bluuebunny/crossref_metadata_2025 huggingface dataset:
Is there a link between physical activity and Amyotrophic Lateral Sclerosis?
Authors: La Torre Giuseppe , Masala Daniele
Published: April 2023

The Amyotrophic Lateral Sclerosis (ALS) is a chronic and progressive neuro-degenerative pathology that starts in adult age and usually leads patients to death for respiratory distress after 3 years from the onset of symptoms 

In some studies, vigorous and continuous physical activity due to heavy working activity and sport is associated with ALS. On the other hand other studies are against this association. A study carried out in Europe found overall physical activity is associated with reduced odds of having ALS (OR=0.65, 95% CI=0.48-0.89), and the same protective factor is seen for work-related physical activity (OR=0.56, 95% CI=0.36-0.87) and organized sports (OR=0.49, 95% CI=0.32-0.75.

A recent literature review found that football/soccer may be considered as a possible risk factor for ALS (level C) and there is a strong need for further research that must take into account the numerous confounding factors that could be present in this field. However only well conducted observational studies, such as cohort and case-control studies, carried out with the same design in different countries could give a final answer to this suspected but still unconfirmed association
Are knowledge and skills acquired during the Master Degree in Nursing actually put into practice? A pilot study in Italy
Authors: Massimi Azzurra , Marzuillo Carolina , Di Muzio Marco , Vacchio Maria Rosaria , D'Andrea Elvira , Villari Paolo , De Vito Corrado
Published: April 2023

Background. Literature on the evaluation of the Master’s Degree in Nursing is scarce. The objective of this pilot study was to test a questionnaire aimed at monitoring the activities of nurses after receiving the Master’s degree.

Methods. An electronic questionnaire was administered to 36 graduates who obtained the Master’s degree during the academic year 2010/2011.

Results. Almost 80% of the participants judged their level of improvement in knowledge and skills during the course to have been satisfactory, but the level of implementation of these competencies at work was quite low.

Conclusion. Competencies acquired during the Master’s degree course are not always put into practice.
The Relevance of Epigenetic Biomarkers for Breast Cancer and Obesity for Personalised Treatment in Public Healthcare: A Systematic Review
Authors: Goettler Andrea , Haslberger Alexander , Ambrosino Elena
Published: April 2023

Background: Personalised medicine has gained attention as a result of the advances of genomic research in the last decade. This includes the rise in epigenetic research, which focuses on the environmental influences on the genome and examines biomarkers that might be useful for cancer therapy. This study investigates the epigenetic biomarkers for breast cancer and its risk factor, obesity, and evaluates their relevance for global public health.

Methods: A systematic search of articles published from 2005 to May 2015 was performed in PubMed for epigenetic breast cancer marker. An additional literature search was carried out on the epigenetic markers of obesity.

Results: The search resulted in 84 articles on breast cancer, which demonstrate the various applications of epigenetic markers for breast cancer diagnostics, prognostics and treatment. Particularly, non-invasive blood-based diagnostic biomarkers and epigenetic therapy could improve the health outcomes of cancer patients using a personalised approach. The 14 obesity-related articles highlight the epigenetic link of disease and risk factors and emphasise the relevance of nutritional influences.

Conclusions: Although epigenetics offers many opportunities, new discoveries have to be confirmed first in clinical settings to ensure advantages over traditional methods. Furthermore, before personalised epigenetic therapy can be applied in public health it is crucial to ensure a fair implementation in both high and low-income settings globally.
Epidemiology of drug use in Perugia (Italy) through the analysis of the Keratin Matrix
Authors: Mercurio Isabella , Troiano Gianmarco , Melai Paola , Agostinelli Veronica , Simone Rosaria , Nante Nicola , Bacci Mauro
Published: April 2023

Background Drugs and their metabolites can be incorporated into hair so hair testing has become s an alternative and complementary method to assess the extent of drugs abuse. The aim of our study has been to use hair samples to rebuild the epidemiology of illicit substances use  in Perugia.

Methods We conducted a cross-sectional study from May to July 2012 asking hairdressers of Perugia to collect hair samples and to compile a schedule for each one. The samples were analyzed in laboratory: the extraction of basic substances was performed adding methanol; the extraction of acid substances was obtained adding  NAOH.  After derivatization, 1μl of each solution was analyzed through gas chromatography / mass spectrometry The data were  organized in a database and processed using R version 3.2.2.

Results We collected 238 samples. The most detected drugs were: THC-TMS identified in 15 samples, MDMA in 9, Beg-TMS in 8. There is a statistically significant difference in drug use between centre (23,36%) and periphery (5,34%). Age and sex have not represented influencing factors. The substance with the highest concentration in the keratin matrix is ketamine (9834,86 ng/100 mg of hair).

