bluuebunny/crossref_metadata_2025 huggingface dataset:
To assess community care services effectiveness: the use of the Chronic Obstructive Pulmonary Disease in-patient admission rate
Authors: Gilardi Francesco , Scarcella Paola , Mancinelli Sandro , Buonomo Ersilia , Liotta Giuseppe
Published: April 2023

Background

Assessment of appropriateness is a criteria of increasing relevance for delivering health care services. In Italy elderly hospital admissions for Chronic Obstructive Pulmonary (COPD) disease is one of the chosen indicators to measure the appropriate use of services. This study describes the characteristics of hospital admissions at a regional level for COPD – DRG 88 and to evaluates their relationship with other indicators linked to the provision of hospital or community care services.

Methods

Data on hospital admissions for COPD in the years 2006 and 2011 were collected from hospital discharge records. Correlations among acute in-patients admission rates by Italy’s Regions and provision of Long Term Care (LTC) services have been analyzed through univariate and multivariate linear regression models.

Results

The national rate of hospitalization for COPD decreased from 2006 to 2011 (-35%). The COPD in-patient admission rate showed a weak inverse relation with the provision of LTC that was statistically significant only for 65-74 age-group in 2006. The reduction was greater than 60% for those under the age of 75 and around 14% for those over 74 years.

The inclusion in the interpretative model the rate of beds per capita in and the rate of General Practitioners improves the percentage of variability between the regions in the rate of hospitalization for the DRG 88 explained by the model itself.

Conclusion

The reduction in hospitalizations for COPD in the over-fifty age group is particularly noticeable; it seems mainly related to factors other than to the operation of those services outside the hospital.
Avedis Donabedian: The Giant
Authors: Bucci Roberto , Colamesta Vittoria , La Torre Giuseppe
Published: April 2023

“Giant” is the most frequent word in commemorating Avedis Donabedian. Rarely there was such agreement among scholars worldwide to define the role of a scientist in the field of Public Health. And it’s impossible to disagree. Avedis Donabedian had a really huge role in the progress in Public Health studies. It’s not exaggerated even to say that his insights influenced all scientific research.
Recent findings on the impact on Public Health systems of drugs use and abuse
Authors: Rossi Carla
Published: April 2023

This special issue of Epidemiology, Biostatistics and Public Health derives from a very strict selection of the more than 100 papers presented at the 8th ISSDP Conference (Rome, CNR, 21-23 May 2014).
Drug induced mortality: a multiple cause approach on Italian causes of death Register
Authors: Grippo Francesco , Pappagallo Marilena , Burgio Alessandra , Crialesi Roberta
Published: April 2023

Background: Drug-related mortality is a complex phenomenon that has several health, social and economic effects. In this paper trends of drug-induced mortality in Italy are analysed. Two approaches have been followed: the traditional analysis of the underlying cause of death (UC) (data refers to the Istat mortality database from 1980 to 2011), and the multiple cause (MC)analysis, that is the analysis of all conditions reported on the death certificate (data for 2003-2011 period).

Methods: Data presented in this paper are based on the Italian mortality register. The selection of Icd codes used for the analysis follows the definition of the European Monitoring Centre for Drugs and Drug Addiction. Using different indicators (crude and standardized rates, ratio multiple to underlying), the results obtained from the two approaches (UC and MC) have been compared. Moreover, as a measure of association between drug-related causes and specific conditions on the death certificate, an estimation of the age-standardized relative risk (RR) has been used.

Results: In the years 2009-2011, the total number of certificates whit mention of drug use was 1,293, 60% higher than the number UC based. The groups of conditions more strongly associated with drug-related causes are the mental and behavioral disorders (especially alcohol consumption), viral hepatitis, cirrhosis and fibrosis of liver, AIDS and endocarditis.

Conclusions : The analysis based on multiple cause approach shows, for the first time, a more detailed picture of the drug related death; it allows to better describe the mortality profiles and to re-evaluate  the contribution of a specific cause to death.
The frequency of polidrug use in a driving population in Rome
Authors: Lagravinese Giovanni Michele , Mammone Alessia , Rossi Carla , De Vita Miriam , Marino Valeria , Feola Alessandro , Marsella Luigi Tonino
Published: April 2023

In Italy the illicit substances routinely tested are cannabinoids, cocaine, opiates, amphetamines / methamphetamine, MDMA and similar but these substances are not the most use in our country. In particular, the consumption of ketamine represents an emerging problem. Ketamine is a anesthetic with hallucinogenic and dissociative effects and these are the ones sought for the voluptuary pur-pose, while the amnesic effect are exploited for drug facilitated sexual assault. Our study was car-ried out to assess the positivity for the illicit substances routinely tested and also for ketamine in a population of 182 patients arrived at the emergency room of the Hospital “San Camillo Forlanini” of Rome, for which have been required toxicological tests on the basis of Articles 186 and 187 of the New Highway Code.

