bluuebunny/crossref_metadata_2025 huggingface dataset:
Cocaine and stimulants, the challenge of self-regulation in a harm reduction perspective
Authors: Zuffa Grazia , Ronconi Susanna
Published: April 2023

A significant body of research on cocaine users recruited outside the “captive” populations (i.e. studies from samples of users who have not been enrolled through drug addiction services) has been carried out in many European countries and outside Europe. These studies show a variety of patterns and trajectories of use other than “addictive” use. The reason of most “controlled” use lies in a wide set of self-regulation “rules” users “naturally” apply to keep drug use at bay and prevent the disruption of everyday life. Not only is this perspective at odds with the “pathological” perspective of professionals, focused as this is on “addiction” originated from the chemical properties of drugs and individual psychological deficit; it also challenges the social representation of drugs as intrinsically “out of control” substances and of drug users’ helplessness under the influence of drugs.The paper describes the workstream Innovative cocaine and poly-drug abuse prevention programme, developed in 2013 by the Italian NGO Forum Droghe within the European project New Approaches in Drug Policy &Interventions (NADPI), aimed at linking findings from research on “controls” to operational models in drug addiction services. Through a critical overview of the disease model and taking cues from users’ self regulation strategies, a new “self regulation” operational model has been developed, focused on users’ control abilities; and on social context and setting of use, following the drug/set/setting paradigm. The self regulation model may be seen as a development of the Harm Reduction approach to drug policies, aimed at decreasing the negative consequences of drug use without necessarily reducing the consumption of drugs.
Health Related Quality of Life norm data of the Italian general population: results using the EQ-5D-3L and EQ-5D-5L instruments
Authors: Scalone Luciana , Cortesi Paolo Angelo , Ciampichini Roberta , Cesana Giancarlo , Mantovani Lorenzo Giovanni
Published: April 2023

Background: Many studies have been conducted in Italy to assess Health-Related Quality-of-Life (HRQoL) in subjects with different diseases. However, no recent HRQoL population norm data were available to make comparisons with diseased populations. We assessed HRQoL norm data using the generic instrument EQ-5D in its standard version (EQ-5D-3L) and with the recently introduced version (EQ-5D-5L).

Methods: A survey was conducted on 6,800 individuals representative of the Lombardy general adult population for age, gender and geographical distribution. Each participant underwent a telephone interview with questions using the EQ-5D-3L and the EQ-5D-5L descriptive systems, the visual analogue scale (EQ-VAS) and socio-demographic data.

Results: participants were 48% male, aged on average 51.9 years. With the 3L version, men and women aged 18-35 years reporting a full health state were 71.3% and 56.5%, respectively, those aged >76 years decreased to 29.5% and 13.5%, respectively. The proportion of respondents reporting no problems decreased with the 5L version. The mean (standard deviation) of the EQ-VAS was 87.7(12.1) and 85.0(15.2) among men and women aged 18-35 years, and 68.0(20.6) and 64.4(23.2) in men and women aged >76 years. The mean (standard deviation) utility obtained from the 3L version ranged from 0.965(0.068) and 0.944(0.086) among men and women aged 18-35 years, to 0.880(0.123) and 0.829(0.137) in men and women aged >76 years. Similar results were obtained with the 5L version.

Conclusion: HRQoL norm data are now available from the Italian general adult population, to be used as a reference in clinical sector, economic evaluations and in policy setting.
Comments on: Further studies of Bolivian crocidolite-Part IV: Fibre width, fibre drift and their relation to mesothelioma induction: Preliminary findings, by Ilgren EB, van Orden DR, Lee RJ, Kamiya YM, Hoskins JA
Authors: Magnani Corrado , Barone-Adesi Francesco , Biggeri Annibale , Comba Pietro , Dalmasso Paola , Marsili Daniela , Maule Milena , Merletti Franco , Mirabelli Dario , Pasetto Roberto , Terracini Benedetto
Published: April 2023

Comments on: Further studies of Bolivian crocidolite-Part IV: Fibre width, fibre drift and their relation to mesothelioma induction: Preliminary findings, by Ilgren EB, van Orden DR, Lee RJ, Kamiya YM, Hoskins JA.
Does the use of dietary supplements enhance athletes’ sport performances? A systematic review and a meta-analysis
Authors: De Meo Concetta , De Waure Chiara , De Meo Concetta , Terracciano Elisa , Di Nardo Francesco , Ricciardi Walter
Published: April 2023

Background: The consumption of dietary supplements has increased in recent years.

Despite their widespread use, there is confusion about effects on sport performances.

The aim of this study was to investigate association between use of supplements and enhance of athletes’ sports performance.

Methods: A review and a meta-analysis of studies conducted on Dietary Supplements and Sports between 2003 and 2013 were performed. Enhancement on sport performances was considered as outcome. The following aspects related to enhancement were considered: ergogenic effect (EE), time to exhaustion (TTE), muscular endurance (ME), post-exercise recovery (PER) and body mass (BM). With respect to meta-analysis, data on level of post Exercise Glucose (GpE [mg/dL]) and level of post exercise Lactate (LpE [mmol/L]) were considered as  indicators of TTE, PER and EE. Similarly, Change in Body Mass (CBM) [kg] was used as indicator of BM.