Conclusions The use of keratin matrix offers high advantages in the toxicological analysis compared to conventional biological matrices and let us analyze the situation in Perugia where the increased market of drugs caused constant rise of drug addiction. However, because of the limits of this method, only the simultaneous use of keratin matrix and other traditional indicators, could furnish more precise information.
Hand washing in operating room: a procedural comparison
Authors: Stilo Alessia , Troiano Gianmarco , Melcarne Lucia , Gioffrè Maria Eufemia , Nante Nicola , Messina Gabriella , Laganà Pasqualina
Published: April 2023

BACKGROUND Hand washing has been considered a measure of personal hygiene for centuries and it is known that an improper hand hygiene by healthcare workers is responsible for about 40% of nosocomial infections. Therefore, surgical hand preparation is a critical element for healthcare safety in order to reduce microbial contamination of  surgical wound in case of non detected break of the gloves. The aim of our study is to evaluate the efficacy three antiseptics: Povi-iodine scrub; EPG (Ethanol, Hydrogen Peroxide, Glycerol, recommended by WHO), and common marseille soap type in a liquid formulation.

METHODS It was designed a randomized, double-blind, single-center study conducted in the University Hospital of Messina, from January to June 2013. We asked operators to put the fingertips of their right hand (if not left-handed) for one minute on the PCA medium, before washing with the three types of antiseptics, and after washing and drying. Drying was made using sterile gauzes or disposable wipes. Then, we measured the number of colony forming units per mL (CFU/mL) and calculated the percentage of microbial load reduction.

RESULTS 211 samples have been considered for statistical analysis: in 42 samples, in fact, initial microbial load was lower than after washing. Washing with EPG reduced CFU/ml from  a mean of 38,9 to 4,1 (86,5% reduction), washing with povi-iodine scrub from 59,55 to 12,9 (75,9% reduction) and washing with Marseille soap from 47,26 to 12,7 (64,3% reduction).

CONCLUSIONS Our study shows that washing with EPG has superior efficacy in CFU reduction. Antiseptic hand washing, however, cannot be considered the only measure to reduce infections: the anomaly of some results (initial microbial load lower than after washing)  demonstrates that drying is an essential phase in the presurgical preparation. Therefore, hand hygiene must be part of a more complex strategy of surveillance and control of nosocomial infections
Multiplicative models for survival percentiles: estimating percentile ratios and multiplicative interaction in the metric of time
Authors: Bellavia Andrea , Bottai Matteo , Orsini Nicola
Published: April 2023

Evaluating percentiles of survival was proposed as a possible method to analyze time-to-event outcomes. This approach sets the cumulative risk of the event of interest to a specific proportion and evaluates the time by which this proportion is attainedIn this context, exposure-outcome associations can be expressed in terms of differences in survival percentiles, expressing the difference in survival time by which different subgroups of the study population experience the same proportion of events, or in terms of percentile ratios, expressing the strength of the exposure in accelerating the time to the event. Additive models for conditional survival percentiles have been introduced, and their use to estimate multivariable-adjusted percentile differences, and additive interaction on the metric of time has been described. On the other hand, the percentile ratio has never been fully described, neither statistical methods have been presented for its models-based estimation. To bridge this gap, we provide a detailed presentation of the percentile ratio as a relative measure to assess exposure-outcome associations in the context of time-to-event analysis, discussing its interpretation and advantages. We then introduce multiplicative statistical models for conditional survival percentiles, and present their use in estimating percentile ratios and multiplicative interactions in the metric of time. The introduction of multiplicative models for survival percentiles allows researchers to apply this approach in a large variety of context where multivariable adjustment is required, enriching the potentials of the percentile approach as a flexible and valuable tool to evaluate time-to-event outcomes in medical research.
Prevalence of Alcohol Consumption among University Students in Baghdad: A Cross-section survey from Iraq
Authors: Al-Ameri Rawa Jaafar Kadhim , Al-Badri Husham J Abd , Lafta Riyadh K
Published: April 2023

Background: Alcohol consumption is a well-known public health problem, especially among university students. It was poorly studied in Middle East, especially in Iraq, due to religious and social taboos. This study conducted to throw a light on the prevalence of Alcohol consumption among university students in Baghdad.

Subjects and methods: A survey conducted in three universities (Baghdad, Al-Mustansiriyah and Al-Nahrain) from Baghdad city, in the duration between January and May 2015.A semi-structured questionnaire form used to collect the data from 1435 university students. The sample selected by multistage random sampling technique with probability proportion to size.

Results: The average age (range) of the studied sample was 19.8 (18 - 24) years; more than a half of them were females 760 (53%). Alcohol consumption was reported by 9.7% (95%CI: 8.2% - 11.2%) of the participants (19.7% males vs. 0.8% females). Heavy Alcohol consumption was reported by 12.2% of consumers. Male students living out of their families or relatives and those of medical group colleges found to be risk factors for Alcohol consumption (PR= 2.65, 95% CI: 1.72 - 4.1) and (PR= 2.72, 95%CI: 1.48 - 5.01) respectively. No significant relations showed between demographic characters of female students and Alcohol consumption.

Conclusions: Usage of Alcohol was relatively prevalent among university students in Baghdad, in spite of religious and social barriers in Iraq.

