bluuebunny/crossref_metadata_2025_split huggingface dataset:
Manual on the creation of quality indicators for population based cancer screening programs in Italy
Authors: Rivolta S , Ponti A , Deandrea S , Campari C , Zorzi M , Zappa M ,   on the behalf of the ICSIWG
Published: October 2020

Abstract

Issue
In many countries the organized screening programs have been in the frontline in developing and implementing the evaluation of the quality of screening and of the entire process of care following a positive test. Over the years, the three Italian Screening Groups (GIS) have separately published indicators and standards concerning the programs for breast, cervical and colorectal cancers they were responsible for, thus hampering coherence, homogeneity. In addition, at local level, an increasing number of indicators have been observed with difficult to monitor all of them.

Description of the Problem
The Screening Indicators Manual, prepared by a multidisciplinary working group, represents the guidance agreed upon by the Italian Screening Network (ONS) and the three GIS on how to develop, implement, communicate and maintain a set of quality indicators for the evaluation of cancer screening programs.

Results
The Manual indicates that the three GIS must first constitute, with ONS, the common steering committee made of six-nine experts. The involvement of the public and the management of the conflicts of interests are foreseen. The conceptual framework distinguishes indicators of context, coverage and process. It is based on six dimensions: efficacy, efficiency, security, appropriateness, person centeredness, equity. There are four macro-processes: invitation; test, further assessment and diagnosis; treatment and follow-up; evaluation. The methods include: a survey of the existent indicators, their selection with the Delphi method, the evaluation of the completeness of the resulting indicators set, its integration, when needed, by means of a public call, and finally a new Delphi round. Appropriate standards, empirical or evidence based, are then identified. Last, indicators are assigned to core or library list based on priority.

Lessons
Select, define and measure an indicator is a way to understand what we are aiming at even more than provide the measure of how we do it.

Key messages
The creation of the Manual allows to build a coherent evaluation framework for the three screening programs. The Manual promotes the adoption of rigorous methods and make feasible the monitoring activity according to its purpose, level of observation and detail of information needed.
Estimating life expectancy among older multimorbid adults to personalize preventive care
Authors: Gastens V , Del Giovane C , Anker D , Syrogiannouli L , Schwab N , Rodondi N , Chiolero A 
Published: October 2020

Abstract

Background
Providing high value care and avoiding care overuse is a challenge among older multimorbid adults. There is evidence on benefits and harms of cancer screening and cardiovascular diseases (CVD) preventive treatment up to the age of 75. However, this evidence is not directly applicable to older multimorbid patients. Because each cancer and CVD preventive care has a specific lagtime to benefit, many guidelines recommend tailoring preventive care according to the estimated life expectancy (LE). However, there is no tool to estimate LE among multimorbid patients. Our objectives are therefore to develop new mortality risk prognostic indices and to derive a new LE estimator, what will help clinicians tailoring preventive care in older multimorbid adults.

Methods and Results
We conduct a prospective cohort study by extending the follow-up of 822 patients in Bern, Switzerland, included in the OPtimising thERapy to prevent Avoidable hospital admissions in Mulitmorbid older people (OPERAM) study over 3 years. Detailed information about cancer screening and CVD preventive treatment will be collected. We will identify variables independently associated with mortality and weight the variables to create 1 year and 3 year mortality prognostic indices. We will transform the 3 year prognostic index into a LE estimator. Preliminary results will be presented at the congress.

Conclusions
We will develop the first life expectancy estimator specifically for older multimorbid adults. This tool will help clinicians to tailor cardiovascular and cancer preventive care in older multimorbid adults.

Key messages
Because of the lagtime to benefit, personalizing preventive care by estimated life expectancy is recommended. We will provide the first life expectancy estimator for older multimorbid adults.
Risk of amyotrophic lateral sclerosis and exposure to particulate matter: A case-control study
Authors: Filippini T , Mandrioli J , Malagoli C , Cherubini A , Maffeis G , Vinceti M 
Published: October 2020

Abstract

Background
Amyotrophic lateral sclerosis (ALS) is fatal neurodegenerative disease with still unknown etiology. Some environmental and occupational risk factors have been proposed, including air pollution, as suggested by recent studies. We carried out a case-control study in order to assess ALS risk due to environmental exposure to particulate matter ≤10 µm (PM10).

Methods
We recruited ALS patients referred to the Modena Neurology Unit between 1994-2015 and a reference group sampled from the population of Modena province. Using a geographical information system-based dispersion model, we estimated outdoor air PM10 levels at the geocoded subjects' addresses of residence at the time of diagnosis. We computed odds ratio (OR) and 95% confidence interval (CI) of ALS according to increasing PM10 exposure, using an unconditional logistic regression model adjusted for age and sex.