Results: The most investigated dietary supplements were: Creatine, Carbohydrates, Beta-alanine, Proteins. The qualitative analysis evaluating the effect of supplements on sports listed by the International Olympic Committee has achieved interesting results: supplements didn’t show statistically significant effects when compared to placebo in more than 48% of papers.

For the quantitative analysis, 15 studies were considered. The meta-analysis showed that there was no significant effect of Beta-alanine, Creatine and Carbohydrates on LpE and GpE. Furthermore, a non-significant increase in BM was observed in athletes undergoing Creatine compared to placebo.

Conclusion: Considering the increasing attention to this topic, it would be interesting to investigate the existing awareness about effectiveness and possible risks of supplements.
Assessment of the knowledge and attitudes of preliminary school students toward smoking in Baghdad
Authors: Abbas Jabbar Sahib , Husham J Abd Al-Badri
Published: April 2023

Background: Early smoking considered as a major challenge for health promoters, as well it is socially not acceptable, thus interventions must tackle childhood starts of smoking.

Aim: Assessing the knowledge and attitude of preliminary students towards tobacco use. 

Methods: A cross-sectional study conducted among 2195, 5th grade students from 30 preliminary schools in Baghdad (15 from each side Karkh & Rusafa) during November 2014. They were selected by multistage sampling technique.

Results:  Participated students age ranged between (10-13) years and (51.9%) of them were girls, (54.3%) of their parents were nonsmoker while the rest reported that both or one of them are smokers, direct and indirect risks of cigarette  smoking were known by (82.4%) and (66.2%) respectively, and (70.8%) of students’ families were found to wear their kids from smoking hazards, while more than (50%) of them have received health education massages from their teachers. Sitting near smoker person was not in favor of (86.2%) of the participants, as (51.4%) considered it religiously inconvenient and (34.6%) considered smoking as a sign of no self-confidence. At last, (73.7%) of the surveyed students agreed with smoking prohibition in public places while (25.8%) opposed that.

Conclusion: In spite of the high percentage of students’ parents were smokers; nevertheless, risks of smoking are well known by the surveyed students and they showed positive attitudes toward smoking prohibition in public places. Parental advising for quit smoking and urging teachers to educate their students about smoking hazards are thought to be the right action.
Parametric and nonparametric two-sample tests for feature screening in class comparison: a simulation study
Authors: Landoni Elena , Ambrogi Federico , Mariani Luigi , Miceli Rosalba
Published: April 2023

Background. The identification of a location-, scale- and shape-sensitive test to detect differentially expressed features between two comparison groups represents a key point in high dimensional studies. The most commonly used tests refer to differences in location, but general distributional discrepancies might be important to reveal differential biological processes.                                                        

Methods. A simulation study was conducted to compare the performance of a set of two-sample tests, i.e. Student's t, Welch's t, Wilcoxon-Mann-Whitney, Podgor-Gastwirth PG2, Cucconi, Kolmogorov-Smirnov (KS), Cramer-von Mises (CvM), Anderson-Darling (AD) and Zhang tests (ZK, ZC and ZA) which were investigated under different distributional patterns. We applied the same tests to a real data example.                  

Results. AD, CvM, ZA and ZC tests proved to be the most sensitive tests in mixture distribution patterns, while still maintaining a high power in normal distribution patterns. At best, the AD test showed a loss in power of ~ 2% in the comparison of two normal distributions, but a gain of ~ 32% with mixture distributions respect to the parametric tests. Accordingly, the AD test detected the greatest number of differentially expressed features in the real data application.  

Conclusion. The tests for the general two-sample problem introduce a more general concept of 'differential expression', thus overcoming the limitations of the other tests restricted to specific moments of the feature distributions. In particular, the AD test should be considered as a powerful alternative to the parametric tests for feature screening in order to keep as many discriminative features as possible for the class prediction analysis.
Internet Addiction: a prevention action-research intervention
Authors: Andrisano Ruggieri Ruggero , Santoro Emanuela , De Caro Francesco , Palmieri Loredana , Capunzo Mario , Venuleo Claudia , Boccia Giovanni
Published: April 2023

The aim of this paper was to present an action-research intervention for the prevention of Internet addiction (IA) in schools. Applying a pre-experimental research design model, a total of 90 young subjects (45 males and 45 females) were treated using a peer education programme. The Internet Addiction Test was used as a screening tool pre- and post-treatment and analysed using a paired t-test. The results showed a significant positive difference in the post-treatment values for both males and females. This research highlights the link between IA and cultural and social aspects of the disease in addition to discussing the difficulties of IA prevention.
Food related risks during pregnancy: how much do women know about it?
Authors: Ricchi Eleonora , Serafini Andrea , Troiano Gianmarco , Nante Nicola , Petraglia Felice , Messina Gabriele
Published: April 2023

Aim Infection with Toxoplasma gondii and Listeria monocytogenes during pregnancy can lead to severe illness in the foetus but it can be prevented by simple hygienic measures. This study evaluated the knowledge that women have about food related risk and the information sources used.