Family and college staff supervision and education of the students with meetings targeting health risks and sequels of Alcohol hazardous consumption are the effective ways to control this practice.
Diabetes mellitus and colorectal cancer screening in the population of the Italian region Friuli Venezia Giulia
Authors: Valent Francesca , Gobbato Michele , Franzo Antonella , Gongolo Francesco
Published: April 2023

Aims: Colorectal cancer is the most common cancer in Italy, where screening programs are now in place all over the country. We conducted a research to assess whether the use and outcomes of colorectal cancer screening are different between diabetics, who are at increased risk of developing colorectal cancer, and non-diabetics in the Italian Northeastern region Friuli Venezia Giulia.

Methods: This was a retrospective population-based study which used the administrative databases of the regional health information system as the sources of information. For the two screening rounds 2010-2011 and 2012-2013, we compared adherence to the program and the results of the fecal occult blood tests and of the colonoscopy among diabetic and non-diabetic residents.

Results: Overall, more than 300,000 persons were invited for the colorectal cancer screening in each round. Of them, approximately 8.8% were diabetic. In the regional population, adherence to the screening program was significantly lower among diabetics than among non-diabetics. The proportion of positive fecal occult blood tests was higher among diabetics than among non-diabetics. Among diabetics, the detection rate for initial and advanced adenomas was higher than among non-diabetics, whereas no clear pattern was observed for the detection of cancers.

Conclusion: In Friuli Venezia Giulia, efforts should be directed at improving the management of diabetic patients and at reducing the inequalities in access to care due to this comorbidity.
Factors associated with macrosomia among singleton live-birth: A comparison between logistic regression, random forest and artificial neural network methods
Authors: Amini Payam , Maroufizadeh Saman , O Samani Reza , Hamidi Omid , Sepidarkish Mahdi
Published: April 2023

Background: Macrosomia with adverse outcomes for mother and infant is affected by several risk factors. Classification methods including logistic regression, random forest and artificial neural network are used to determine high risk groups for macrosomia.

 

Methods: This cross-sectional study was conducted on 4342 pregnant women who gave singleton live-birth in Tehran, Iran from 6-21 July 2015. The performed methods were compared using tools such as sensitivity, specificity and accuracy. McNemar's test checked differences in proportion among methods. To assess the association between the observed and predicted values, Kappa statistic was calculated.

 

Results: Mother’s BMI, SES, mother’s education, parity, mother’s age, gestational age and mother’s occupation are the most important variables affecting macrosomia identified by RF method with the highest accuracy 0.89. The association of RF predictions and observed values using Ø coefficient, contingency coefficient, Kendall tau-b and kappa were 0.43, 0.39, 0.43 and 0.31, respectively.

 

Conclusion: Based on our findings, random forest had the best performance to classify macrosomia comparing to artificial neural network and logistic regression and may be used as an appropriate method in such data.
Shifting Patterns of BMI and Skinfold Fatness among US Children: 1985/87 vs. 2012
Authors: Yang Yan , Zhu Weimo Zhu , Wang Songtao
Published: April 2023

Background: Childhood obesity has been recognized as a major public health concern. The purpose of this study was to determine specific shifting patterns of BMI and skinfold fatness across different age and sex groups between 1985/87 and 2012.

Methods: The data of 9,366 children aged 8-15 years from two nationally representative surveys, i.e., 1985/87 National Children and Youth Fitness Study I & II and 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey, were analyzed. Specifically, changes of BMI-based obesity prevalence and shifting patterns of BMI, height, weight, skinfold body fat percentage (skinfold-fat%), subscapular skinfold, and triceps skinfold from 1985/87 to 2012 were estimated by age and sex using the 1985/87 quartiles as the baseline.

Results: Significantly increased obesity prevalence were reconfirmed for both boys (12.12%, P <.001) and girls (3.53%, P <.001) from 1985/87 to 2012. Except for height, all other measures in 2012 experienced an unbalanced shifting pattern, mainly from other quartiles into the 4th quartile of 1985/87.

Conclusion: The shifting of both boys’ and girls’ BMI and skinfold-fat% were all concentrated in the 4th quartile of 1985/87, indicating not only that there was a significant increase in BMI and skinfold-fat% in the U.S. children from 1985/87 to 2012, but also into the overweight and obese subgroups, which serves as a serious warning for childhood obesity epidemic and public health.
Investigation of breast cancer screening among the women of Khorramabad (west of Iran): A cross-sectional study
Authors: Anbari Khatereh , Ahmadi Seyyed Amir Yasin , Baharvand Parastoo , Sahraei Naser
Published: April 2023