The choice of this kind of population allows to have an accurate and reliable epidemiological data about the real diffusion of voluptuary use of drugs. The study examines 182 samples subjected to routine toxicological investigations in the period be-tween October 2011 and August 2012. The Authors have researched the presence of ethanol, cannabinoids, cocaine, opiates, amphetamines and benzodiazepines with the use of “ADVIA Chemistry Systems ”, while the ketamine is tested by a single-phase tests on urine [Sure Screen Diagnostic (Di. Ra.Lab)] with a cut-off level of this method is 1000ng/ml. During this period we have considered 182 patients (males 78%, females 22%). The mean age was 34 years (standard deviation 13, minimum 15, maximum 80). Most of the admission were during the last days of the week (Thursday 17%, Friday 15%, Saturday 15% and Sunday 17%). With re-spect to the clinical needs of subjects admitted, 42% were admitted with a red code. Considering a single substance analysis, 46 subjects resulted positive to alcohol (25%), 38 to can-nabinoids (21%), 24 to opioids (13%), 20 to cocaine (11%), 19 to benzodiapezine (10%) and 7 to ketamine (4%). Among those who resulted positive to at least one substance (95, 52% of the sample) 55 subjects re-sulted positive to one substance (58%), 27 to two substances (28%) and 13 to three or more substances (13%). Poly-use was evaluated with an indicator previously proposed by Fabi et al in 2013. This resulted in a polydrug-use score equal to 2.93 (standard deviation 1.7, minimum 1.5, maximum 9.25).
Sociodemographic determinants of knowledge on the figure of radiologist: results of a survey in large university hospital
Authors: Cicchetti Giuseppe , Leoncini Emanuele , Panic Nikola , Merlino Biagio , Boccia Stefania , Bonomo Lorenzo
Published: April 2023

Introduction

Despite overlaying an irreplaceable role as a key diagnostic tool in modern medicine, the role of radiologist still appears to be unclear to patients.

Methods We conducted a survey in outpatient clinic of Radiological Sciences Department of the University Hospital “A. Gemelli” in Rome, aiming to assess how correct patients identify the figure of the radiologist. The patients were interviewed by the trained physician using structured questionnaire.

Results We included the number of 259 patients. Majority were female 63.3%, most were 60-69 years old (24.3%), have finished second grade secondary school (35.1%) and were subjected to magnetic resonance (28.6%) while the least were subjected to chest X-ray (8.1%). Only 38.7% answered correctly to question No 1 “Who performed your examination?”, and only 30.9% correctly identified the radiologist as a person interpreting the exam (question No 2 “Who is going to interpret your radiological examination?”). Overall, 16.8% responded correctly to the both questions. Significantly less patients with primary school (OR: 0.18, CI 95% 0.06-0.49) and first grade secondary school (OR: 0.37, CI 95% 0.18-0.75) correctly addressed the question No 1 in compare to those with second grade secondary school. The first grade secondary education (OR: 0.43, CI 95% 0.20-0.92) was inversely associated with correct answer to question No 2.  Patients with primary education were significantly less prone to give both correct answers (OR: 0.12, CI 95% 0.02-0.60).

Conclusion We report insufficient knowledge among patients on radiologist’s role in healthcare system. The level of knowledge is associated with level of education.
Lorenzo Tomatis: A Great Doctor in the Broadest Sense
Authors: Bucci Roberto , Colamesta Vittoria , La Torre Giuseppe
Published: April 2023

Lorenzo Tomatis was a great doctor in the broadest sense: he gave a major contribution to cancer research, devoting himself to study cancer causes and prevention. His job was not only to serve Public Health but to denounce social and health inequalities without threats by political and economic constraints.
Longitudinal Causal Inference of Cognitive Function and Depressive Symptoms in Elderly People
Authors: Yao Ping , Meng Can
Published: April 2023

Objective: the association between depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]) and subsequent cognitive function (Mini-Mental State Examination [MMSE]) is equivocal in literature. To examine the causal relationship between them, we use longitudinal data on MMSE and CESD and causal inference to illustrate the relationship between two health outcomes.

Method:  Data were obtained from the Hispanic Established Populations for Epidemiologic Studies of the Elderly. Participants included 3050 noninstitutionalized Mexican Americans aged 65 and older followed from 1993-2001. Cognitive function and depressive symptoms were assessed using the MMSE and CESD at baseline and at 2, 5, and 7 years of follow-up. Independent variables were sociodemographics, CESD, medical conditions. Marginal structural causal models were employed to evaluate the extent to which cognitive function depend not only on depressive symptoms measured at a single point in time but also on an individual’s entire depressive symptoms history.

 Discussion: our results indicate that if intervention to reduce 1 points of depressive symptoms were made at two years prior to assessing cognitive function, they would result in average improvement in cognitive function of 0.12, 95% CI [0.06, 0.18],P<.0001. Conclusion: The results suggest that health intervention of depressive symptoms would be useful in prevention of cognitive impair.
Concomitant medication use and its implications on the hazard pattern in pharmacoepidemiological studies: example of antidepressants, benzodiazepines and fracture risk
Authors: De Bruin Marie Louise , Abbing-Karahagopian V. , Souverein PC , Korevaar JC , Leufkens HGM , Egberts TCG , Gardarsdottir H.
Published: April 2023

Background: Antidepressants and benzodiazepines are often co-prescribed and both associated with an increased fracture risk, albeit with distinctive hazard patterns. Timing of initiation of one with respect to the other and duration of use may influence the combined fracture hazard.