Methods We surveyed pregnant women and new mothers in[Removed for blind peer review], using a questionnaire approved by health direction, processed by an optical reader and analyzed using χ² test and Odds Ratio.

Results 149 women responded to the survey, 78.5% of them received information from the gynaecologist, 45% from internet and then books/pamphlets. 67.8% felt well informed about food-related risks connected. 94% of them knows Toxoplasma; 39.5% ignore Listeria instead. From our results it’s evident  that graduated women tend to identify all foods as less secure and had better attitudes on cleaning refrigerator, on respecting temperatures, on avoiding consumption of undercooked foods, on protecting food before consumption.

Conclusions Pregnant women have good awareness of food-related risks. However there’s a high confusion, due to the use of internet and other not reliable sources. This study demonstrates that it’s necessary to improve the organization of nutritional education by adequately trained health personnel.
The Relation between Contraception Methods and Quality of Life
Authors: Bahri Narjes , Tohidinik Hamid R , Bilandi Roghayeh R , Larki Mona , Hooshangi Fatemeh , Soltanian Maliheh
Published: April 2023

Objectives:  Assess the relationship between contraception methods and quality of life in women of reproductive age.

Methods: This cross sectional study was conducted in Gonabad, Iran. Multi-stage sampling method was used to select 18-45 year-old women with using a contraceptive methods during the last six months. Demographic and the Short Form 36 (SF-36) Quality of Life Questionnaires were used for data collection. For statistical analysis the Stata11 and SPSS16 software were used. The level of significance was set at P < 0.05. After performing different statistical tests in bivariate analysis, the multi-variable linear regression was used to assess the association between method of contraception and domains of quality of life adjusting for other confounding factors

Results: Women with Tubal sterilization had significant worse “physical functioning” [adjusted regression coefficient=-5.14 (95%CI:-10.2 to -0.01)] but better “general health perceptions” [adjusted regression coefficient=6.8(95%CI: 2.1 to 11.5)] than those preferring male condom (reference). Women whose husbands had vasectomy had also on average significant better score of “general health perceptions” than condom users (reference) [adjusted regression coefficient=7.1(95%CI: 0.23 to 14)]. Withdrawal showed on average higher score of “vitality” than condom users (reference) [adjusted regression coefficient=25.07(95%CI: 7.44 to 42.6)].

Conclusion: The results showed that some aspects of women's quality of life could be affected by using different contraception methods.
Demographic and Socio-economic determinants of maternal health insurance coverage in Zambia
Authors: Mulenga James Nilesh , Bwalya Bupe B. , Gebremeskel Yordanos
Published: April 2023

Background: The importance of health insurance to individual and society at large cannot be overemphasized. It plays a critical role through enabling access to health care services and cushions the individual from catastrophic treatment costs. This study assessed the demographic and socioeconomic determinants of maternal health insurance coverage in Zambia.
Methods: The study analysed the data from the 2013-14 Zambia Demographic and Health Survey (ZDHS) using univariate, bivariate, binary logistic regression analyses to examine the relationship between demographic and socioeconomic and maternal health insurance coverage in Zambia.
Results: The findings indicate that a very low proportion of the women(3%) have health insurance coverage in Zambia. The study also found that  being married, access to media, higher age category, higher education level, being employed have a positive influence on  health insurance coverage while province of residence and type of place of residence are negatively associated with health insurance coverage among women in Zambia. 
Conclusions:The study concludes that health insurance among women in Zambia is associated with marital status, access to media, age, education level, employed status, province of residence and type of place of residence. Given these findings, the study recommends that health insurance providers should tailor their health insurance packages not only to the needs of the employed but the unemployed, the younger age groups, the informal sector and those in the rural areas
Determination of Minimum Sample Size Requirement for Multiple Linear Regression and Analysis of Covariance Based on Experimental and Non-experimental Studies
Authors: Adam Bujang Mohamad , Sa’at Nadiah , Tg Abu Bakar Sidik Tg Mohd Ikhwan
Published: April 2023

Background: MLR and ANCOVA are common statistical techniques and are used for both experimental and non-experimental studies. However, both types of study designs may require different basis of sample size requirement. Therefore, this study aims to proposed sample size guidelines for MLR and ANCOVA for both experimental and non-experimental studies.

Methods: We estimated the minimum sample sizes required for MLR and ANCOVA by using Power and Sample Size software (PASS) based on the pre-specified values of alpha, power and effect size (R2). In addition, we also performed validation of the estimates using a real clinical data to evaluate how close the approximations of selected statistics which were derived from the samples were to the actual parameters in the targeted populations. All the coefficients, effect sizes and r-squared obtained from the sample were then compared with their respective parameters in the population.

Results: Small minimum sample sizes required for performing both MLR and ANCOVA when r-squared is used as the effect size. However, the validation results based on an evaluation from a real-life dataset suggest that a minimum sample size of 300 or more is necessary to generate a close approximation of estimates with the parameters in the population.

