bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in the prevalence of MetS and its components between 2011 and 2018 in the Roma Population
Authors: Piko P , Dioszegi J , Kosa Zs , Sandor J , Adany R 
Published: October 2021

Abstract

Background
Metabolic syndrome (MetS) is a worldwide problem with severe health consequences, which are further exacerbated by the current COVID-19 pandemic. In this study, we examine the changes in the prevalence of MetS and its components among the Roma (one of the most vulnerable ethnic group in Europe) in two disadvantaged counties of North-eastern Hungary in the period between 2011 and 2018.

Methods
Two health examination surveys were performed in the Hungarian Roma population aged 20-64 years in 2011 (n = 458) and in 2018 (n = 374). The data from these surveys were used to examine how the prevalence of MetS and its components and the prevalence of relevant preventive medication changed during the study period.

Results
The increase in the prevalence of MetS itself in the whole Roma population was not found to be significant in the period examined (although it increased from 40.0% up to 46.0%, p = 0.080); however, there was a significant increase in the prevalence of central obesity (from 62.7% to 73.3%, p = 0.001) and raised blood pressure (BP) or treated hypertension (from 45.2% to 54.5%, p = 0.007). These changes were mainly observed in the younger age groups, so the risk for MetS increased significantly in the 20-34 (OR = 1.10, p = 0.038) and 35-49 (OR = 1.07, p = 0.048) year-old groups in the 2018 study population compared to the 2011 one. A favourable non-significant decrease was observed in the prevalence of raised fasting plasma glucose concentration (from 29.0% to 24.1%, p = 0.107) and reduced HDL-C levels (from 60.3% to 55.6%) over the study period.

Conclusions
The increasing prevalence of hidden hypertension and, consequently, the number of untreated individuals with raised BP (from 29.6% to 43.5%, p = 0.014) among women is quite alarming; therefore, a targeted public health strategy and targeted interventions are desperately needed to prevent further worsening of the current situation.

Key messages
Among Roma women, the prevalence of hidden hypertension and, consequently, of elevated blood pressure increased significantly over the study period. Stopping the increasing trend of MetS would require interventions which focus on the increasing prevalence of central obesity and hypertension in the Roma population.
The burden of seasonal influenza-associated complications in Italy: a systematic review
Authors: Giacchetta I , Primieri C , Cavalieri R , Domnich A , de Waure C 
Published: October 2021

Abstract

Background
Influenza is the infectious disease with the highest impact on population health in the European Union in terms of disability-adjusted life years. Reliable country-specific influenza-associated burden estimates play a crucial role in informing prevention and control measures to minimize the health and economic burden of the disease. Our purpose was to provide a comprehensive summary of available scientific literature on the burden of seasonal influenza on the Italian population.

Methods
We performed a systematic literature review of articles published until 31 July 2020. PubMed, Embase and Web of Science were searched. The search strategy included a combination of search terms related to burden, influenza and Italian population. We included studies investigating seasonal influenza-related complications and/or mortality in Italy. A meta-analysis of data was not pre-planned because of the expected heterogeneity in study populations and outcomes.

Results
A total of 16 studies were included in the qualitative synthesis, out of an original yield of 9,268 articles. Ten (62.5%) and 8 (50%) studies analyzed influenza-related complications and hospitalizations, respectively, while 8 (50%) assessed influenza-related deaths. Only 3 studies (19.7%) concerned pediatric age. The synthesis of results showed that patients with chronic conditions might have an increased risk for complications up to almost 3 times as compared to healthy people. Hospitalization due to influenza can occur from less than 1% to more than 5% according to the study setting (general practice or emergency room). Excess deaths rates were estimated to be over 6-fold higher for the elderly than for the rest of population.

Conclusions
Although there are still gaps in existing data, there is evidence of the significant burden that influenza places each year especially on high-risk groups. Summaries of the available data may inform decision-making in regard to vaccine strategies and public health policies.

Key messages
Existing data show evidence of significant burden of influenza on Italian population, especially on high-risk groups. Summaries of country-specific influenza-related burden are crucial in informing vaccine strategies.
The impact of age when screening for latent tuberculosis infection - is it a problem?
Authors: Almeida Santos J , Duarte R , Nunes C 
Published: October 2021

Abstract

Background
Older population in developed countries represents a large reservoir of tuberculosis (TB) infection. Knowledge if age can contribute to false negative results in the immunological tests available for screening latent TB infections (LTBI) is critical to improve their usefulness in Public Health strategies for TB control. The aim of this study was to ascertain whether age was a risk factor for false negative (FN) results in the tuberculin skin test (TST) and in an interferon gamma release assay (IGRA).