Abstract. Breast cancer is the most common women's cancer that more than 90% of the patients can be treated or even cured through early diagnosis. So we intend to investigate the status of breast cancer screening in Khorramabad, a city in the west of Iran. In the present cross-sectional study, the study population included 457 number of 20 to 65 year old women referring to the health centers of Khorramabad during the second half of 2015 to receive health care services. The sampling method was multistage random-cluster. A multi-part questionnaire were used. Fisher exact test, chi-square and independent t tests were used to analyze the data.  The regular self-breast exam (SBE) had been carried out by 12.3% of the women, visiting doctors for regular clinical breast exam (CBE) had been done by 6% of the respondents and regular mammography every one to two years had been performed by 2.4% of the women. A statistically significant relationship was seen between occupation (P = 0.001), regular consumption of contraceptive pills (P = 0.032), history of breastfeeding, history of breast cancer in the first degree relatives (P = 0.001), and a history of cancer in the second degree (P = 0.005) relatives, and the regular SBE. Planning to enhance the women's awareness about breast cancer and the methods of early diagnosis and designing educational programs can be an important step to reduce deaths and disabilities caused by this disease among the women in such deprived cities.
Guidelines of the minimum sample size requirements for Kappa agreement test
Authors: Bujang Mohamad Adam , Baharum Nurakmal
Published: April 2023

Background and aims:

    To estimate sample size for Cohen’s kappa agreement test can be challenging especially when it is expected that the true marginal rating frequencies are not the same. This study aims to present the tables that display a minimum sample size determination for an agreement test when certain assumptions are hold.

Method:

    We adopted the sample size formula provided by Flack and colleagues (1988) to calculate the minimum sample sizes required using PASS software. The power is pre-specified to be at least 80% and the alpha to be less than 0.05. The effect sizes were derived from several pre-specified estimates such as the pattern of the true marginal rating frequencies and the difference between the two kappa coefficients in the hypothesis testing.

Results:

    When the true marginal rating frequencies are the same, the minimum sample size determination can range from 2 to 698 depending on the actual value of the effect size. When the true marginal rating frequencies are not the same, then the majority of the minimum sample size required for this condition is more than double than that required sample size when the true marginal rating frequencies are the same.

Conclusion:

  Concerning that the sample size formula could produce a very extreme small sample size, therefore, the determination of K1 and K2 should be based on reasonable estimates. We recommend for all sample size determinations for Cohen’s kappa agreement test, the true marginal rating frequencies can be assumed the same. Otherwise, it will be necessary to multiple the estimated minimum sample size by two to accommodate if the true marginal rating frequencies is not the same.
Classical causation research practices and sufficient-component cause model – Appraisal and pitfalls
Authors: AlRawahi Abdul Hakeem Hamood
Published: April 2023

The sufficient-component cause model is one of the most discussed recent theories in disease causation. Despite some limitations, it seems one of the best theories to explain real world phenomena. It seems that this model has many implications on the current classical research methods related to disease causation. However, these implications have not been sufficiently explored. Therefore, based on the sufficient-component cause model, this paper aims to review, identify and rectify pitfalls in the classical causation research practices, especially those related to cohort study design.
Design and validation of a self-administered questionnaire to assess knowledge, attitudes and behaviours about Zika virus infection among general population in Italy
Authors: Gianfredi Vincenza , Bragazzi Nicola Luigi , Nucci Daniele , Zanella Francesca , Martinelli Domenico , Camilloni Barbara , Villarini Milena , Moretti Massimo , Stracci Fabrizio
Published: April 2023

Background Zika (ZIKV), a flavivirus firstly identified in rhesus monkeys in Zika Forest of Uganda, in 1947, is an emerging virus  transmitted mainly by mosquitoes bites. Due to ZIKV adaptation to humans, that can maintain a mosquito-human-mosquito transmission cycle, it is essential to know the attitudes, knowledge and behaviours of general population regarding ZIKV prevention. Our main study aims were to develop and validate a questionnaire administered to the general population, in order to assess attitudes, knowledge and behaviours around prevention and control of Zika infection. Methods A questionnaire was developed based on a comprehensive review of the extant literature, pre-existing questionnaires and experts focus groups. Results The final, validation version of the questionnaire comprised 8 items, with good psychometric properties (Cronbach’s alpha of 0.81). Overall test/re-test concordance was 0.86, ranging from 0.76 to 0.94 according to each item. Conclusion In conclusion, the questionnaire seems to be an appropriate and useful tool to detect cognitive gaps concerning behaviours responsible for possible transmissions of the disease, even in a non-endemic country such as Italy. Future analysis will explore the factorial structure of the questionnaire as well as knowledge, beliefs and attitudes concerning ZIKV among Italian general population.
The Heterogeneous Effects of Family Structure on Early Child Health
Authors: Mulenga Mulenga Chonzi
Published: April 2023

Background

Ending preventable deaths of newborns and children under 5 years of age by 2030 is one of the targets of the Sustainable Development Goals. Data from the 2013-14 Zambia Demographic and Health Survey shows that there has been improvements in some indicators of child health over the years and this has coincided with the widespread demographic changes in family formation. It’s hypothesized that children from monogamous households tend to have much better health outcomes compared to single or polygynous households. This study therefore set out to examine the effect of heterogeneous family structures on early child health.