The objective of our study was to describe patterns of concomitant use of benzodiazepine and antidepressants in terms of timing of initiation and duration and to illustrate the potential impact of various scenarios of timing of co-use on hip fracture hazard.

Methods: Patients initiating antidepressant therapy (2002-2009) were identified from the Netherlands Primary Care Research Database. Concomitant benzodiazepine use was assessed according to the start time of benzodiazepine with respect to antidepressant therapy start. Duration of concomitant use was estimated relative to the length of antidepressant treatment episode. 

Results: Among 16,087 incident antidepressant users, 39.0% used benzodiazepines concomitantly during their first antidepressant treatment episode. The time of initiation of benzodiazepine use was variable (64.4% starting before, 13.7% simultaneous and 21.9% after antidepressants). Duration of concomitant use in the three groups varied. 

Conclusions: Co-prescribed medications with a common adverse event, may not only require accounting for concomitant use, but also the timing of start and duration of use as the overall hazard may vary accordingly.
The relevance of citizen involvement in Health Technology Assessment. A concrete application in the assessment of HPV co-testing in the Autonomous Province of Trento
Authors: Dalle Fratte Chiara Francesca , Passerini Adriano , Vivori Cinzia , Dalla Palma Paolo , Guarrera Giovanni Maria
Published: April 2023

Background

Specific programs have been developed in the latest decades to involve patients in Health Technology Assessments (HTAs). However, there are no structured practises in Italy and citizen’ perspective is rarely included in HTA reports. Aim of this study is to explore citizen’ opinions about cervical cancer screening with Human Papillomavirus (HPV) co-testing in the Autonomous Province of Trento (PAT).

Methods

Two focus groups were conducted: one with representatives of patients’ associations, the other one with women between 31 and 64 years and their family members. Following aspects were investigated: the importance of cervical cancer screening programs; the impact of HPV test on women’ and their partners’ life; needs, expectations, and critical aspects of the new screening method.

Results

Organised screening programs are very important for all participants. HPV co-testing screening is preferred to cytology for its higher sensitivity, but different opinions came out regarding the longer screening interval after normal HPV and Pap test results. Citizen stressed that correct, clear, and unambiguous information have to be provided to the whole population (men included). A cardinal role plays the patient-doctor relationship in informing and taking care, also emotionally, of women, their partners and relatives in case of positive HPV test.

Conclusion

In order to facilitate the introduction of the new screening method, various media must be used to spread clear and unambiguous information, as well as informative and educational meetings with doctors and caregivers. Citizen perspective was included in the report for the Health Trust and played an important role in the decision process.
Bayesian Age-Period-Cohort Model of Lung Cancer Mortality
Authors: Tharu Bhikhari P. , Kafle Ram C. , Tsokos Chris P.
Published: April 2023

Background

The objective of this study was to analyze the time trend for lung cancer mortality in the population of the USA by 5 years based on most recent available data namely to 2010. The knowledge of the mortality rates in the temporal trends is necessary to understand cancer burden.Methods

Bayesian Age-Period-Cohort model was fitted using Poisson regression with histogram smoothing prior to decompose mortality rates based on age at death, period at death, and birth-cohort.Results

Mortality rates from lung cancer increased more rapidly from age 52 years. It ended up to 325 deaths annually for 82 years on average. The mortality of younger cohorts was lower than older cohorts. The risk of lung cancer was lowered from period 1993 to recent periods.Conclusions

The fitted Bayesian Age-Period-Cohort model with histogram smoothing prior is capable of explaining mortality rate of lung cancer. The reduction in carcinogens in cigarettes and increase in smoking cessation from around 1960 might led to decreasing trend of lung cancer mortality after calendar period 1993.
Co-Plot Method: A Research on Tobacco Control in the European Region
Authors: Cangur Sengul , Ercan Ilker , Ozkaya Guven
Published: April 2023

BACKGROUND: The aim of this study is to introduce the uncommonly used Co-Plot method which is called the multivariate graphical analysis and to apply this method to a data set including tobacco control in European region.METHODS: This study uses the data from the World Health Organization database according to Human Development Index of European countries. It takes into account variables such as smoking prevalence in young people and adults, the proportion of smoking-related deaths and domestic legislations casespertaining to tobacco products and analyses the data using the Co-Plot method.RESULTS: Results of the study demonstrated that smoking prevalence and restrictions on advertising of tobacco products were highly negatively correlated. The proportion of deaths associated with smoking-related diseases increased parallel to the increase in the smoking prevalence in young people and adults. Norway, France and Finland have enforced legal limitations on direct and indirect advertising, and thus there has been a decline in smoking prevalence among young people andadults. In some countries, including Ireland, Italy and Serbia, the prevalence of smoking among the young has decreased due to the new or increased legal restrictions on the sale distribution of tobacco products. The governments in the Czech Republic, Kazakhstan, Estonia, Croatia, the Netherlands,Belgium, and Poland have placed restrictions on direct and indirect advertising. The distribution of other causes-related deaths and lung cancer-related deaths are high.CONCLUSION: The restrictions on tobacco products were tightened in time with the increased prevalence of smoking and proportion of smoking-related deaths. It can be said that the significantrelationships identified in this study have even more pertinence in developed countries. Consequently, Co-Plot method has enabled deeper data interpretations of the relationships between the countries and the variables in this study.
Prevalence of double burden of malnutrition among urban school going Bodo children aged 5-11 years of Assam, Northeast India
Authors: Mondal Nitish , Basumatary Bardoi , Kropi Junali , Bose Kaushik
Published: April 2023

Background: Overweight, obesity and thinness are major important determinants of adverse public health issues, which lead to the development of several preventable non-communicable disease and ill-health conditions.