Methods
Retrospective cohort study carried out using data from the Portuguese National Tuberculosis Surveillance system (2008-2015). Were included all active pulmonary TB cases with an IGRA (n = 597) and/or TST (n = 6185) result. TST outcomes were interpreted using a 5mm (TST-5mm) and 10mm (TST-10mm) cutoff. Logistic regression analysis crude and sex-adjusted was used to evaluate the association of age to the risk of FN results.

Results
Patients with a TST result presented a mean age of 42.7 years and patients with an IGRA result presented a median age of 45.5 years. TST-5mm, TST-10mm and IGRA had 36.5%, 43.9% and 24.5% FN results, respectively. Older patients presented a statistically significant association with the risk of FN TST results, regardless of using a 5mm [71-80years: OR 2.209; &gt;80years: OR 2.491; p &lt; 0.001] or 10mm [71-80years: OR 1.986; &gt;80years: OR 2.308; p &lt; 0.001] cut-off. Age was not a predictive factor for FN IGRA results. However, older patients presented a significant association with indeterminate IGRA results [71-80years: OR 3.808; &gt;80years: OR 5.214; p &lt; 0.001].

Conclusions
When using TST as part of the Public Health strategies for screening elderly patients, healthcare professionals should bear in mind that there is an increased risk of obtaining a FN result. On the other hand, age did not show an association with the occurrence of FN IGRA results, which suggests that this test could perform better when screening for LTBI in older patients.

Key messages
TST in elderly people is associated with false negative results thus, when using this test for screening for LTBI, a negative result should be interpreted with caution. IGRA was not associated with false negative results in elderly people, however indeterminate results can occur more frequently, thus performing better in this population group.
Background exposure to polychlorobiphenyls and mortality: A systematic review and meta-analysis
Authors: Fiolet T , Mahamat-Saleh Y , Frenoy P , Kvaskoff M , Romana-Mancini F 
Published: October 2021

Abstract

Polychlorinated biphenyls (PCBs) are a family of 209 congeners known to be highly persistent in the environment and with long-range transport leading to a ubiquitous pollution. This group of persistent organic pollutants is known to be carcinogenic and to have endocrine-disrupting properties. Due to bioaccumulation along the food chain, the main route of exposure in general population is through diet. High level toxicity was well characterized with mass poisoning episodes and occupational cohort but the association with PCBs exposure at low doses with mortality in general population is uncertain. We conducted a systematic review and meta-analysis to assess whether background exposure levels of PCBs increase all-cause and cancer- and cardiovascular-specific mortality risk in the general population, following the National Toxicology Program/Office of Health Assessment and Translation framework. Studies were identified by searching PubMed, Embase and Web of Science up to 1st of January, 2021. Random-effects meta-analysis was used to estimate summary relative risks (SRRs). Eight prospective cohort studies met our inclusion criteria, leading to 72,852 participants including 17,805 deaths. Overall exposure to PCBs was not statistically significantly associated with all-cause mortality (SRR=1.13, 95% CI = 0.90-1.41, n = 7 studies, low certainty); however, dietary exposure to PCBs was associated with an increased risk of cardiovascular-specific mortality (SRR=1.38, 95% CI = 1.14-1.66, n = 3 studies, moderate certainty), while no association was found with cancer-specific mortality. Bayesian meta-analysis and subgroup analyses confirmed these findings. Our meta-analysis suggests that background exposure to PCBs is associated with an increased risk of cardiovascular-specific mortality in the general population with a “moderate” level of evidence. This should be interpreted with caution given the small number of studies on mortality in the general population.

Key messages
This meta-analysis fails to highlight any clear association between background level of PCB exposure and all-cause and cancer-specific mortality, probably due to the limited number of studies. This study brings new evidence of an increased risk of cardiovascular-specific mortality associated with a higher exposure to PCBs in the general population, with a moderate level of certainty.
Energy and macronutrients intake in an Italian infants cohort at 24 months of age
Authors: Valdi G , Moretti V , Concina F , Pani P , Carletti C , Ronfani L , Parpinel M 
Published: October 2021

Abstract

Background
Dietary habits during infancy and early childhood could have short and long-term health effects and could influence future adults' dietary habits. Acting during this sensitive period of life could be crucial. In 2006 a prospective infants cohort study was established at the Maternal and Child Institute - Burlo Garofolo in Trieste, Italy (Trieste Infant Feeding Cohort - TIF cohort) to assess energy and nutrients intake during the first three years of infants' life. This nutritional analysis focused on dietary habits of infants at 24 months of age.

Methods
Dietary data were collected using a 3-day dietary record (3-d DR) and data were analysed using a nutritional software containing the Italian Food Composition database and integrated with data from nutritional labels and literature. Energy and macronutrients intake were compared with the Italian Dietary Reference Values (DRV) and the WHO recommendation. Differences by sex were also assessed.