Methods

Using data from the 2013-14 ZDHS, the study employed the Kids Recode (KR) data file which contains information about children under the age of five (5) of interviewed women. The analysis was conducted at three levels: descriptive, bivariate and multivariate.

 Results

The study established that family structure had a statistically significant effect on early child health and that there was heterogeneity in the health outcomes of the children from different forms of marriage, with the ever married and polygamous marriage categories showing higher odds of having underweight children. The study also established that mother’s nutrition status, region, sex of child, mother’s age at birth of the child and child vaccination were also among other factors associated with the early child health in Zambia.

 Conclusion

There is need for the government to implement policies that will limit the exposure of children to adverse health which would require more costly interventions later in life.
Longitudinal Joint Modelling of Binary and Continuous Outcomes: A Comparison of Bridge and Normal Distributions
Authors: Amini Payam , Verbeke Geert , Zayeri Farid , Mahjub Hossein , Maroufizadeh Saman , Moghimbeigi Abbas
Published: April 2023

Background: Longitudinal joint models consider the variation caused by repeated measurements over time as well as the association among the response variables. In the case of combining binary and continuous response variables using generalized linear mixed models, integrating over a normally distributed random intercept in the binary logistic regression sub-model does not yield to a closed form. In this paper, we assessed the impact of assuming a Bridge distribution for the random intercept in the binary logistic regression submodel and compared the results to that of normal distribution.

 Method: The response variables are combined through correlated random intercepts. The random intercept in the continuous outcome submodel follows a normal distribution. The random intercept in the binary outcome submodel follows a normal or Bridge distribution. The estimations were carried out using a likelihood-based approach in direct and conditional joint modeling approaches. To illustrate the performance of the models, a simulation study was conducted

Results: Based on the simulation results and regardless of the joint modeling approach, the models with a Bridge distribution for the random intercept of the binary outcome resulted in a slightly more accurate estimations and better performance.

Conclusion: In addition to the fact that assuming a bridge distribution for the random intercept in binary logistic regression yields to the same interpretation of parameter estimates in marginal and conditional forms, our study revealed that even if the random intercept of binary logistic regression is normally distributed, assuming a Bridge distribution in the model will result in more accurate results.
A Bayesian Logistic Regression approach in Asthma Persistence Prediction
Authors: Spyroglou Ioannis I. , Spöck Gunter , Chatzimichail Eleni A. , Rigas Alexandros G. , Paraskakis E.N.
Published: April 2023

Background: A number of models based on clinical parameters have been used for the prediction of asthma persistence in children. The number and significance of factors that are used in a proposed model play a cardinal role in prediction accuracy. Different models may lead to different significant variables. In addition, the accuracy of a model in medicine is really important since an accurate prediction of illness persistence may improve prevention and treatment intervention for the children at risk.

Methods: Data from 147 asthmatic children were analyzed by a new method for predicting asthma outcome using Principal Component Analysis (PCA) in combination with a Bayesian logistic regression approach implemented by the Markov Chain Monte Carlo (MCMC). The use of PCA is required due to multicollinearity among the explanatory variables.

Results: This method using the most appropriate models seems to predict asthma with an accuracy of 84.076% and 86.3673%, a Sensitivity of 84.96% and 87.25% and a Specificity of 83.22% and 85.52%, respectively.

Conclusion: Our approach predicts asthma with high accuracy, gives steadier results in terms of positive and negative patients and provides better information about the influence of each factor (demographic, symptoms etc.) in asthma prediction.
Evaluating Infant Complementary Feeding Pattern and Some Related Factors in Health Care Centers in Khorramabad, 2017 Year
Authors: Anbari Khatereh , Tajabadi Zohreh , Baharvand Parastoo , Bazvand Mostafa , Babak Khodadadi
Published: April 2023

Objective: Inappropriate starting of complementary feeding is an important factor leading to infant growth delay and malnutrition. This study was aimed to determine the complementary feeding pattern and some related factors in health care centers in Khorramabad. 

Methods: This cross-sectional study, included 300 one year old infants who had referred to nine health care centers in Khorramabad by multistage sampling. In present study, we used a questionnaire included individual information about mothers and infants and a checklist for evaluating breastfeeding and complementary feeding. Chi-square test and one way ANOVA were used to analyze the data. 

Results: In present study, 50.7% of infants were girls and 60.3% of cases were the first infant in their family. 59.3% of infants were delivered by cesarean. Average age of starting complementary feeding was 0.5 8.5. 75.7% of infants had exclusive breastfeeding up to first six months of their life. Among most cases, the first complementary food was rice flour porridge (29.3%) and almond porridge (15.7%). Most mothers had acquired necessary information about complementary feeding by using booklets (20.7%) and physician guidance (16.7%). There was a statistically significant relationship between age of starting complementary feeding and mother’s education (P=0.043) level and employment status (P=0.001). 