Results
For the study 132 participants (52 cases/80 controls), mean of annual average and maximum PM10 levels were 5.2 and 38.6 µg/m3, respectively. Using fixed cutpoints at 5, 10 and 20 of average annual PM10 levels, compared with subjects &lt;5 µg/m3, we did not find an excess ALS risk associated with PM10 exposure, since OR was 0.87 (95%CI 0.39-1.96), 0.94 (0.24-3.70), and 0.87 (0.05-15.01) at 5-10, 10-20 and ≥20 µg/m3, respectively. When using maximum annual PM10 levels, we found an excess ALS risk for subjects exposed at 10-20 µg/m3 (OR = 4.27, 0.69-26.51) compared with exposure below 10 µg/m3. However, risk decreased with further exposure increase at 20-50 (OR = 1.49, 0.39-5.75), and ≥50 µg/m3 (OR = 1.16, 0.98-4.82).

Conclusions
Our findings do not suggest that PM10 exposure is associated with ALS risk, even at the high levels of exposure characterizing a Northern Italy province. However, the statistically imprecise increased risks associated with maximum annual exposure levels suggest the need of further investigations.

Key messages
Outdoor particulate matter exposure seems not associated risk of amyotrophic lateral sclerosis. Only exposure to high concentrations of particulate matter might increase risk of amyotrophic lateral sclerosis.
Adherence to medication among Tunisian adults with type 2 diabetes
Authors: Amara A , Ghammem R , Zammit N , BenFredj S , Maatoug J , Ghanam H 
Published: October 2020

Abstract

Introduction
Diabetes mellitus is a growing public health concern. Despite compelling evidence about the effectiveness of medications, studies have indicated that less than 50% of patients achieved therapeutic targets. The aim of this study was to assess the adherence to type 2 diabetes mellitus treatment and its determinants.

Methods
A cross-sectional study was conducted between April and June 2017 in the Endocrinology and internal medicine departments of Farhat Hached University Hospital in Sousse, Tunisia. A convenient sample of patients who fulfilled the eligibility criteria was recruited. A pre-tested questionnaire was used to gather information. This was followed by assessing patients' adherence to diabetes medications using the eight-item Morisky Medication Adherence Scale (MMAS-8).

Results
A total of 330 patients with Type 2 Diabetes Mellitus participated in this study. The mean ±SD age of patients was 58.96±10.3 with female predominance (60.3%). More than half of participants were with high cardiovascular risk. In most cases (70.6 %), participants were moderate adherent. Results showed that patients become non-adherent as the disease gets older (p = 0.001). In addition patients with health insurance were significantly more adherent comparing to those who did not have it (p = 0.01). Regarding self-care practices and other metabolic risk factors' effects, our data revealed that exercising 30 minutes below than 5 times in week and poor self-management of diet were associated with low adherence (p &lt; 10-3). On the other hand, patients who have started insulin therapy were less adherent than those who had not yet (0.01). Patients with diabetic retinopathy or maculopathy were significantly more prone to be non- adherent, with respective percentage of 39.1% and 37.5%.

Conclusions
This study provides insights into the determinants of non-adherence, ultimately guiding the effective interventions through development of structured long-term policies not yet implemented.

Key messages
In most cases (70.6 %), participants were moderate adherent. Patients with diabetic retinopathy or maculopathy were significantly more prone to be non- adherent.
Effectiveness of mud-therapy in rheumatic and dermatologic diseases: a systematic review
Authors: Mingrone V M , Paduano S , Venturelli F , Marchesi I , Valeriani F , Bassi M C , Borella P , Bargellini A 
Published: October 2020

Abstract

Background
Thermal mud therapy alone or in combination with thermal water baths is widely used in clinical practice for the management of rheumatic and dermatologic diseases in many countries. Despite its long history and tradition, its biological action and its clinical effectiveness are still not clear. The aim of this systematic review is to synthetize the current evidence on the mud therapy effects on pain, function and quality of life in patients with rheumatic and dermatologic diseases.

Methods
PubMed/Medline, Embase, and Cochrane Library were searched for articles about the comparative effectiveness of mud therapy alone or combined with other therapies on pain, function and quality of life in adults with rheumatic or dermatological diseases without any restrictions of severity. Studies were searched up to 15 October 2019. We included randomized and non-randomized trials and comparative cohort studies, as well as non-comparative case series and case reports only for safety outcomes. The following outcomes were considered: pain assessed by validated scales or through painkillers drugs consumption, function (i.e. muscle tone, joint motility and stiffness) assessed by validated scores, quality of life and autonomy assessed by validated scales and adverse events. Laboratory inflammation parameters were investigated as secondary outcomes.

Results
A total of 2,455 articles were retrieved through database search, remaining 1,914 records after duplicates removed. The selection by title and abstract led to include 140 studies for full-text evaluation. The screening of full-text is still being carried out. The majority of 140 records assess the effects of mud therapy in patients with osteoarthritis (51 articles), osteoarthrosis (12) and psoriasis (10).