Results
3d-DR was filled for 157 infants. Available carbohydrates (CHO) and starch intakes were significantly significant higher in males (p &lt; 0.05). The percentage contribution of CHO to total energy intake was in line with DRV (75.8% of infants within the reference interval (RI)) similarly 75.2% of infants are within the RI for fats. Proteins' contribution to energy intake, instead, was above the RI for 53.5% of infants over the RI and the daily protein intake was greater than the estimated DRV (median 43.9 g/d, IQR of 16.2 g/d vs median DRV 10.3 g/d, IQR 1.3 g/d).

Conclusions
The results show a substantial adherence with recommendations for macronutrient intakes except for the excess protein intake. Elevated protein intake play a role in developing long-term health consequences and seems linked to overweight and obesity. Further evaluation of protein intake should be desirable.

Key messages
Nutritional studies are essential tools to assess dietary habits in infants and allow to contribute of reference recommendations evolution. Macronutrients analysis, with a particular focus on proteins intake, can help to evaluate children’ dietary patterns, to intercept and possibly correct unhealthy habits.
Outcomes and predictive factors of weight loss: an evaluative retrospective study in Tunisia
Authors: Ayedi Y , Harizi C , Abdessalem H , Skhiri A , Fakhfakh R 
Published: October 2021

Abstract

Introduction
Morbid over-weight is associated with adverse health outcomes such as cardio-vascular diseases, diabetes, hyperlipidemia, hypertension… Obesity treatment needs special and personalized care. Moderate loss weight from 5% to 10% is beneficial for primary reduction of these disorders.

Aim
Identify predictive factors of weight loss of at least 5% of baseline weight and describe improvement of metabolic syndrome

Methods
We performed a retrospective evaluative study in Obesity Research Unit in the National Institute of Nutrition of Tunis from October 2016 to March 2018. We included adult women, whose BMI was &gt; =30 kg/m2. Anthropometric and biological parameters were taken in the first consultation (T0). Then, adequate and personalized care (diet, physical activity, and psychological support) was received. Monthly check-ups were done to detect eventual diet errors. Evaluations were done in 3 and 6 months (T1) and (T2). We performed univariate and then, logistic regression to determine predictive factors of successful loss weight by at least 5%.

Results
We included 73 obese women. Mean age was 42.63 +/- 11.8 yo. One third of the patients were in menopause. At T0: 83.1% have had a weak physical activity while mean BMI was 39.98 +/- 6.47 kg/m2. Fourteen patients had had hypertriglyceridemia and 43 had hypo-HDLemia. Eighteen were hypertensive. Eighteen were diabetic. At T2: mean weight loss was 5.92 +/- 4.34 kg. Fifty-seven percent of patients have successfully lose more than 5% of their baseline weight. Mean BMI was 37.59 +/- 6.51 Kg/m2. A significant improvement of rates of cholesterol and triglycerides was found. Logistic regression found that predictive factors to weight loss were successful loss weight at 1 month, diminution of TSH hormone and augmentation of Phosphorus intake.

Conclusions
A large proportion of obese women may be sensitive to moderate weight loss but a further effort is necessary to maintain effective weight loss on long term.

Key messages
Moderate weight loss is beneficial for health. Personnalized care is required to help obese women.
The HTA of genomic applications in Italy: methodological and organisational preparedness
Authors: Migliara G , Pitini E , Baccolini V , Isonne C , Mazzalai E , Salerno C , Turatto F , De Vito C , Marzuillo C , Villari P 
Published: October 2021

Abstract

Background
The formal process to determine the value of a health technology is Health Technology Assessment (HTA). Two key components are required to implement the HTA of genomic applications: the development of a specific methodology and an adequate network. This work aims to review the state of HTA in Italy and to assess its preparedness for genomic applications, both at a national and regional level.

Methods
For the national level, a narrative review of the policy documents regulating the HTA process was conducted. For the regional level, an update of a previous survey on the topic (SIHTA/AGENAS 2016) was performed through the search and analysis of regional websites, and grey and scientific literature.

Results
Various national centres share a role in the governance of the HTA process and/or in the production of reports, such as the National Agency for Regional Healthcare Services (since 2006), the Steering Committee of the Italian National HTA Program for Medical Devices and the National centre for HTA (since 2017). 76% of the Regions has specific regulations for the HTA process. Of these, 68.8% regulate the reporting phase, 62.5% the priority setting, 81.3% the assessment, 50% the appraisal, and 43.8% the dissemination. The following dimensions were assessed: “technical characteristics”, “health problem and current use”, “cost and economic effectiveness” by 62.5% of the Regions; “efficacy”, “safety”, “organizational aspects” by 56.3%; “ethical aspects” by 25%; “social aspects”, and “legal aspects” by 18.8%.