Conclusion: Related authorities should begin comprehensive and effective education by using novel training strategies to raise mothers' knowledge about age of starting complementary feeding and how to do it at health care centers.
Self-Rated Health among General Population in the West of Iran: A Cross-Sectional Analysis of Socioeconomic Determinants
Authors: Rezaei Satar , Karyani Ali Kazemi , Khosravipour Masoud , Khosravi Farid , Rezaeian Shahab
Published: April 2023

Background: Self-rated health (SRH), as a powerful independent predictor of mortality, has been used worldwide.However, there is currently lack of information about the SRH in Iran as a developing country. This study was conductedto investigate the relationship between SRH and socioeconomic factors in the general population in western Iran.Methods: A cross-sectional study was conducted in 2017 enrolling 1,444 subjects aged 18 years and over in fiveareas of Kermanshah City, Iran. A single question of SRH with five scales of excellent (coded as 1), very good, good,fair, or poor (coded as 5) was used. Univariate and multiple logistic regression models were performed to determinefactors associated with poor self-rated health.Results: The proportion of poor SRH was 14.7%. Multiple logistic regression showed that the most importantdeterminants of poor SRH were older age (adjusted odds ratio (AOR)31-50year=1.96, AOR≥51year=4.93, married status(AOR=2.53), divorced or widowed status (AOR=2.62), self-reported income level as middle (AOR=2.51) andlow (AOR=4.59), rural residency (AOR=1.5), low physical activity (AOR=11.97), and having chronic diseases(AOR=6.85). In addition, the educational level had a negative relationship with poor SRH (AOR academic=0.47).Conclusion: Our results revealed that both individual and social factors are directly associated with poor SRH.Therefore, these determinant factors should be considered in health policies and planning for promoting health andSRH in the west of Iran.
A Cross-sectional study to explore the challenges faced by Myanmar women in accessing antenatal care services
Authors: Kabir Russell , Haider Mohammad Rifat , Kordowicz Maria
Published: April 2023

Background: Myanmar has one of the highest maternal mortality rates in the Southeast Asian region, with most maternal deaths occuring at the time of delivery. The aim of this research was to identify the relationship between socio-demographic characteristics of Myanmar women and utilisation of antenatal care services.
Methods: This is a descriptive cross-sectional study utilising the Myanmar Demographic and Health Survey Data 2015-16. A total of 13,454 women agedbetween 15-49 years were surveyed. This study sampled married women only (n=7870).
Results: The mean age of the respondents was 35 years and the majority of respondents (50.7%) belonged to the 35-49 age group. Approximately 46.3% of respondents reported more than four antenatal care service (ANC) visits and almost 54% respondents attended ANC during their second and third trimesters. This study found that women with no education, poorer socioeconomic status, less access to mass media, living in rural areas and with more children were not utilising ANC services adequately.
Conclusion: Strategies should be introduced to encourage pregnant women to attend a minimum of four antenatal check-ups and there should be adequate monitoring in place of the timing of ANC visits during pregnancy.
A multi-sectoral intervention model to scale up family planning services utilization at the primary health care level: evidence from a priority district, Fayoum governorate, Egypt
Authors: Elden Nesreen Mohamed Kamal , Khairy Walaa Ahmed , Amin Tarek Tawfik
Published: April 2023

Background: Egypt is one of the most populous countries in the Middle East and Africa. Evidence from developing countries revealed that increasing family planning use is associated with substantial declines in fertility and population growth. The objective of this study was to assess the impact of implementing a multisectoral intervention model on the family planning utilization at the Primary Health Care (PHC) level in a priority district, Fayoum governorate, Egypt. 

Methods: A quasi-experimental design was conducted from July 2016 to September 2016. The model targeted 10 PHC units out of 23 at Tamia district, with two types of interventions; health sector and non-health sector related interventions carried out in the intervention units and their catchment areas. The family planning utilization of the intervention units (n=10) was compared to the control units (n=13). Additionally, the overall family planning utilization at the district level was measured. 

Results: Following the implementation of the interventions, the overall family planning utilization at the district level showed a significant increase in mean ± Standard Error of the Mean (SEM) of new family planning clients (44.4±11.0vs. 63.3±13.8; P= 0.006) recording 43% change. The mean ± SEM of intrauterine devices dispensed from the intervention units significantly increased by 391% (3.5±1.0 vs. 17.2±3.3; P=0.002). Findings from the control units didn't reveal significant increase regarding the dispense of any family planning method. 

Conclusion: Mobilizing and optimizing resources use, empowering district authorities and strengthening collaboration across sectors were key drivers of the success of this model in scaling up family planning services utilization.
Obesity: transition from adolescence to adulthood and feedback partial gmm logistic model with time-dependent covariates
Authors: Fang Di , Irimata Kyle M. , Rhodes Rachael N. , Wilson Jeffrey R.
Published: April 2023

Background: The aim of this study is to investigate the impact of certain covariates on obesity. More importantly, we seek to determine the feedback of obesity on depression, and physical activity as they transition from adolescence to young adulthood.