Conclusions: We proposed sample size calculation when r-squared is used as an effect size is more suitable for experimental studies. However, taking a larger sample size such as 300 or more is necessary for clinical survey that is conducted in a non-experimental manner.
The new European regulation on personal data protection: significant aspects for data processing for scientific research purposes
Authors: Preite Francesca , Salardi Silvia , Gesuita Rosaria , Villani Simona , Trerotoli Paolo , Guardabasso Vincenzo , Zambon Antonella
Published: April 2023

On 27 April 2016, after a troubled gestation,, Regulation 2016/6791 of the European Parliament and of the Council on the protection of natural persons with regard to the processing of personal data and on the free movement of such data was finally published.

The Regulation is to have a two-year transitional period, meaning it will actually enter into force in the first half of 2018.
Productive aging, work engagement and participation of older workers. A triadic approach to health and safety in the workplace
Authors: Magnavita Nicola
Published: April 2023

Background

Aging of the workforce poses a dramatic challenge for health and safety in all European countries.

Method

Our study was based on a comprehensive review of the literature on productive aging, work engagement, and human engineering, with particular reference to older worker issues.

Results

Productive aging, work engagement, and participatory ergonomics appear to be the most promising areas of research in the field of worker aging. An analysis of intervention programs enabled us to identify three main approaches that could be used to tackle the problem. These include encouraging older adults to be involved in work activities, enhancing their work engagement, and sustaining their productive efforts through participatory changes in the working environment and the promotion of healthy lifestyles. Occupational health and safety services in the workplace must extend their activities of prevention to encompass not only traditional environmental risk factors, but also non-occupational risk factors, so that this holistic approach promotes good practices and positive attitudes.

Conclusions

A set of recommendations and policy briefs for supra-national, national and local authorities was formulated.
Identifying predictors of progression to AIDS and mortality post-HIV infection using parametric multistate model
Authors: Hamidi Omid , Poorolajal Jalal , Tapak Leili
Published: April 2023

OBJECTIVES: The human immunodeficiency virus (HIV) has already remained as a major public health problem all over the world. This study aimed to identify the prognostic factors influencing the disease progression in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Iran, using parametric multi-state models to take into account the intermediate event in the analysis.  

METHOD(S): The data of the present retrospective cohort study was extracted in Tehran from April 2004 to March 2014. The number of 2473 HIV-infected patients in Behavioral Diseases Counseling Centers was enrolled. The outcomes of interest were the transition times from HIV diagnosis to AIDS and AIDS to death. The effect of several prognostic factors on both transitions was investigated.

RESULTS: Parametric models indicated that AIDS progression was significantly associated with an increase in age (P = 0.017), low education (P = 0.026), and a decreased CD4 cell count (P = 0.001). Furthermore, the AIDS-related death was significantly associated with male sex (P = 0.010), tuberculosis coinfection (P = 0.001), antiretroviral therapy (P = 0.001) and a decreased CD4 cell count (P = 0.035).

CONCLUSION: The results of this study indicated that CD4 cell count was one of the most important prognostic factors that affected and accelerated both HIV→AIDS and AIDS→DEATH transitions and antiretroviral treatment was found to be an effective measure in decelerating survival of patients with AIDS to death state. The usual Cox Model is not able to identify some of these prognostic factors.
The reform of the Italian Legislation on Childhood immunization
Authors: Montanari Vergallo Gianluca , Zaami Simona , Cocchiara Rosario Andrea , La Torre Giuseppe , Marinelli Enrico
Published: April 2023

Over the past few decades, giant strides have been made in the field of vaccinations, the range of vaccines available has been broadened, with a higher degree of safety and effectiveness. Paradoxically, distrust towards childhood immunization has also increased in the public opinion, a significant share of which sees not so much its advantages as the possibility of potentially serious side-effects. Vaccinations pose an issue as to the reconciliation of interests pertaining, on the one hand, to the safeguard of health, spelled out in art.13 of the Italian Constitution, and to the freedom of personal choice, protected in art.13, on the other. Therefore, the question to which the authors of this paper have sought to answer reads as follows: should immunization, and childhood immunization in particular, be deemed mandatory treatment, or is it best left up to the parents to choose? The legislation on the subject appears outdated and untimely, and the dichotomy between “mandatory vaccination” and “recommended vaccination” only adds to the sense of confusion in the public opinion. It appears necessary to improve the quality of vaccination counseling practices in childcare, but such activities need to take place within the framework of a broader strategy, centered on the fostering of a culture of prevention, backed by scientific research to the fullest extent possible. The paper’s authors point to the absolute necessity for a new, updated set of national regulations aimed at overcoming current inconsistencies and the discrepancies in guidelines set forth by each region.
European survey on knowledge and attitudes of public health professionals on public health genomics: Pilot Study
Authors: Rosso Annalisa , D'Andrea Elvira , Di Marco Marco , Pitini Erica , Unim Brigid , De Vito Corrado , Marzuillo Carolina , Villari Paolo
Published: April 2023

Background: During the past decade a debate has arisen on the possible utility of genomic science for public health purposes. Within this context, a survey is being conducted to assess attitudes of European public health (PH) professionals belonging to EUPHA network regarding their role in the implementation of public health genomics (PHG), and their knowledge and attitudes regarding genetic testing and the delivery of genetic services.