Aims and objectives: The objectives of the present study were to assess the prevalence and certain socioeconomic and demographic factors affecting the double burden of malnutrition among urban children of Assam, Northeast India.

Materials and Methods: The present cross-sectional study was undertaken among 1017 (528 boys; 489 girls) the tribal Bodo children aged 5-11 years of Udalguri district of Assam, Northeast India by using the stratified random sampling method. Height and weight were obtained using standard anthropometric procedures and Body Mass Index (BMI=weight/height2, kg/m2) was calculated. The prevalence of thinness, overweight and obesity was assessed by using recently proposed age-sex specific BMI based international classification/reference of Cole et al.

Results: The overall prevalence of overweight (boys 13.45%; girls 11.04%) was found slightly greater than obesity (boys 11.93%; girls 10.02%). The result showed that 10.23% and 11.04% were suffering from thinness among boys and girls, respectively. Binary logistic regression analysis showed that the odds were found to be significantly associated with ≤ 10th standard mothers' education, 1st earning head and Rupees <10000 income households (p<0.05) for thinness. Similarly, greater risks were observed in 5-6 years, 7-9 years, ≥7 household members and a lower association with ≤ 10th standard mothers’ education for being overweight-obesity (p<0.05).

Conclusion: The emergence of overweight-obesity with higher degree of thinness, hence the prevalence of ‘double burden of malnutrition’ in this population. Appropriate nutritional intervention programmes, dissemination of nutrition related awareness among parents and community level are necessary to reduce the future possibility of double malnutrition burden among other ethnic populations of India.
Catastrophic Health Expenditure and Household Impoverishment: a case of NCDs prevalence in Kenya
Authors: Mwai Daniel , Muriithi Moses
Published: April 2023

ntroduction and problem: Non-Communicable Diseases (NCDs) have become one of the leading causes of morbidity and mortality in Kenya. Their claim on financial and time resources adversely affects household welfare. Health care cost for NCDs in Kenya is predominantly paid by households as OOP. Health expenditure on NCD stands at 6.2% of Total Health Expenditure which is 0.4 % of the total gross domestic product of the country. This expenditure scenario could have implications on household welfare through catastrophic expenditure in Kenya. Most studies done on catastrophic expenditure in Kenya have not looked at the effect of NCD on poverty. Methodology: The paper has investigated the determinants of catastrophic health spending in a household with special focus on the NCDs. It has also investigated the effect of catastrophic expenditure on household welfare.A National household level survey data on expenditure and utilization is used. Controlling for endogeneity, the results revealed that NCDs and communicable diseases contribute significantly to the likelihood of a household incurring catastrophic expenditure. Results: Although all types of sicknesses have negative effects on household welfare, NCDs have more severe impacts on impoverishment. Policy wise, government and development partners should put in place a health financing plan entailing health insurance and resource pooling as a mean towards social protection.

Key words:  ,
Psychological symptoms and quality of life in a population living in the "New Towns" of L'Aquila after he 2009 earthquake
Authors: Grappasonni Iolanda , Petrelli Fabio , Traini Enea , Grifantini Giuliana , Mari Massimo , Signorelli Carlo
Published: April 2023

Background: Following the earthquake in L'Aquila of 04.06.2009 more than 65,000 people lost their homes. In order to provide rapid accommodation to those people, the Italian Government implemented the CASE project (Complex Anti-seismic Sustainable Environment-friendly), with the construction of 19 "New town" in the surrounding areas of the city. The New towns are built in rural areas, far from the center of the city, without  many basic services. The purpose of this study was to evaluate the prevalence of mental disorders, the levels of psychological symptoms and quality of life in a sample of the population living in such reality.

Methods: Brief Symptom Inventory (BSI), the Impact of Events Scale-Revised (IES-R), and the Manchester Short Assessment of Quality of Life (MANSA), were used.

Results: 107 people were interviewed. The mean scores of the GSI of the BSI were 0.70 (SD=0.55). The total score of the IES-R scale was used and the cut-off represented by the 33 value, was exceeded by 59.81% of the sample. The average value was 37.85 (SD=19.49) (range 0-83). 14 people of them (21.88%) obtained an average value ≥ 60. The mean score on the MANSA was 4.5 (SD=0.98), range 1.8-6.3.

Conclusion: From the results, it appears that this housing solution could be an additional element of trauma that overlaps with that suffered during the quake.
The Comparison of Hookah Smoking Prevalence in Medical Students between 2009 and 2014
Authors: Nakhostin-Roohi Babak
Published: April 2023

Background: Hookah smoking is increasing worldwide. It is estimated the worldwide prevalence of daily hookah smoking is 100 million. The aim of this study was to compare hookah smoking prevalence in Islamic Azad University medical students in the city of Ardabil between 2009 and 2014.

