugs and lipid modifying agents. Administrative databases underestimate the complexity of older patients in neurological rehabilitation wards. More reliable data can be obtained by adding the analysis of drug prescriptions, but correction for potentially inappropriate prescription seems necessary to avoid an over-estimation of comorbidities.
Survey of Italian Pediatricians on awareness, experiences and beliefs regarding direct-to-consumer genetic testing in minors
Authors: Baroncini Anna , Torricelli Francesca , Cocchi Guido , Corsello Giovanni
Published: April 2023

Background: Our study wanted to assess Italian pediatricians’ awareness, experience and beliefs regarding directto-consumer (DTC) genetic tests (GT) in minors, with a focus on those for predisposition to complex disease, lyfestyle, athletic ability and other inborn talents.
Methods: A 28-item questionnaire was administered through the SurveyMonkey® web platform to the 9,086 members of the Italian Society of Pediatrics for which a valid email address was available. The survey was opened from April through November 2017. Statistical analyses were performed using the Graphpad software package.
Results: 36.2% of the 442 respondents were aware of DTC-GT, but only 23.1% of them felt adequately prepared to meet families’ information needs. The first three sources of knowledge were the Internet (20.98%), magazines/ newspapers (16.78%) and TV/Radio (14.33%), while companies’ direct marketing activity influenced knowledge only in 2.45% of the cases. Only 16.4% of the aware respondents had been already approached for advice. More than 95% of the pediatricians who were aware would not advise DTC-GT for lifestyle, athletic performance or other inborn skills. 69.2% was unfavourable to susceptibility tests for complex diseases. Most of them expressed an interest in learning more and indicated as preferred sources of information public policies issued by professional societies.
Conclusion: The low awareness and experience and the vendors’ tiny contribution to knowledge suggest a still limited penetration of DTC-GT companies in Italy. A great interest in learning more was found. Scientific societies are best positioned to support health professionals in this educational goal thanks to their role of trusted sources of information and guidance.
Social Media’s Influence on Parents’ Decision-Making Process of Child Vaccinations
Authors: Wachob David , Boldy Amanda
Published: April 2023

Background: This study examined parent perceptions towards child vaccinations, and sources used leading to inoculation decisions.

Methods: A survey was electronically dispersed to parents to examine their perceptions of vaccinations, what source they used to form their decisions, and whether or not they have their children vaccinated.

Results: Significant differences on perceptions about vaccinations, those who followed the recommended vaccination schedule, and what sources of information they used were found. There was a significant relationship between parents who ranked using social media as their primary source and reports that they did not, or will not, vaccinate their children.

Conclusions: Where parents obtain health-related information was shown to be a significant factor on vaccine perceptions and whether children were inoculated or not.
The role of coffee consumption in breast and ovarian cancer risk: updated meta-analyses
Authors: Bamia Christina , Turati Federica , Guha Neela , Van den Brandt Piet , Loomis Dana , Ferraroni Monica , La Vecchia Carlo , Tavani Alessandra , Guercio Valentina
Published: April 2023

Background: Coffee consumption in relation to female hormone-related cancers has been investigated but metaanalyses regarding breast and ovarian cancer include studies published up to 2012 with inconsistent results for ovarian cancer.

Methods: We conducted two updated meta-analyses of studies published up to June 2016 to quantify the association of coffee intake with breast and ovarian cancer risk with random effects models. We used the dataset developed by the International Agency for Research on Cancer Working Group for Monograph 116 meeting (May 2016). We additionally performed a PubMed search in June 2016.

Results: Summary relative risks (RRs) (95% confidence intervals (CI)) for the study-specific highest vs. lowest coffee consumption were for breast and ovarian cancer respectively: 0.97 (0.93–1.00, Ι2 5.5%, 40 studies, 76,728 cases) and 1.03 (0.93–1.14, Ι 2 31.9%, 31 studies, 13,111 cases). For decaffeinated coffee the corresponding RRs were: 1.00 (0.93-1.08, I2 32.2%, 13 studies) and 0.83 (0.71-0.96, I2 about 0%, 9 studies). The association of coffee with ovarian cancer risk was higher among publications before (RR=1.37, 1.12–1.69) compared to after 2000 (RR=0.96, 0.86-1.06).