Methods: A pilot on-line survey was conducted on professionals from Sapienza University of Rome and the Vrije University of Amsterdam. The survey tool is composed of 5 sections: Personal details, Professional activity, Knowledge on genetic testing and delivery of genetic services, Attitudes on genetic testing and delivery of genetic services, Attitudes on the role of PH professionals in PHG.

Results: 34 people responded to the questionnaire, mostly medical doctors (61,8%). No respondents correctly identified all evidence-based applications of genetic testing. More than one third of respondents agreed that it would be more important to invest resources in the social and environmental causes of ill health than in genetic testing. Nearly 70% thought that PHG needs to be grounded on evidence of effectiveness, a lower rate agreed ii should be grounded on cost-effectiveness. The rate of agreement with the proposed roles of PH professionals in PHG was very high.

Conclusions: This pilot study showed a positive attitude but the need to improve knowledge of PH professionals on PHG. It provided useful input for the implementation of the survey to all members of the EUPHA network.
Evaluating the Reform of Healthcare System in Sicily: variations of efficiency and appropriateness between 2008 and 2010
Authors: Sapienza Francesca , Matranga Domenica
Published: April 2023

Background. Sicilian government has developed a very ambitious Reform through the Regional Law n. 5 (14th April 2009). Hospitals were requested to ensure the quality of care through monitoring of appropriateness and quality of service. The aim of this study was to assess variations of efficiency and organizational appropriateness of healthcare delivery before and after this Reform and to show patterns associated to different types of healthcare delivery organizations.

Methods. This study was based on repeated cross-sectional data for 118 (out of 129) short-term, acute-care, non teaching-and-research Sicilian hospitals, in 2008 and 2010. Congestion and slacks analysis was used, with four inputs, two desirable outputs and two undesirable outputs of healthcare delivery.

Results. The loss of desirable output increased between 2008 (23%) and 2010 (31%). Most of the variation between two years in the measured inefficiency could be attributed to congestion due to inappropriate care (p=0.009) and scale inefficiency (p=0.028). Hospitals that have undergone an organizational transformation did not show congestion in the study period. Conversely, hospitals with no variations in their organization were congested in association to the shortfall in the ODs (p=0.019) and in DHs (p=0.018).

Conclusion. This study has shown the general worsening of efficiency of acute-care Sicilian hospitals from 2008 and 2010 and, in particular, has suggested that the reduction of efficiency was due to hospitals that have not undergone an organizational transformation. They are medium-low sized and low-complexity public hospitals and for-profits, while larger and high-complexity organizations resulted the least congested ones.
Effectiveness of educational interventions to improve genomic competency in non-­‐geneticist medical doctors: a systematic review of the literature
Authors: Pastorino Roberta , Calabrò Giovanna Elisa , Lagerberg Tyra B.M. , Michelazzo Maria Benedetta , Boccia Stefania
Published: April 2023

Background. Given rapid advances in genomics, continuing medical education of medical doctors (MDs) is crucial for appropriate integration of human genome discoveries into healthcare and disease prevention. This work presents a systematic review of educational interventions aimed at improving genomic competency in non‐geneticist MDs, with consideration of how outcomes are affected by intervention type (face-to-face learning, distance learning, decision aids and information provision).

Methods.  We performed a systematic search of MEDLINE, ISI Web of Science, and SCOPUS databases for the relevant studies on educational interventions and genomic competency, published in English language between January, 1st, 2001 and March, 31th, 2017. In order to synthesize the results of the eligible studies, we evaluated the effect of education on knowledge, management and confidence, and we compared the outcomes between different intervention types.

Results.  We included sixteen studies including different educational interventions. The majority of studies reported significant effects on at least one component of genomic competency. When the improvement in clinical application of genomic knowledge was evaluated, moderate or null effect has been reported for the different intervention types.

Conclusions. The majority of studies included reported a positive impact of genomic education on non‐geneticist MDs genomic competency. However, no clear conclusion can be drawn given the heterogeneity of the studies in terms of methods, intervention types and outcome measurements. Future studies considering effectiveness of interventions with a focus on long-term outcomes are recommended.
Predictors of Bluetongue development in Sardinia (Italy) identification, using multilevel logistic mixed model
Authors: Loi Federica , Gigli Berzolari Francesca , Laddomada Alberto , Coccollone Annamaria , Scrugli Andrea , Ghironi Annalisa , Putzolu Angelo , Rolesu Sandro , Cappai Stefano
Published: April 2023

Objectives: The Bluetongue Virus is one of the most studied ruminant diseases, affecting particularly sheep and goats. This study aims to identify, for the first time, the specific risk factors influencing the disease development in Sardinia, using multilevel logistic regression model, in order to give a contribution to the sanitary programs and favour the early detection.  