Conclusions
The HTA is specifically addressed at a National level, but there is an overlap of institutional roles in its governance. At regional level, while most Regions have HTA specific regulations, there is great heterogeneity among them in the phases regulated and in the dimensions evaluated. Moreover, there is a lack in evaluation of dimensions essential for a comprehensive assessment of genomic applications, like ethical, social and legal aspects”.

Key messages
Policy documents on HTA are well developed and integrated in the governance of the NHS. However, there seems to be a dispersion of value with various centres partially overlapping in their functions. There is a lack of evaluation in dimensions fundamental for genomic tests, due to the implications of privacy violations, impact on quality of life and abuses that can follow these tests.
Deprescribing for community-dwelling elderly: A systematic review of economic evaluations
Authors: Romano S , Figueira D , Teixeira I , Perelman J 
Published: October 2021

Abstract

Background
Multimorbidity among the elderly represents a serious challenge for health systems. Older adults are often exposed to polypharmacy and inappropriate medication, which are associated with adverse events and increased healthcare use. This study aims to identify and synthetize the economic evidence of deprescribing interventions among community-dwelling elderly.

Methods
Literature was systematically reviewed on the cost and effectiveness of deprescribing interventions in adults aged ≥65 years living in the community. MEDLINE, EconLit, Scopus, Web of Science, CEA-TUFTS, CRD York and Google Scholar databases were searched from inception to February 2021. Grey literature was also explored. Titles and abstracts, and subsequently full-text articles were screened according to inclusion and exclusion criteria. Studies' quality was appraised using the extended Consensus on Health Economics Criteria list.

Results
A total of 6,154 articles were identified, of which 89 were retrieved for full-text review, yielding 14 studies. Most were conducted in Europe (n = 9), followed by North (n = 3) and South America (n = 1), and China (n = 1). Settings included community pharmacies, primary care/general practices and patientś homes. Most deprescribing interventions were delivered within a pharmacist-doctor collaboration. Twelve studies were trial-based economic evaluations with a time horizon varying from 2 to 12 months. Cost-effectiveness ranged from dominant to an incremental cost-effectiveness ratio of $112,932/QALY. Nine studies scored &gt;80% (good) and two scored ≤50% (low) on critical quality appraisal.

Conclusions
There are few economic evaluations of deprescribing interventions focused on community-dwelling elderly. Although results varied across settings, time horizon and intervention complexity, most interventions were cost-effective according to the WHO threshold. Deprescribing interventions are promising from an economic viewpoint, but more studies are needed.

Key messages
There is a paucity of economic evaluation studies conducted on deprescribing interventions of community-dwelling elderly. Research suggests that most interventions are cost-effective or even dominant compared to usual care.
Healthcare waste management processes and transition towards a circular economy
Authors: Mokra J , Loosova J 
Published: October 2021

Abstract

The new Waste Directive 2018/851/EU strengthens the role of waste prevention and emphasizes recycling to facilitate the transition to a circular economy. So far, it has not been legislatively necessary for the Czech Republic to look at waste from a broader perspective, especially in healthcare, where the waste management is perceived as a separate process suitable for outsourcing. With the new directive and the transition to a circular economy, the waste management process becomes part of strategic management processes. These processes are partially systematically covered by the standards of the environmental management system, used mainly in the industrial sector. The optimal solution is a reassessment of the entire waste management of the medical facility and the inclusion of the principle of waste prevention in the decision to purchase a product or service. The necessary condition for the successful implementation of the circular economy is to minimize negative impacts on health and the environment while maintaining the economic sustainability of such a solution. Setting up generally sustainable management of medical facilities thus goes beyond current clinical practice. The health technology assessment model provides several domains that complement life cycle analysis and health impact assessment, including a health risk assessment method. The outputs of the above analyzes and evaluations cover the maximum scope of public interest in healthcare. A practical approach is developing a system of methodologies based on the methods mentioned above, which respect the whole chain of strategic processes of healthcare facilities and involve maximum stakeholders in the evaluation process. We test the approach on a pilot facility in the project SS01010276 ‘Sustainable healthcare waste management: economically feasible minimization of impacts on health and environment' supported by the Technology Agency of the Czech Republic within the Environment for Life Program.

Key messages
The approach aims to add value to traditional waste management approaches and integrate the long-term interests of key stakeholders using the overlapping outcomes of respective assessments. A sustainable approach to healthcare waste management must be developed with the involvement of all key stakeholders and concerning their interests within their position in the assessment process.