Method: Of 2956 Islamic Azad University medical students, Ardabil branch, almost 25% of students {737 students (226 males vs. 511 females; 436 subjects at 2009 vs. 301 subjects at 2014)} were randomly selected to participate in this survey. An anonymous self-administered questionnaire was used after verbal informed consent according to the Review Committee of Ardabil Branch Islamic Azad University Medicine School approved protocol. A cluster sampling technique was used. The questions focused on gender, hookah smoking status, and students’ replies for the following issues: (1) Kind of hookah (2) Frequency of smoking (3) Motivation of hookah use (4) Place of smoking use (5) and Second-hand exposure to hookah.

Results: Hookah use showed significant decrease in male students compared with five years ago (P<0.05). Frequency of molasses (tobacco with sweetened fruit flavors and mild aromatic smoke) use has significantly enhanced among both genders in 2014 compared with 2009 (P<0.05). Furthermore, second-hand exposure to hookah was significantly higher among both nonsmoker genders at 2014 compared with 2009 (32.7% at 2014 vs. 13.2% at 2009). Conclusion: Unfortunately, in spite of knowledge promotion among medicine school students in recent years, hookah use is still prevalent among medical students. Molasses use has significantly increased and second hand exposure to tobacco has escalated since 2009.
Analysis of the role of General Practice in preventing Avoidable Hospitalisation through a multilevel approach
Authors: Rosano Aldo , Ricciardi Walter , Van der Zee Jouke
Published: April 2023

Objective. To examine the relationship between Avoidable Hospitalisation (AH) and the activities of General Practitioners (GPs). The study was carried out in the Lazio Region (Italy) within different organizational models of primary care (PC) delivery.
Methods: Secondary data of a set of GP activities delivered to the Lazio population as listed in the Lazio GPs in 2008, were used. For each GP a set of health services delivered to the patients on their practice lists were measured. The relation between the rates of AH, acute and chronic conditions separately, and the rates of such health services were analyzed through the use of a multilevel Poisson regression model, adjusted according to patients’ health status.
Results: The study included data from all the active GPs (4,837) in the Lazio Region and their 4,666,037 registered patients. The overall AH rate of the registered patients was 7.7 per 1,000, 2.2 for acute and 5.5 for chronic conditions. The diagnostics prescription by GPs is associated with a 7% (IRR=0.93;95% C.I.:0.89-0.97) reduction of the chronic AH rate. Patients registered at GPs working within a team practice resulted in a hospitalisation rate decrease of 5% (IRR= 0.95; 95% C.I.:0.91-0.99)  for avoidable acute conditions.
Conclusion: The study showed that the role of GPs in preventing AH is substantial, particularly when team practice is performed and specifically when additional diagnostics are prescribed. The study is further evidence in favor of the validity of AH as an outcome measure of quality and accessibility of primary care.
Salad Consumption in Relation to Daily Dietary Intake and Diet Quality among U.S. Adults, 2003-2012
Authors: An Ruopeng , Khan Naiman
Published: April 2023

Backgrounds: This study examined salad consumption in relation to daily dietary intake and diet quality among U.S. adults.

Methods: Nationally representative sample came from the National Health and Nutrition Examination Survey 2003-2012 waves. Salad consumption was identified through both Food and Nutrient Database for Dietary Studies codes for salad items and combination code for components of and/or additions to salads. First-difference estimator addressed confounding bias from time-invariant unobservables (e.g., eating habits, taste preferences) by using within-individual variations in salad consumption between 2 nonconsecutive 24-hour dietary recalls.

Results: Approximately 28.7% of U.S. adults consumed salad on any given day. Among salad consumers, salad consumption occupied 12.5% of daily total energy, 62.8% vegetable, 11.9% fruit, 18.4% fiber, 9.1% sugar, 20.3% total fat, 14.7% saturated fat, 14.9% cholesterol, and 17.7% sodium intake. Compared to no salad consumption on a dietary recall day, salad consumption was associated with increased daily intake of total energy by 461.5 kJ (110.3 kcal), vegetable 85.0 g, fiber 1.0 g, sugar 5.7 g, total fat 10.0 g, saturated fat 1.3 g, cholesterol 18.7 mg, and sodium 216.3 mg. Salad consumption was associated with an increase in the Healthy Eating Index-2010 score by 4.2.

Conclusion: Salad consumption is related to better overall diet quality but also higher total energy, sugar, fat, cholesterol, and sodium intake. Interventions that promote salad consumption should provide low-energy-dense, nutrient-rich salad products. Salad consumers should prudently evaluate the caloric and nutrient content of salad in order to make informed and more healthful diet choices.
Suicide Mortality Risk in Kermanshah Province, Iran: A County-level Spatial Analysis
Authors: Rostami Mehran , Jalilian Abdollah , Ghasemi Shadi , Kamali Artin
Published: April 2023

Background: Kermanshah province has one of the highest suicide rates in Iran. The aim of this study is to explore spatial variations in the relative risk of suicide across the counties of Kermanshah province.