Methods: The data of the present retrospective study, collected from informatics systems of Istituto Zooprofilattico della Sardegna, are referred to all 15,780 Sardinian sheep farms observed for 3 years (2012-2014). The outcome of interest was dichotomous and defined the development of Bluetongue outbreak, after serological test or clinical signs. The effect of several region-specific prognostic factors on disease spread was investigated.

Results: The final model indicated that Bluetongue development was significantly associated with an increase in number of animals (P < 0.0001), number of cattle around farm (P  < 0.0001), water surface area (P =0.002), and amount of rainfall in the previous days (P < 0.0001). Furthermore, the altitude over 450 MASL (P < 0.0001), the vaccination prophylaxis (P < 0.0001) and the previous outbreak event (P < 0.0001) had a protective effect against the outcome.

Conclusion: The results of this study indicated that number of animals and the amount of rainfall were the most important risk factors that affected the Bluetongue development, while the vaccination prophylaxis was found to be an effective measure in decelerating the disease spread.
Challenges and opportunities in establishing an Health Examination Survey
Authors: Donfrancesco Chiara , Palmieri Luigi , Lo Noce Cinzia , Vanuzzo Diego , Giampaoli Simona
Published: April 2023

In Italy, the last 30 years witnessed the implementation of cross-sectional surveys providing baseline data on numerous risk factors collected from random samples of the adult general population.

In order to support those groups who would like to implement an health examination survey (HES), according to the experience of  the CUORE Project surveys, the objective of this paper is to describe some information related to the organization of a survey (examination sites and sampling, selection of analytic laboratory, coordination and personnel involved, sample selection, recruitment and appointment scheduling, informative notice and informed consent, participation rate, non-participation bias, quality assurance, survey data, long term storage of the samples, internal quality control, external quality assessment, feedback to participants, error checking, correction and documentation of the data, transfer and storage of the data, statistical analyses and interpretation of results, dissemination of results), usually shortly described  in scientific papers but relevant when an HES is planned.
Health-Related Quality of Life among Atrial fibrillation Patients Undergoing Anticoagulation Therapy
Authors: Matalqah Laila Mahmoud , Radaideh Khaldoon M.
Published: April 2023

In Malaysia, studies sought to evaluate the health-related quality of life (HRQoL) among patients undergoing anticogaultaion therapy are still recent and scarce as there is no specific tool available. This cross sectional descriptive study was undertaken with a representative cohort of atrial fibrillation patients undergoing anticoagulation therapy. Using prevalence based sampling techniques, a total of 339 patients were recruited from the Anticoagulation Clinics at two public hospitals in Penang, Malaysia. A bilingual specific instrument; Duke Anticoagulation Satisfaction Scale (DASS) and a generic instrument; the European Quality of Life scale (EQ-5D-3L) were used for data collection. The mean (SD) age of the patients was 60.4±14.5 years, with 204 (60.2%) males dominating the entire study. The majority of patients were from lower socioeconomic level and one third of subjects had a secondary level of education. DASS instrument presented a good average score of 70.8 (±19.8), while the means±SD of EQ-VAS was 69.3% (± 16.3%) and for the EQ-Index (TTO) was 79.8%  (± 26.5%) indicated satisfactory health related quality of life (HRQoL) in our study participants.

Their QoL perception is affected positively by age, education level, and occupation and negatively by sex gender and previous hemorrhagic event. The worse evaluations were in mobility and pain domains. Consequently, it was noted that warfarin therapy is not usually associated with a significant decrease in perceived health, unless a bleeding episode has occurred. Results from this study could be useful in clinical practice, particularly in newly detected AF patients, at point where improving HRQoL is still possible.
Network analysis of comorbidity patterns in heart failure patients using administrative data
Authors: Ieva Francesca , Bitonti Daniele
Published: April 2023

Background: Congestive Heart Failure (HF) is a widespread chronic disease characterized by a very high incidence in elder people. The high mortality and readmission rate of HF strongly depends on the complicated morbidity scenario often characterising it.

Methods: Data were retrieved from the healthcare administrative datawarehouse of Lombardy, the most populated regional district in Italy. Network analysis techniques and community detection algorithms are applied to comorbidities registered in hospital discharge papers of HF patients, in 7 cohorts between 2006 and 2012.Results: The relevance network indexes applied to the 7 cohorts identified death, ipertension, arrythmia, renal and pulmonary diseases as the most relevant nodes related to HF, in terms of prevalence and closeness/strenght of the relationship. Moreover, 3 clusters of nodes have been identified in all the cohorts, i.e. those related to cancer, lung diseases and heart/circulation related problems.Conclusions: Network analysis can be a useful tool in epidemiologic framework when relational data are the objective of the investigation, since it allows to visualize and make inference on patterns of association among nodes (here HF comorbidities) by means of both qualitative indexes and clustering techniques.
Acute myocardial infarction and stroke registries. The Italian experience
Authors: Palmieri Luigi , Veronesi Giovanni , Ferrario Marco Mario , Corrao Giovanni , Donfrancesco Chiara , Carle Flavia , Giampaoli Simona
Published: April 2023

