bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of four analytic strategies for complex survey data: a case-study of Spanish data
Authors: Masood Mohd , Newton Tim , Reidpath Daniel D 
Published: April 2023

Purpose: The aim of this secondary data analysis was to investigate the effect of four different analytical strategies: Model Based Analysis (MBA), Design Based Analysis (DBA), Multilevel Model Based Analysis (MMBA), and Multilevel Design Based Analysis (MDBA), on the model estimates for complex survey data.
Methods: Using data from the World Health Survey-Spain explanatory models for the outcome Metabolic Equivalent of Task (METs) were calculated using MBA, DBA, MMBA, and MDBA. Regression coefficients, standard errors (SE) and the Akaike Information Criterion (AIC) from all the models were compared.
Results: DBA showed highest estimates for most of the variables, including consistently higher SE than all other model - 20% to 48% higher than estimates for MBA, 10% to 37% for MMBA and 23% to 35% for MDBA. The SE for MDBA were 2.5% to 13% higher than estimates derived from MMBA in level 1 predictors, but SE in MMBA was higher by 18% for level 2 predictors. Values of AIC suggested the model derived by MDBA was the best fit and DBA the poorest fit of the four models.
Conclusion: With minimum AIC, MDBA appeared to be the most appropriate approach to analyze complex survey data. To confirm the finding of present study a future work on a simulation data would be required.
Prophylactic use of Saccharomyces boulardii probiotics in preventing antibiotic-associated diarrhea: a single center hospital-based case-control study in Serbia
Authors: Panic Nikola , Tufegdzic Maja , Boccia Stefania , Stokic Marija , Bulajic Milutin 
Published: April 2023

Background. Antibiotic-associated diarrhea (AAD) develops through the loss of normal bacterial intestinal flora. We have conducted a case-control study in order to assess whether prophylactic administration of Saccharomyces boulardii (S. boulardii) prevents occurrence of AAD among adult hospitalized patients.
Methods. Single-center hospital based case-control study was conducted in University Clinic “Dr Dragisa Misovic-Dedinje”, Belgrade, Serbia. Hospital records were screened in order to identify all the patients developing AAD in period January 1. 2010 – August 31. 2015. For every case, one age and gender matched control was randomly selected among patients hospitalized at the same time at the same department who were administered with antibiotics and did not develop AAD. For both cases and controls data were extracted on demographics, medical history, indication for use of antibiotics, antibiotics used, and prophylactic use of S.boulardii probiotics. The relationship between occurrence of AAD and putative risk factors were measured using the odds ratios (ORs) and their 95% confidence interval (CI) derived from logistic regression analysis.
Results. Number of 59 cases and 59 controls were included in the study. Most of AAD cases were associated with old age (mean age of 78.05), and almost half (49.15%) were hospitalized on geriatrics department. Most prescribed class of antibiotics among cases was III generation cephalosporins (50.85%), followed by fluoroquinolones (28.81%) and trimethoprim-sulfamethoxazole (20.34%). Significantly more cases than controls were treated with carbapenems (16.95% vs. 5.08% respectively, p=0.04). Significantly less cases were administered with prophylactic S. boulardii probiotics (18.64% vs. 42.37% p=0.005). We identified prophylactic use of S. boulardii to act protectively against development of AAD from both univariate (OR: 0.31, 95% CI: 0.14-0.72) and multivariate analysis (OR:0.36, 95% CI: 0.14-0.80). Use of carbapenems was borderline significant risk factor for development of AAD in univariate (OR: 3.81, 95% CI: 0.99-14.64) as well as multivariate analysis (OR: 3.82, 0.91-16.08) (Table 3). Conclusion. Prophylactic use of probiotics containing Saccharomyces boulardii acts protectively against antibiotic-associated diarrhea among hospitalized patients.
Is there a link between physical activity and Amyotrophic Lateral Sclerosis?
Authors: La Torre Giuseppe , Masala Daniele 
Published: April 2023