Methods: This is an applied ecological study in which county-level counts of suicide deaths recorded by the forensic medicine organization of Kermanshah province during the period March 21, 2006 to March 20, 2013 have been used. Following a Bayesian approach, Besag, York and Mollie's (BYM) model was fitted to the number of suicide deaths of males, females and all persons to make inference about the relative risk of suicide across the counties of the province.

Results: Over the study period and based on 95% credible intervals, Kangavar, Harsin and Sonqor counties had significantly lower relative risks of suicide for both males and females, Slas-Babajani, Paveh, Javanrud and Ravansar counties had significantly lower relative risks of suicide only for males and Kermanshah county had a significantly higher relative risk of suicide only for males. The relative risk of suicide for the other counties were not significantly different from the province’s overall risk neither for males nor females.

Conclusion: The counties of Kermanshah province can be classified into four categories by the level of relative risk of suicide: low relative risk for both males and females, low relative risk only for males, high relative risk only for males and average relative risk. Findings from this study could be used to specify priority counties for suicide prevention initiatives.
Trend in BMI z-score among Private Schools’ Students in Delhi using Multiple Imputation for Growth Curve Model
Authors: Grover Gurprit , Gupta Vinay K , Arora Monika
Published: April 2023

Objective: The aim of the study is to assess the trend in mean BMI z-score among private schools’ students from their anthropometric records when there were missing values in the outcome. Methodology: The anthropometric measurements of student from class 1 to 12 were taken from the records of two private schools in Delhi, India from 2005 to 2010. These records comprise of an unbalanced longitudinal data that is not all the students had measurements recorded at each year. The trend in mean BMI z-score was estimated through growth curve model. Prior to that, missing values of BMI z-score were imputed through multiple imputation using the same model. A complete case analysis was also performed after excluding missing values to compare the results with those obtained from analysis of multiply imputed data. Results: The mean BMI z-score among school student significantly decreased over time in imputed data (β= -0.2030, se=0.0889, p=0.0232) after adjusting age, gender, class and school. Complete case analysis also shows a decrease in mean BMI z-score though it was not statistically significant (β= -0.2861, se=0.0987, p=0.065). Conclusions: The estimates obtained from multiple imputation analysis were better than those of complete data after excluding missing values in terms of lower standard errors. We showed that anthropometric measurements from schools records can be used to monitor the weight status of children and adolescents and multiple imputation using growth curve model can be useful while analyzing such data
The accuracy of currently used WHO´s Body Mass Index cut-off points to measure Overweight and Obesity in Syrian women: A correlation study
Authors: Bakir Mohammed A , Al-Bachir Mahfouz M , Hammad Kholoud B , Habil Khuzama M , Ahmad Husam H
Published: April 2023

Purpose: Obesity is a common health problem in both developed and developing countries. BMI is commonly used to identify obesity. However, there is increasing evidence that the relationship between BMI and BF% differs among various ethnicities. The main objectives of this study are (1) to evaluate the correlation between BF% as determined by BIA, DEXA, Deuterium oxide (D2O) and BMI, (2) to assess the accuracy of currently used WHOÅLs BMI cut-off points to identify overweight and obesity among Syrian women.

Material and Methods: A total of 908 healthy Syrian women aged 18-60 years participated in this study. Weight, height, BMI, BF% assessed by BIA and DEXA, and D2O have been determined.

Results: BF% results obtained by BIA and DEXA, and D2O revealed strong correlations. BMI showed a statistically significant correlation with BF% determined by BIA, DEXA and D2O. Obesity when defined as BMI ≥ 30 and as BF% > 35% (derived from BIA, DEXA and D2O) classified 43%, 52.5%, 75.9% and 72.7% of women as obese, respectively. ROC analysis defined BMI cut-off points for overweight and obesity of 22.5 and 25.7, respectively. Using the new BMI cut-off point, the prevalence of obesity among Syrian women was increased by 24%.

Conclusions: The current BMI cut-off points recommended by WHO underestimate the prevalence of overweight and obesity among Syrian women. Our data suggests that it is important to lower the proposed WHOÅLs BMI cut-off points for the Syrian women.
Medical Students Knowledge and Attitude Towards Direct-To-Consumer Genetic Tests
Authors: Giraldi Luca , Colotto Marco , Pastorino Roberta , Arzani Dario , Vayena Effy , Ineichen Christian , Boccia Stefania
Published: April 2023

Aims: This study reports on the attitudes of 179 Italian Medical Students to direct-to-consumer genetic test and to participation in research practices.

Methods: Data were collected using a self-completion online questionnaire sent to 380 medical students at the faculty of Medicine of the Università Cattolica del Sacro Cuore in Rome, Italy. Questions pertained issues related to awareness and attitudes towards genetic testing, reactions to hypothetical results, and views about contributing to scientific research.

Results: The response rate was 47.1%. Less than 50% of students were aware of DTC genetic test. Seventy-four percent of the sample were interested in undergoing DTC genetic test, and the main reason was being aware on genetic predisposition to diseases. Among those who were not willing to undergo a genetic test, the main reason was the lack of confidence in the results. In the hypothetical situations of an increased disease risk after undergoing DTC genetic testing, respondents would take actions to reduce that risk, while in the opposite scenario they would feel unaffected because of the probabilistic nature of the test.