Cardiovascular diseases (CVD) are the leading causes of death and hospitalisation in nearly all European countries and accounted for almost 40% of all deaths in 2013. With the exception of few rigorous but limited studies carried out in some geographical areas, data available on CVD incidence and prevalence is generally limited and of poor quality, despite the magnitude of the CVD phenomenon. The EUROCISS Project, supported by the Health Monitoring Programme of the DG SANCO from 2000 to 2007, provided general guidance and updated methods for the surveillance of Acute Myocardial Infarction and Stroke. The Italian population-based registry of major coronary and cerebrovascular events was set up following EUROCISS recommendations; it also took into account the experience acquired by Italy in the MONICA project since the mid-1980s and continued with the coordination of the EUROCISS The project: “A population-based AMI register: assessing the feasibility for a pilot study to implement a surveillance system of acute myocardial infarction (AMI) in Mediterranean countries according to EUROCISS recommendations” in the framework of the EuroMed Programme, followed major practical and operative issues for the implementation of a population-based registry for coronary and cerebrovascular events, which are here described. This paper includes the definition of target population, data sources, events, indicators, quality methods, and the description of a software used to implement the registry.
Knowledge of public health informatics among Italian medical residents: design and preliminary validation of a questionnaire
Authors: D’Aloisio Francesco , Bragazzi Nicola Luigi , Bridgewood Charlie , Poletto Marco , Guicciardi Stefano , Zanobini Patrizio , D’Ambrosio Angelo , Bianchi Francesco Paolo , Quattrone Filippo , Barbara Andrea
Published: April 2023

Background: public health requires strong information skills and competencies, as it is information-intensive and information-driven. Public health informatics has been defined as the “systematic application of information, computer science, and technology to public health practice, research, and learning”. New information and communication technologies offer unprecedented opportunities, such as linking smart-phones and mobiles devices to web based tools for data collection, enabling and enhancing participatory epidemiology. However, being an emerging discipline, despite its potential and importance, public health informatics is often neglected and overlooked, being rarely offered as course. The present study was designed as a pilot study, with the aim of designing and validating a questionnaire on the knowledge of public health informatics among medical residents in public health in Italy. 

Methods and Results: thirty-two Italian residents in public health volunteered to take part into the study. Mean age of the sample was 31.44±2.23 years, most responders were males (68.8%), from northern Italy (53.1%), at the third year of residency (34.4%) and currently doing practical training at the clinical management staff/hospital directorate (34.4%). Other places of training were the Prevention Department (21.9%), the Institute of Hygiene (18.8%), the local health units and the territory (12.5%), the occupational health service (6.3%) and the Regional Health Agency (3.1%). Cronbach’s alpha coefficient yielded a value of 0.909, demonstrating excellent psychometric properties of the instrument. 

Conclusion: in conclusion, the developed questionnaire seems to be an appropriate and useful tool to detect gaps concerning knowledge, education and practices of public health informatics among residents in public health.
A new numerical method for processing longitudinal data: clinical applications
Authors: Stura Ilaria , Perracchione Emma , Migliaretti Giuseppe , Cavallo Franco
Published: April 2023

Background: Processing longitudinal data is a computational issue that arises in many applications, such as in aircraft design, medicine, optimal control and weather forecasting. Given some longitudinal data, i.e. scattered measurements, the aim consists in approximating the parameters involved in the dynamics of the considered process. For this problem, a large variety of well-known methods have already been developed.
Results: Here, we propose an alternative approach to be used as effective and accurate tool for the parameters fitting and prediction of individual trajectories from sparse longitudinal data. In particular, our mixed model, that uses Radial Basis Functions (RBFs) combined with Stochastic Optimization Algorithms (SOMs), is here presented and tested on clinical data. Further, we also carry out comparisons with other methods that are widely used in this framework.
Conclusions: The main advantages of the proposed method are the flexibility with respect to the datasets, meaning that it is effective also for truly irregularly distributed data, and its ability to extract reliable information on the evolution of the dynamics.
Realizing the Prospects of the Demographic Dividend in Selected Arab Countries
Authors: Youssef Hala , Elden Nesreen Mohamed Kamal , Ali Hala Abou
Published: April 2023

Background: For most Arab countries, the coming ten years will reveal a real challenge with their changing age structure. Currently, a demographic window of opportunity is unlocked in many of those countries with the increase in the fraction of population in the working-age. Hence, the study investigates the relation between population growth and dependency ratio as demographic indicators and the per capita growth domestic product (GDP).

Methods: A  time-series analysis  model  was developed for  Egypt and Morocco versus the Republic of Korea as an economically empowered country that had the same initial conditions in the early sixties. Data exploited are drawn from the World Bank and OECD databases. We adopt an income per capita growth model to analyze the role of demographic factors, mainly working-age share.