The Amyotrophic Lateral Sclerosis (ALS) is a chronic and progressive neuro-degenerative pathology that starts in adult age and usually leads patients to death for respiratory distress after 3 years from the onset of symptoms
In some studies, vigorous and continuous physical activity due to heavy working activity and sport is associated with ALS. On the other hand other studies are against this association. A study carried out in Europe found overall physical activity is associated with reduced odds of having ALS (OR=0.65, 95% CI=0.48-0.89), and the same protective factor is seen for work-related physical activity (OR=0.56, 95% CI=0.36-0.87) and organized sports (OR=0.49, 95% CI=0.32-0.75.
A recent literature review found that football/soccer may be considered as a possible risk factor for ALS (level C) and there is a strong need for further research that must take into account the numerous confounding factors that could be present in this field. However only well conducted observational studies, such as cohort and case-control studies, carried out with the same design in different countries could give a final answer to this suspected but still unconfirmed association
Are knowledge and skills acquired during the Master Degree in Nursing actually put into practice? A pilot study in Italy
Authors: Massimi Azzurra , Marzuillo Carolina , Di Muzio Marco , Vacchio Maria Rosaria , D'Andrea Elvira , Villari Paolo , De Vito Corrado 
Published: April 2023

Background. Literature on the evaluation of the Master’s Degree in Nursing is scarce. The objective of this pilot study was to test a questionnaire aimed at monitoring the activities of nurses after receiving the Master’s degree.
Methods. An electronic questionnaire was administered to 36 graduates who obtained the Master’s degree during the academic year 2010/2011.
Results. Almost 80% of the participants judged their level of improvement in knowledge and skills during the course to have been satisfactory, but the level of implementation of these competencies at work was quite low.
Conclusion. Competencies acquired during the Master’s degree course are not always put into practice.
The Relevance of Epigenetic Biomarkers for Breast Cancer and Obesity for Personalised Treatment in Public Healthcare: A Systematic Review
Authors: Goettler Andrea , Haslberger Alexander , Ambrosino Elena 
Published: April 2023

Background: Personalised medicine has gained attention as a result of the advances of genomic research in the last decade. This includes the rise in epigenetic research, which focuses on the environmental influences on the genome and examines biomarkers that might be useful for cancer therapy. This study investigates the epigenetic biomarkers for breast cancer and its risk factor, obesity, and evaluates their relevance for global public health.
Methods: A systematic search of articles published from 2005 to May 2015 was performed in PubMed for epigenetic breast cancer marker. An additional literature search was carried out on the epigenetic markers of obesity.
Results: The search resulted in 84 articles on breast cancer, which demonstrate the various applications of epigenetic markers for breast cancer diagnostics, prognostics and treatment. Particularly, non-invasive blood-based diagnostic biomarkers and epigenetic therapy could improve the health outcomes of cancer patients using a personalised approach. The 14 obesity-related articles highlight the epigenetic link of disease and risk factors and emphasise the relevance of nutritional influences.
Conclusions: Although epigenetics offers many opportunities, new discoveries have to be confirmed first in clinical settings to ensure advantages over traditional methods. Furthermore, before personalised epigenetic therapy can be applied in public health it is crucial to ensure a fair implementation in both high and low-income settings globally.
Epidemiology of drug use in Perugia (Italy) through the analysis of the Keratin Matrix
Authors: Mercurio Isabella , Troiano Gianmarco , Melai Paola , Agostinelli Veronica , Simone Rosaria , Nante Nicola , Bacci Mauro 
Published: April 2023

Background Drugs and their metabolites can be incorporated into hair so hair testing has become s an alternative and complementary method to assess the extent of drugs abuse. The aim of our study has been to use hair samples to rebuild the epidemiology of illicit substances use in Perugia.
Methods We conducted a cross-sectional study from May to July 2012 asking hairdressers of Perugia to collect hair samples and to compile a schedule for each one. The samples were analyzed in laboratory: the extraction of basic substances was performed adding methanol; the extraction of acid substances was obtained adding NAOH. After derivatization, 1μl of each solution was analyzed through gas chromatography / mass spectrometry The data were organized in a database and processed using R version 3.2.2.
Results We collected 238 samples. The most detected drugs were: THC-TMS identified in 15 samples, MDMA in 9, Beg-TMS in 8. There is a statistically significant difference in drug use between centre (23,36%) and periphery (5,34%). Age and sex have not represented influencing factors. The substance with the highest concentration in the keratin matrix is ketamine (9834,86 ng/100 mg of hair).
Conclusions The use of keratin matrix offers high advantages in the toxicological analysis compared to conventional biological matrices and let us analyze the situation in Perugia where the increased market of drugs caused constant rise of drug addiction. However, because of the limits of this method, only the simultaneous use of keratin matrix and other traditional indicators, could furnish more precise information.
Hand washing in operating room: a procedural comparison
Authors: Stilo Alessia , Troiano Gianmarco , Melcarne Lucia , Gioffrè Maria Eufemia , Nante Nicola , Messina Gabriella , Laganà Pasqualina 
Published: April 2023