Methods: Using 15 years of nationally representative data from 6560 adolescents (Add health data), we estimate feedback and associations between depression, and activity scale on obesity while we adjusted for gender, age, race/ethnicity, socioeconomic status through a GMM logistic regression model with time-dependent covariates.

Results: Activity (p<0.001) and depression (p<0.001) have significant impact on Obesity. In early years, alcohol had no impact (p=0.895 and p=0.476) on obesity but in later years it did (p<0.001). In the early years, television hours had an impact but as they got older, it did not.

Conclusion: Our findings suggest that public health researchers can target obesity simultaneously with depression, and activity scale. These findings contribute new insights into the feedback of obesity on depression, and activity. This unique model allows segments of associations to be addressed rather than assuming all associations remain the same over 15 years.
Bayesian model averaging: improved variable selection for matched case-control studies
Authors: Mu Yi , See Isaac , Edwards Jonathan R.
Published: April 2023

Background: The problem of variable selection for risk factor modeling is an ongoing challenge in statistical practice. Classical methods that select one subset of exploratory risk factors dominate the medical research field. However, this approach has been criticized for not taking into account the uncertainty of the model selection process itself. This limitation can be addressed by a Bayesian model averaging approach: instead of focusing on a single model and a few factors, Bayesian model averaging considers all the models with non-negligible probabilities to make inference.

Methods: This paper reports on a simulation study designed to emulate a matched case-control study and compares classical versus Bayesian model averaging selection methods. We used Matthews’s correlation coefficient to measure the quality of binary classifications. Both classical and Bayesian model averaging were also applied and compared for the analysis of a matched case-control study of patients with methicillin-resistant Staphylococcus aureus infections after hospital discharge 2011-2013.

Results: Bayesian model averaging outperformed the classical approach with much lower false positive rates and higher Matthew’s correlation scores. Bayesian model averaging also produced more reliable and robust effect estimates.

Conclusion: Bayesian model averaging is a conceptually simple, unified approach that produces robust results. It can be used to replace controversial P-values for case-control study in medical research.
Continuity correction of Pearson’s chi-square test in 2x2 Contingency Tables: A mini-review on recent development
Authors: Serra Nicola , Rea Teresa , Di Carlo Paola , Sergi Consolato
Published: April 2023

The Pearson’s chi-square test represents a nonparametric test more used in Biomedicine and Social Sciences, but it introduces an error for 2x2 contingency tables, when a discrete probability distribution is approximated with a continuous distribution. The first author to introduce the continuity correction of Pearson’s chi-square test has been Yates F. (1934). Unfortunately, Yates’s correction may tend to overcorrect of p-value, this can implicate an overly conservative result. Therefore many authors have introduced variants Pearson’s chi-square statistic, as alternative continuity correction to Yates’s correction. The goal of this paper is to describe the most recent continuity corrections, proposed for Pearson’s chi-square test.
Demographic and Regional Trends of Smoking among Thai Females from 1986 to 2014
Authors: Gautam Nirmal , Lim Apiradee , Ueranantasun Attachai
Published: April 2023

Background: Smoking is a major public health burden causing substantial morbidity and mortality. The aim of the study was to assess the prevalences and demographic trends of smoking among Thai females. 

Methods Data from Thailand’s National Statistics Office for 1986 to 2014 were used. Multiple logistic regression was implemented to identify the prevalences and trends of female smoking by region (Bangkok, Central, Northeast, North, and South) and area (Rural and Urban). 

Results: The overall prevalence of smoking was 3.4% among females aged 15 years and above in 2014. Gradually decreasing trends of smoking were observed from 1991 to 2007. Afterwards, the trends of smoking was found higher in 2011 to 2014 among aged 15-39 years. Furthermore, there were substantial differences in female smoking in different regions and areas. Of those, the Northern Thailand and rural areas had the highest prevalence of smokers. 

Conclusion: Smoking among Thai females in the past 20 years had a decreasing trend, but it can be seen that since 2007 the trend of smoking had shown an increasing trend and a variation among the regions. This imply that, tobacco control policies are important and in need particularly for young females, living in rural areas and Northern provinces.
Maternal Dietary Pattern with an Emphasis on Child Growth Pattern and Exclusive Breastfeeding Duration
Authors: Borazjani Fatemeh , Hardani Amir Kamal , Bokaee Shadi , Angali Kambiz Ahmadi
Published: April 2023

Background: maternal nutrition and breast milk nutrient concentration are associated with infant's growth. Enhanced knowledge encourages mothers to breast feed for the sake of optimizing growth and development.

Methods: the current study was performed longitudinally in some rural areas, south of Iran, from birth to six months. Out of 319 candidates with serial anthropometric measurements of an infant, including weight, height, and head circumference at four times (birth, two, four, and six months ), 195 were included in the multivariate regression model (total measurements, n=776) to construct the pattern of growth. Then, information regarding demographic background, lactation status and infant supplementation intake status, feeding practices, maternal anthropometric measurements, and food frequency questionnaire were collected from mothers and their children during six months in two rural health centers.