Conclusion: Our meta-analyses provide strong, quantitative evidence that coffee consumption is not related to breast cancer risk and appears to be unrelated to ovarian cancer risk.
Improving Homecare Risk Management and Patient Safety
Authors: Lauta Enrico , Abbinante Crescenza , Maiellaro Lorenza , Rizzi Ruggiero , Dormio Pietro , Defilippis Vincenzo
Published: April 2023

Background: Risk management in the domiciliary healthcare setting is a harder challenge than in a hospital environment. Many, not always predictable, variables related to the patient, the caregiver, the health professionals and the home environment make it impossible to guarantee complete safety in homecare. The first aim of the study was to verify that the Electrical Medical Devices (EMD) and medical Consumables Supplies (CS) provided to mechanically ventilated and artificially fed patients at home comply with requirements for safe homecare. 

Methods: We conducted a Failure Modes, Effects and Criticality Analysis (FMECA) on two processes, mechanical ventilation and artificial feeding at home, and defined a local institutional list of the requirements for safe home healthcare; a checklist containing all the items in the list was administered to ventilated and artificially fed patients at home. 

Results: The checklist was used for 92 home patients, sex M/F=52/40, mean age 59,8±22 years (range 2÷102 years). Many failures were highlighted when the checklist was applied and problems affecting AMBU resuscitator bags, tracheostomy tubes, ventilators in patients being mechanically ventilated around-the-clock and ventilator circuits were identified as the most critical potential vulnerabilities for homecare patients. 

Conclusion: The checklist is a simple and valid tool for implementing proactive clinical risk management initiatives in homecare. Although it is impossible to guarantee complete safety in any healthcare environment, scheduling periodic checks with checklists to assess the quantitative and qualitative adequacy of EMD and CS provided to the patient could contribute to the homecare risk reduction.
Determinants of vitamin D deficiency among Bangladeshi children: A hospital based case-control study
Authors: Hawlader Mohammad DH , Zaman Sanjana , Rahman Moshiur , Khan Mohammad NM , Hossain Aazia , Ahsan Gias U
Published: April 2023

Background: Risk factors of vitamin D deficiency among children have been identified in many developed countries but not yet in some developing countries like Bangladesh. Therefore, the aim of this study was to identify the determinants of vitamin D deficiency among Bangladeshi children. 

Methods: This case-control study was conducted at 2 paediatric hospitals in Dhaka city from January to June 2017. We recruited 198 vitamin D deficient cases and 198 apparently healthy controls. Data were analyzed using IBM SPSS, where quantitative variables were analyzed using descriptive statistics. The association between vitamin D deficiency with different lifestyle and dietary factors were analyzed by using Chi-square test. A 2-tailed p-value less than 0.05 were considered as statistically significant. Univariate and multivariate logistic regression analysis were performed to confirm the association. 

Results: The study revealed that not playing outdoor games (OR=3.09; 95% CI 1.46, 6.54), playing video/ TV/mobile games (OR=4.14; 95% CI 1.97-8.67), no sun exposure (OR=2.42; 95% CI 1.25-4.67), no milk consumption (OR=3.01; 95% CI 1.38-6.57), no sea fish consumption (OR=2.20; 95% CI 1.19-4.08) and not exclusively breastfeeding (OR=2.03; 95% CI 1.14-3.63) were significantly associated with vitamin D deficiency. 

Conclusion: We concluded that improper lifestyles and nutritional habits are the key determinants of Vitamin D deficiency among Bangladeshi children. Strategy for hypovitaminosis D prevention should be implemented immediately, which includes vitamin D supplementation of breastfed infants and ensuring adequate maternal vitamin D status during pregnancy. Also an awareness program should be initiated to promote a healthy lifestyle and to improve nutritional habits.
Italian contribution to University Autonomy in Kazakhstan: the Erasmus+ project “Transition to University Autonomy in Kazakhstan” (TRUNAK)
Authors: Azzolini Elena , Ricciardi Maria Luisa , Vukovic Vladimir , Ricciardi Walter , Boccia Stefania , Bruno Stefania
Published: April 2023

University autonomy is the capacity of universities to be self-governing
Teaching medical statistics to undergraduate medical students: what is taught and what is really useful for a medical professional? A report of the Education Committee of the Italian Society of Medical Statistics and Clinical Epidemiology (SISMEC)
Authors: Gallo Ciro , Cavallo Franco , Bossi Anna
Published: April 2023

Background: There is a large heterogeneity among the courses of medical statistics in Italian Medical Schools. 

Aims: (1) To describe issues that are dealt with in the statistics undergraduate medical courses in Italian medical Schools. (2) To investigate which methodological topics are deemed as more useful for the education of undergraduate medical students by clinical teachers. 