Conclusions
Our results will provide a synthesis of the current evidence on the mud therapy effectiveness, useful to evaluate its inclusion within clinical protocols for the treatment of rheumatic and dermatologic diseases.

Key messages
The majority of studies report the treatment with mud for rheumatic diseases. The synthesis of the evidence is useful to evaluate the mud therapy as treatment for rheumatic and dermatologic diseases.
Functional disability in Brazilian octogenarians: data from the 2013 National Health Survey
Authors: Stolses Bergamo Francisco P M , de Assumpção D , Silva Arbex Borim F , Gomes de Macedo Bacurau A , Pita Ruiz A M , Liberalesso Neri A 
Published: October 2020

Abstract

Background
The impairment of function capacity implies a greater risk of biological and social vulnerability, increasing the demand for healthcare services and caregivers.

Objective
Estimate the prevalence of functional disability in the performance of basic and instrumental activities of daily living (BADL and IADL) among long-lived Brazilians (≥80 years) according to sociodemographic characteristics and self-rated health.

Methods
A cross-sectional study was conducted with data from seniors who participated in the 2013 National Health Survey (n = 1498). Functional disability was defined as difficulty performing at least one of the six BADL or five IADL. Independent associations were determined using Poisson multiple regression analysis, with the calculation of prevalence ratios and 95% confidence intervals adjusted for chronic diseases.

Results
Mean age was 84.8 years (CI95%: 84.5-85.1); 59% were women; 62% were self-declared white; and 63% had no private health insurance. The prevalence of functional disability in BADL and IADL was 33.8% (CI95%: 30.6-37.2) and 66.4% (CI95%: 62.5-70.2), respectively. Only 17.7% participated in organized social activities and only 15.5% rated their health as poor/very poor. Regarding BADL, greater disability was found among those ≥85 years of age, among men and those who rated their health as poor (p &lt; 0.05). Regarding IADL, greater disability was found among those ≥85 years of age, those without a conjugal life, illiterate individuals and those who rated their health as poor (p &lt; 0.05).

Conclusions
Approximately 1/3 and 2/3 of long-lived Brazilian exhibited restricted skills for maintaining their autonomy and independence regarding the performance of BADL and IADL, respectively. The present findings underscore the importance of family and social support networks to assist older adults in the performance of basic and instrumental activities of daily living as well as activities related to mobility.

Key messages
The impairment of function capacity increases the demand for healthcare services and caregivers. Approximately 1/3 and 2/3 of long-lived Brazilians have functional disability regarding the performance of basic and instrumental activities of daily living, respectively.
Is haze control effective? A research based on regional public perception differences
Authors: Li Y , Chen Y Y 
Published: October 2020

Abstract

Background
Beijing-Tianjin-Hebei region (BTHR) is a world-class city group in China. However, haze severity of BTHR ranked in the top in China, 2014. As haze has certain impact on people's physical and psychological health, government has taken various measures to actively manage it in recent years. We try to answer the question: From public perception, whether haze control in BTHR has achieved a little success?

Methods
According to region and gender, we select four groups as respondents: BTHR and non-BTHR men, BTHR and non-BTHR women. We investigate their perception towards haze related issues. After collecting 400 anonymous questionnaires, we use clustering by fast search and find of density peaks (CFSFDP) algorithm to divide the investigated population into different clusters that represent different perception situations. Then, we test whether the frequency of each group divided into four clusters was consistent with the overall distribution frequency by fitting test.

Results
Questionnaires are automatically divided into four clusters by CFSFDP. The results of test (p &gt; 0.1) show that the four groups are consistent (no significant difference) with overall clustering. Overall average score for “public perception to haze control” is 2.974 (full-score is 5.000), belonging to middle and upper level.

Conclusions
The cluster results show that there is no significant difference in the perception of haze control effect among four groups. Therefore, for the public in BTHR, there is no significant difference in their recognition of haze control compared with that in other regions, and the overall scores are all at the middle and upper levels. From public perception, effect of haze control in BTHR is in line with that in other regions.

Key messages
Using clustering algorithm and statistical test to identify the difference of public perception of haze control. From the perspective of public perception, haze control in BTHR has achieved initial results.
The long-term burden of war injuries in LMICs: Case of the Lebanese War of 2006
Authors: Kobeissi E , Menassa M , Honein-AbouHaidar G , Abdul Khalek R , Chaya B , Elamine A , Abu-Sittah G , El Achi N 
Published: October 2020

Abstract

Background
Armed conflict is a major cause of disability and mortality, particularly in LMICs. July 12, 2006 marks the start of a 33-day war in Lebanon which resulted in at least 1191 deaths and 4409 injured, the vast majority of whom were civilians. Little is known about the consequences of war-injuries inflicted on civilians. The AUB arm of the NIHR PrOTeCT Group aims to identify 1) war-injury characteristics associated with high burden of care 2) the long-term socioeconomic burden and 3) the quality of life of the injured civilians and their access to healthcare and medicine under conditions of war.