Results: The most important association between dietary factors and infant anthropometrics (weight, height, and head circumference) involved Factor2 vegetables, including leafy vegetables, tomato, onion and garlic, (weight β=0.35 95%CI 0.27 - 0.44, length β=3.82 95%CI 3.42 - 4.22, head circumference β=2.55 95%CI 2.32 - 2.79) and Factor1 fruit, including orange, kiwi, cherries, watermelon, date, and grapes) (weight β=0.117 95%CI 0.04-0.189, length β=0.59 95%CI 0.257-0.929, head circumference β=0.307 95% CI 0.108-0.507), respectively. Generalized Estimation Equation model revealed that Factor2 dairy (including low fat milk, yogurt and dough) significantly contributed to weight growth velocity (β=-0.009 95% CI -0.016 - 0.001).

Conclusion: a dietary habit of fruit and vegetables, which are rich in bioactive components by breast feed mother showed better growth for infants. As growth is multifactorial, maternal nutrition and breastfeeding duration is a simple modifiable factor which can affect the subsequent growth and development of the child during the first six months.

Key words: exclusive breastfeeding, growth, anthropometric measures, maternal nutrition, and multivariate multiple regression.
Associations between sociodemographic characteristics and tobacco usage in adult cancer survivors: Evidence from a population-based study
Authors: Mann Alexander J , Malcolm Janice C
Published: April 2023

Background: the risk of developing new cancers persists for 15 million cancer survivors in the United States, yet many continue to engage in high-risk behaviours. This analysis aims to compare tobacco use in cancer-free respondents and cancer survivors, in order to elucidate trends and behavioural patterns associated with increased tobacco use in individuals that have survived cancer. 

Methods: the Health Information National Trends Survey data of 2014 and 2017 was analysed for this study. Descriptive statistics were generated, and the likelihood of tobacco use was predicted using weighted logistic regression. Included in the study population were 941 cancer survivors, predominantly white (80%), 60-70 years of age, married (52%), with some level of education past high school (65%). 

Results: the current smoking rate for cancer survivors was 12.1% versus 14.3% for those without cancer. Sub-high school education (OR 3.02, 95% CI [1.11-8.19]), separation/divorce (OR 2.71, 95% CI [1.52-4.83]), female gender, and lower household income were associated with an increased likelihood of cigarette use amongst cancer survivors. Cervical cancer (19.2%) and lymphoma (20%) survivors were most likely to smoke cigarettes compared to other cancer survivors. 

Conclusions: this study demonstrated certain sociodemographic characteristics increase the likelihood of cigarette smoking in cancer survivors. These outcomes suggest cancer survivors with only high school education or lower, and those with household incomes of less than $35,000 are at greater risk and should be targeted for personalised tobacco cessation interventions in the future. High prevalence of smoking in cervical cancer survivors and an increased risk of tobacco-linked cancers suggests focus must be directed to interventions targeting female cancer survivors. Allocating further resources toward the at-risk populations identified in this study may reduce further morbidities in cancer survivors.
Towards Value-Based Healthcare and the Role of Regional Agencies: the Approach of the Veneto Region
Authors: Comoretto Rosanna I , Gasparetto Teresa , Tavazzi Erica , Gregori Dario
Published: April 2023

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Discovering potential blood-based cytokine biomarkers for Alzheimer’s disease using Firth Logistic Regression
Authors: Abdullah Mohammad Nasir , Wah Yap Bee , Zakaria Yuslina , Majeed Abu Bakar Abdul , Huat Ong Seng
Published: April 2023

Background: Alzheimer’s disease (AD) is a neurodegenerative disorder where patients suffer from memory loss, cognitive impairment and progressive disability. Individual blood biomarkers have not been successful in defining the disease pathology, progression and diagnosis of AD. There is a need to identify multiplex panels of blood biomarkers for early diagnosis of AD with high sensitivity and specificity. This study focused on identification of cytokine biomarkers. The maximum likelihood estimates of the ordinary logistic regression model cannot be obtained when there is complete separation and the alternative is Firth logistic regression which uses a penalised Maximum Likelihood in parameter estimation. 

Methods: This paper reports a Firth logistic regression application in finding potential blood-based cytokine biomarkers for Alzheimer’s disease in a matched case control study. We used a principle component analysis to discriminate the correlated, completely separated covariates. 

Results: The Firth logistic regression results showed that nine individual biomarkers IL-1β, IL-6, IL-12, IFN-γ, IL-10, IL-13, IP-10, MCP-1 and MIP-1α had a significant relationshipwith elevated risk for AD as compared to the healthy control (HC). Principal component analysis with varimax rotation for the nine biomarkers revealed four factors (total variance explained=85.5%). The main principal component biomarkers were IL-1β, IL-6, IL-13 and MCP-1 (total variance explained=62.3%). Firth’s logistic regression model with the first principal component had accuracy of 78.2% with sensitivity and specificity of 71.8% and 75% respectively. 

Conclusion: Firth’s logistic regression is a useful technique in identification of significant biomarkers when there is an issue of data separation.