Results There is a significant relationship between GDP per capita and the proportion of working age population. A significant long-run association between dependency ratio and per capita GDP is confirmed. The reduction of dependency load contributes to GDP per capita growth throughout the study duration by an annual rate of about 9 and 2 percent in Egypt and Morocco, respectively.

Conclusion: The decline in the dependency ratio, or alternatively, the raise in the working age population has a favorable impact on economic growth. The paper presents supporting evidence to scale up the effect of age structure alteration and to realize the demographic dividend in the studied countries.
An observational study on the effects of early and late risk factors on the development of childhood obesity in the South of Italy
Authors: Squeri Raffaele , Genovese Cristina , Palamara Maria Angela Rita , Trimarchi Giuseppe , Ceccio Concetta , Donia Vittoria , Pecoraro Maria , La Monica Giuseppa , La Fauci Vincenza
Published: April 2023

Background: Child obesity is today one of the greatest health emergencies, on such a large scale as to be considered a global epidemic by the WHO and, unfortunately, Italy holds the worst European record.

Methods: We conducted an observational study to investigate the effects of early and late risk factors on the development of primary childhood obesity. We collected anthropometric parameters, information about early risk markers and late risk factors on a sample of 280 children from March 2016 to December 2017.

Results: Statistically significant associations emerged between: child's BMI and education level of the mother (p<0.001) and the father (p<0.05); level of parents' education and qualitative variables (subjects’ physical activity level (p<0.05), consumption of carbonated beverages (p<0.05), fruit juices (p <0.05) and snacks (p<0.05); BMI and the presence or absence of a family history of obesity, DM and cardiovascular diseases. Significant linear correlations were found between weight classification (overweight/obese) and the consumption of carbonated drinks (p<0.05), snack consumption (p<0.05), physical activity levels (p<0.001) and duration of sleep in the afternoon (p<0.05).

Conclusions: In our sample we found incorrect eating habits to be frequently linked to a low level of parental education; particularly for the mother, the main childcare provider.
Early feeding and growth pattern in infants: Using a three-variate longitudinal model derived from Gaussian copula function
Authors: Angali Kambiz Ahmadi , Loeloe Mohammad Sadegh , Akhoond Mohammad Reza , Daneshkhah Alireza , Borazjani Fatemeh
Published: April 2023

Background: The Gaussian copula model was used to generate joint distributions for continuous longitudinal variables on infant types of feeding and longitudinal measures of height, weight and head circumference 

Methods: The study was performed longitudinally in rural areas of southern part of Iran, on children from birth to 9 months of age. Out of 319 infants with serial anthropometric measurements from birth, and 2, 4, 6, 7 and 9 months old, 120 were included. Infants were divided into three groups (breast fed, formula fed and both milk types). A three-variate longitudinal model including Copula function was used to estimate the effect of feeding on growth pattern. All the analyses were performed using SAS version 9.4 (Proc NLmix). 

Results: Ninety infants (75%) were breastfed, sixteen (13.3%) were formula fed and fourteen (11.7%) had combined feeding. Copula model showed that, breast fed children had a better weight gain (β=0.627 95% CI 0.217-1.038 P = 0.003), height (β=2.603 95% CI 1.023-4.183 P = 0.001) and head circumference (β=0.8 95% CI 0.069- 1.531 P = 0.0) as compared to formula fed children. R2 for Copula model was (wt=0.52, ht=0.96, hc=0.84). 

Conclusions: Implication of Copula model was easy to perform. Estimation of the parameters in copula model indicated that, breast milk consumption had a positive effect on the growth of infants.
Methods and introductory results of the Greek national health and nutrition survey - HYDRIA
Authors: Martimianaki Georgia , Naska Androniki , Papatesta Maria Eleni , Peppa Eleni , Orfanos Philippos , Trichopoulou Antonia
Published: April 2023

Background:  According to a large prospective cohort study (with baseline examination in the 1990s) and smaller studies that followed, the population in Greece has been gradually deprived of the favorable morbidity and mortality indices recorded in the 1960s. The HYDRIA survey conducted in 2013-14 is the first nationally representative survey, which collected data related to the health and nutrition of the population in Greece.

Methods: The survey sample consists of 4011 males (47%) and females aged 18 years and over. Data collection included interviewer-administered questionnaires on personal characteristics, lifestyle choices, dietary habits and medical history; measurements of somatometry and blood pressure; and, blood drawing. Weighting factors were applied to ensure national representativeness of results.

Results: Three out of five adults in Greece reported suffering of a chronic disease, with diabetes mellitus and chronic depression being the more frequent ones among older individuals. The population is also experiencing an overweight/obesity epidemic, since seven out of 10 adults are either overweight or obese. In addition, 40% of the population bears indications of hypertension. Smoking is still common and among women the prevalence was higher in younger age groups. Social disparities were observed in the prevalence of chronic diseases and mortality risk factors (hypertension, obesity, impaired lipid profile and high blood glucose levels).

Conclusion: Excess body weight, hypertension, the smoking habit and the population’s limited physical activity are the predominant challenges that public health officials have to deal with in formulating policies and designing actions for the population in Greece.