Methods: (1) An online questionnaire, covering the qualifying teaching issues of medical statistics, was sent to all academic biostatisticians, asking what they were teaching to undergraduate medical students. The reference year was 2015-2016. Undergraduate medical courses were the statistical units. (2) A second survey involved teachers of other medical disciplines with institutional roles, asking to score the usefulness for medical education of a number of topics concerning medical statistics, on a 5-point Likert scale. Only descriptive analyses were performed. 

Results: Fifty-two (96%) case report forms (CRF) were returned from teachers of medical statistics. Most statistical and epidemiological topics were taught except comparison of >2 groups, impact of biases and standardization of rates. Conversely, issues of clinical epidemiology were neglected in about half of degree courses. 

Thirty-three (31%) CRFs were returned from clinical teachers. The percentage of issues deemed very useful or essential ranged from 57% to 94%, with higher scores for those referring to critical assessment of the literature. 

Conclusions: More extensive coverage of clinical epidemiology issues is needed to meet the demand of physicians, as responsible consumers of quantitative research. As biostatisticians we should operate to increase the homogeneity of medical statistics teaching in medical undergraduates’ education
Epidemiology of miscarriage
Authors: La Vecchia Carlo
Published: April 2023

Miscarriages account for about one in six/one in seven pregnancies, and probably over one in five excluding induced abortions, i.e. over 20 million events per year. However, any precise and valid estimate is made difficult by uncertainties in diagnosis, ascertainment, distinction in registration between induced and spontaneous abortions, and certification. These uncertainties vary across geographic region, country and socio-economic status...
Factors associated with Autism Spectrum Disorder: a case-control study in the Lebanese population
Authors: Bitar Tania , Gerges Perla , Kassab Maria-Cristina , Hallit Souheil , Mattar Hanna , Soufia Michel , Andres Christian R.
Published: April 2023

Background: Genetic factors represent the major etiological contributor in Autism Spectrum Disorders (ASD) but several studies also support the involvement of environmental factors. This last hypothesis is reinforced by the evident increase in the prevalence of this disorder in the last decades. Thus, in our study, we aimed to identify the correlation between factors related to sociodemographic elements, to child and mother’s health and ASD in order to dress a best detailed profile of the patients.

Methods: We conducted a case-control study including 64 Lebanese patients with ASD and 67 matched controls recruited from all the Lebanese districts. Our data has been analyzed by SPSS 23.0 and the statistical tests carried out were the Independent Sample t-test and the Chi-Square test. In addition, a multivariate logistic regression analysis has been carried out using variables that showed a p<0.05 in the bivariate analysis.

Results: Our findings suggest that consanguinity (OR=4; 95% CI [1.3-12.04]), familial history of ASD (6.7 [1.1- 39.3]), stress during pregnancy (3.6 [1.5 8.2]) and fetal prematurity (6.3 [1.2-33.01]) were significantly associated with increased odds of ASD. However, our results have shown no association between siblings suffering from diseases such as mental retardation, child’s infections and ASD.

Conclusion: This pilot study carried out in all the regions of Lebanon allowed us to shed the light on factors associated with ASD which might be preventable.
Effectiveness of clinical pathway in subjects with heart failure: A real-world study from Italian health claims
Authors: Rea Federico , Corrao Giovanni , Comoretto Rosanna Irene
Published: April 2023

Background: Several process-of-care indicators have been developed and implemented to improve the quality of heart failure (HF) patients care. The aim of this study is to assess the relationship between a set of recommendations for HF care with measurable clinical outcomes, also in terms of outcomes that could be avoided.

Methods: A retrospective cohort study was carried out on subjects with at least one hospitalization with a primary diagnosis of HF in 2007. Data were retrieved from healthcare utilization databases of Lombardy region (Italy). Exposure to selected recommendations (periodic control of echocardiogram and use of blockers of the renin-angiotensin system and beta-blockers) was recorded. All cause mortality and hospitalization with primary diagnosis of HF were considered as outcomes. Multivariable Cox models and Poisson model were fitted to estimate the exposure-outcome association.

Results: Among 8207 cases of HF, those who adhered to none, one or all recommendations during the first year after diagnosis were 11%, 60% and 30%, respectively. Compared to patients who adhered to no recommendation, a significant mortality risk reduction of 24% (95% CI 17-31%) and 44% (36 52%) were observed for those who adhered to one and all recommendations, respectively. A significant reduction in the rate of re-hospitalizations in subjects adhered to at least one recommendation was also observed. A decreased trend in Population Attributable Fraction for death cases according to follow-up time was observed.

Conclusion: A strict control of patients with HF through regular clinical examinations must be considered as fundamental for the reduction of mortality and re-hospitalizations.