Conclusions: We reported a good level of awareness about DTC genetic test and a high interest in undergoing DTC genetic test in our sample. Nevertheless, opinions and reactions are strongly dependent by the hypothetical good or bad result that the test could provide and by the context whereby a genetic test could be performed. Respondents seem to be exposed to the risk of psychological harms, and a strong regulation regarding their use is required.
Cancer Patients Missing Pain Score Information:- Application with Imputation Techniques
Authors: Vishwakarma Gajendra , Bhattacharjee Atanu , Jose Jesna , Kumar V Ramesh
Published: April 2023

Background: Methods for handling missing data in clinical research have been getting more attentions over last few years. Contemplation of missing data in any study is vital as they may lead to considerable biases and can have an impact on the power of the study.

Objective: This manuscript is dedicated to present different techniques to handle missing observations obtained from repeatedly measured pain score data on palliative cancer.

Methods: This problem caused by subjects drop out before completion of the study. The reason for dropout or withdrawal may be related to study (e.g., adverse event, death, unpleasant study procedures, lack of improvement) or unrelated to the study (e.g., moving away, unrelated disease). The dropout might be very common on studies on palliative cancer patients. The Palliative treatment is designed to relieve symptoms, and improve the quality of life and can be used at any stage of an illness if there are troubling symptoms, such as pain or sickness.

Results: The mean(SD) of observed pain score was 3.638(3.156) whereas the imputed mean values were 3.615(2.980), 3.618(2.954), 3.577(2.892), 3.560(2.999) and 3.627(2.949) respectively for the imputation methods regression, predictive mean matching, propensity score, EM algorithm and MCMC methods for pain score values at visit3. 

Interpretation and Conclusion: The EM algorithm shows the least percentage change from observed values in both visits followed by predictive mean matching method and MCMC methods. The multiple imputation techniques have few advantages; the imputed values are drawsfrom a distribution, so they inherently contain some variation by introducing an additional form of error in the parameter estimates across the imputation
Carcinogenic Tattoos?
Authors: Sabbioni Gabriele , Hauri Urs
Published: April 2023

Millions of people have tattoos. The systemic effects of tattoo colorants (TCs) are mostly unknown. Several tattoos are on the market, which contain carcinogenic compounds such as poly aromatic hydrocarbons compounds or carcinogenic aromatic amines. Using the concept of the EPA for the risk assessment for compounds present in the environment, we estimated an additional lifetime cancer risk of 4.5 per 10000 people with a tattoo of pigment yellow 14. Such a lifetime cancer risk is comparable to the cancer risk estimated for meat consumption.
Low height-for-age among Limbu and Mech children and adolescents from two districts of West Bengal, India
Authors: Banik Sudip Datta , Bhattacharjee Paramita , Mukhopadhyay Barun
Published: April 2023

Background: Low height-for-age (stunting) is a state of chronic undernutrition in children and adolescents. Studies reported that India has very high prevalence of stunting in children, particularly from rural and tribal communities. Objective of the present study was to record prevalence of stunting in 6 to 18 year-old boys and girls from two tribal communities (Limbu and Mech) in Darjeeling and Alipurduar districts of West Bengal, India. The study also aimed to compare height-for-age of the participants with standard growth reference curves.

Methods: In this cross-sectional study, the sample comprises 1523 individuals of both sexes from Limbu (377 boys, 379 girls) and Mech (365 boys, 402 girls) communities. Height data was normalized using LMS.

Results: Overall frequency of stunting among 6 to 18 year-old boys (33%) and girls (34.7%) was remarkably high. Prevalence of stunting was higher in Limbu boys (43.5%) and girls (44.6%) than their age-peers from Mech community (boys 22.2%, girls 25.4%). Height data after normalization, shows that all centile curves of height of Limbu and Mech boys and girls are consistently below the standard height-for-age reference curves of the WHO. Limbu and Mech children appear to be taller with respect to their median (50th percentile) height when compared with the median height of children in the dataset of Indian Council of Medical Research.

Conclusion: High frequency stunting in Mech and limbu children was recorded and situation of girls was worse. There was a tendency of decline in prevalence of stunting with advancement of age among children.
Risk factors for intussusception in childhood gastroenteritis: a nationwide cross-sectional study in Italy
Authors: Mattei Antonella , Fiasca Fabiana
Published: April 2023

Background. The aetiology of intussusception is unknown for most of the cases studied, although some associated conditions have been identified. We aimed to clarify the role played by enteric pathogens as potential risk factors for intussusception.

 

Methods. A retrospective review of the records relating to hospitalizations for gastroenteritis with or without concurrent intussusception in Italian children was conducted among children aged <6 years old during the period 2005-2012. Through a multivariate logistic regression model, the associations, expressed as odds ratios with 95% confidence intervals, were estimated between the presence of gastroenteritis with intussusception and the explanatory variables, such as sex, age, the aetiology of gastroenteritis and whether the subjects lived in the North, South and Islands or Centre Italy.

Results. A total of 174 records related to admissions due to the concomitant manifestation of gastroenteritis and intussusception were extracted and analyzed. The estimate of the adjusted odds ratio confirmed the significant contribution that sex and geographical location made to hospitalizations both for gastroenteritis with concurrent intussusception, and in the associated secondary diagnosis of gastroenteritis, with the exception of the rotavirus, where a different seasonality and a bucking trend were observed. The probability of intussusception became statistically significant lower from 12 months of age to ≤23 months and for age 48-59 months, respect to the first year of life.