Methods
This study employs a mixed-method research design by reviewing medical records of patients admitted to hospitals in Lebanon between July 12th and August 15th, 2006, conducting interviews with patients, and administering the EQ5D5L questionnaire to understand the burden of injuries and the quality of life of patients 13 years after injury. Qualitative and quantitative data analysis methods will be used.

Preliminary Results
25 interviews have been conducted so far. Injured civilians were mostly males, average age 27. The most common mechanism of injury was blast injury. Most patients underwent multiple surgeries as well as revision surgeries. The emerging themes include description of the 1-scene and type of injury; 2-referral process from the injury site to the hospital; 3-the types of services received; and 4-the financial and non-financial long-term impact. They described the long-term burden including chronic pain, poor mobility, anxiety or depression, and limited activities of daily living.

Conclusions
These preliminary results show that civilians injured during the July 2006 war are experiencing physical and psychological sequelae; thus, more services need to be offered to civilians injured during war.

Key messages
Physical impairments related to war injuries influenced the quality of life of study participants. Affordable or free rehabilitation services need to be offered to civilians injured during war.
The spirit of Vienna: health strategies in managing the world drug problem
Authors: Morais D , Silva M 
Published: October 2020

Abstract
Health sciences have always had a lot of influence in the formulation of drug policies. However, the international system for the control of illicit drugs is distant from the World Health Organization, for example. It was in the name of health and well-being protection that the Single Narcotics Convention (1961) established a ban on drugs as a rule, with the exception of medical and scientific uses. But it was also in the name of a health category, Harm Reduction, that the so-called Vienna consensus began to break in 2009: it is about the global bipolarization around drug policy, locating member states in two groups.
Taking strategy as a means designed to achieve a purpose, which updates the position of agents in the International Drug Control System and which operates the renunciation of the other (FOUCAULT, 2001), we ask: what, in the last decade, was their strategy groups of countries in managing the global drug problem? To answer this question, an ethnography of events and documents was carried out, in addition to semi-structured interviews and participant observation. The field research was the 62nd Ministerial Segment of the UN Commission on Narcotic Drugs (Vienna, 2019), when the last 10 years of drug policy were evaluated and the next decade was planned.
Following the Brazilian resolution, created in partnership with Norway, entitled “Promoting measures to prevent transmission of HIV for women who use drugs, including by improving access to post-exposure prophylaxis”, it was possible to observe the effort to maintain that space as a place where health has no voice. Categories such as 'women who use drugs' and 'emergency contraceptives' have been the subject of controversy among diplomats, who have backed down to maintain the already weakened consensus.
It is concluded that health is historically used as a strategy for the prohibition of substances, but it can be a tool for changing the paradigm if observed as an instrument in dispute and based on Harm Reduction

Key messages
Health is the strategy to legitimize drug prohibition, but it can also be the protagonist of the paradigm shift in drug policy if it is anchored in harm reduction. There is an effort to keep the UN's international illicit drug control system out of the health field.
Patient and Public Involvement in health research: evidence on the practice of participant selection
Authors: Lander J , Dierks M L 
Published: October 2020

Abstract

Background
Research on Patient and Public Involvement (PPI) largely focusses on its aims and methods. Aspects regarding who participates in PPI are largely overlooked, though they may impact considerably on the planning, process and outcomes: who exactly are 'patients and public' in PPI? How are participants selected and why? Are and should participants be representative? Our objective was to explore respective practices and perceptions to inform future PPI.

Methods
We conducted a systematic database search to select published PPI in medical and health research. Authors of included publications (n = 315) were addressed via an electronic survey, closed and open responses were assessed using descriptive statistics and thematic content evaluation.

Results
Respondents (40%) reported to have recruited a broad spectrum of participants, often including more than one specific group (56%), e.g. publics with and without topic-wise experience. There were only little differences with respect to selecting participants for different involvement aims and using different recruiting methods. Representativeness was often seen as a crucial recruiting objective (71%), while many considered achieving it (very) difficult (69%). They identified significant respective challenges and desired more guidance on various aspects of planning and conducting PPI (56%).

Conclusions
Recruiting PPI participants and handling representativeness are controversial and are associated with various obstacles. While few prior studies addressed single related aspects using debates and theory, our results add a more comprehensive and empirical perspective, particularly regarding the (real) relevance of representativeness.

Key messages
Study authors need to be more systematic and reasonable in selecting PPI participants and in deciding about the need for representativeness. PPI-guidelines should concretize the most relevant steps for planning and conducting participant selection, so that the practice of PPI can be regarded sound and meaningful.