Conclusions. Our observational study highlighted males, affected by enteric infections, other than rotavirus and parasitic, living in North and Centre of Italy have an increased risk of developing intussusceptions. In the second and fifth year of life the probability of intussusceptions becomes lower than in the first year. Additional research is needed to confirm these findings and evaluate the pathogenesis which may link such infections with intussusception.
Status inconsistency and return to work among foreign-born and native Swedes
Authors: Ranjbar Vania , Fornazar Robin , Hensing Gunnel
Published: April 2023

We investigated potential differences in status inconsistency and time to return to work (RTW) from sickness absence between foreign-born and native Swedes, whether inconsistency was associated with RTW, and if this association was stronger for foreign-borns than natives. Significantly fewer native than foreign-born Swedes reported negative status inconsistency, but RTW did not differ between the groups and inconsistency was not associated with RTW. A positive selection of individuals to the Swedish labour market might help explain the findings. This first study of status inconcistency and RTW requires follow-ups in different settings of labour markets and insurance regulations.
Toward a better understanding of the relationship between influenza vaccine efficacy against specific and non-specific endpoints and vaccine efficacy against influenza infection
Authors: Nauta Jozef , Beyer Walter EP , Kimp Erna PJA
Published: April 2023

In influenza vaccination studies assessing vaccine efficacy (VE), both specific and non-specific endpoints (outcomes) are used. We present a formula for the relationship between VE against influenza-related outcomes (VEO), specific and non-specific, and that against influenza infection (VEI). In its simplest form, the formula comprises two additional parameters: the influenza attack rate among unvaccinated subjects, and the relative risk of the outcome for influenza infected subjects versus non-infected subjects. Both parameters may show large between-seasonal variation, which translates to a large between-seasonal variation of  VEO estimates. With the full form of the formula it can be shown that, contrary to popular believe, VEO may be greater than VEI. We argue that interpreting VEO estimates in terms of “low” or “high” is not possible without taking the costs of an outcome case into account. We conclude that the decision to use a non-specific endpoint as surrogate for influenza infection should be taken in the awareness of these limitations.
Air pollution: a study of citizen's attitudes and behaviors using different information sources
Authors: Carducci Annalaura , Donzelli Gabriele , Cioni Lorenzo , Palomba Giacomo , Verani Marco , Mascagni Giulia , Anastasi Giuseppe , Pardini Luca , Ceretti Elisabetta , Grassi Tiziana , Carraro Elisabetta , Bonetta Silvia , Villarini Milena , Gelatti Umberto
Published: April 2023

Background: From November 2015 to January 2016, the routine air monitoring showed a peak of air pollution (in particular of PM10) that caused alarm in many Italian cities and was widely reported by mass media. After some weeks from this alarm, we tried to evaluate the citizen awareness and interest towards air pollution together with their positive behaviors, using different information sources.

Methods: From September 2015 to March 2016, in parallel with the number of exceedances of the PM10 in Italy we evaluated the press coverage, the average monthly searches on Google and the interest on Twitter. Moreover, a qualitative content analysis on daily newspapers was conducted and a self-compiled questionnaire on the attitudes and behaviors about environmental issues and their determinants was administered to 598 parents involved in the project MAPEC_LIFE (LIFE12 ENV/IT/00614).

Results: The media coverage of the theme of air pollution was very high from the end of 2015 to the beginning of 2016, as well as internet searches and twitter messages. Our qualitative analysis highlighted that only a small portion of articles included information about positive behaviors and environmental awareness. Despite the high media coverage and the satisfactory self-perceived knowledge, the majority of respondents judged negatively the received information (as untrue and incomplete) and declared a limited adoption of pro-environmental behaviors. 

Conclusion: The parallel study of mass media information and people’s attitudes and behaviors seem to indicate that the high media coverage was not followed by a very high motivation towards pro-environmental behaviors.
Decreasing loneliness and social isolation among the older people: systematic search and narrative review
Authors: Stojanovic Jovana , Collamati Agnese , Mariusz Duplaga , Onder Graziano , La Milia Daniele Ignazio , Ricciardi Walter , Moscato Umberto , Magnavita Nicola , Poscia Andrea
Published: April 2023

Introduction

The aim of this study is to sum up the current knowledge on the effectiveness of the existing interventions for alleviating loneliness and social isolation among elderly persons.

Methods

We used a systematic approach and performed a literature search of MEDLINE, ISI Web of science, SCOPUS, The Cochrane Library, and CINAHL databases. After identifying 13 eligible reviews addressing interventions of our interest, we proceeded with a narrative description of the study findings.

Results

The initiatives largely encompassed one-to-one interventions, group activities or community engagement approaches. In particular, technology interventions were recently given much attention. Overall, the studies showed non-satisfying methodological quality and their results were often inconclusive.

Conclusions

Although there is a growing body of evidence referring to implementation of interventions targeting social isolation and loneliness among the elderly, future well-designed interventions are necessary in order to draw firm conclusions.