BACKGROUND Hand washing has been considered a measure of personal hygiene for centuries and it is known that an improper hand hygiene by healthcare workers is responsible for about 40% of nosocomial infections. Therefore, surgical hand preparation is a critical element for healthcare safety in order to reduce microbial contamination of surgical wound in case of non detected break of the gloves. The aim of our study is to evaluate the efficacy three antiseptics: Povi-iodine scrub; EPG (Ethanol, Hydrogen Peroxide, Glycerol, recommended by WHO), and common marseille soap type in a liquid formulation.
METHODS It was designed a randomized, double-blind, single-center study conducted in the University Hospital of Messina, from January to June 2013. We asked operators to put the fingertips of their right hand (if not left-handed) for one minute on the PCA medium, before washing with the three types of antiseptics, and after washing and drying. Drying was made using sterile gauzes or disposable wipes. Then, we measured the number of colony forming units per mL (CFU/mL) and calculated the percentage of microbial load reduction.
RESULTS 211 samples have been considered for statistical analysis: in 42 samples, in fact, initial microbial load was lower than after washing. Washing with EPG reduced CFU/ml from a mean of 38,9 to 4,1 (86,5% reduction), washing with povi-iodine scrub from 59,55 to 12,9 (75,9% reduction) and washing with Marseille soap from 47,26 to 12,7 (64,3% reduction).
CONCLUSIONS Our study shows that washing with EPG has superior efficacy in CFU reduction. Antiseptic hand washing, however, cannot be considered the only measure to reduce infections: the anomaly of some results (initial microbial load lower than after washing) demonstrates that drying is an essential phase in the presurgical preparation. Therefore, hand hygiene must be part of a more complex strategy of surveillance and control of nosocomial infections
Prevalence of Alcohol Consumption among University Students in Baghdad: A Cross-section survey from Iraq
Authors: Al-Ameri Rawa Jaafar Kadhim , Al-Badri Husham J Abd , Lafta Riyadh K 
Published: April 2023

Background: Alcohol consumption is a well-known public health problem, especially among university students. It was poorly studied in Middle East, especially in Iraq, due to religious and social taboos. This study conducted to throw a light on the prevalence of Alcohol consumption among university students in Baghdad.
Subjects and methods: A survey conducted in three universities (Baghdad, Al-Mustansiriyah and Al-Nahrain) from Baghdad city, in the duration between January and May 2015.A semi-structured questionnaire form used to collect the data from 1435 university students. The sample selected by multistage random sampling technique with probability proportion to size.
Results: The average age (range) of the studied sample was 19.8 (18 - 24) years; more than a half of them were females 760 (53%). Alcohol consumption was reported by 9.7% (95%CI: 8.2% - 11.2%) of the participants (19.7% males vs. 0.8% females). Heavy Alcohol consumption was reported by 12.2% of consumers. Male students living out of their families or relatives and those of medical group colleges found to be risk factors for Alcohol consumption (PR= 2.65, 95% CI: 1.72 - 4.1) and (PR= 2.72, 95%CI: 1.48 - 5.01) respectively. No significant relations showed between demographic characters of female students and Alcohol consumption.
Conclusions: Usage of Alcohol was relatively prevalent among university students in Baghdad, in spite of religious and social barriers in Iraq.
Family and college staff supervision and education of the students with meetings targeting health risks and sequels of Alcohol hazardous consumption are the effective ways to control this practice.
Diabetes mellitus and colorectal cancer screening in the population of the Italian region Friuli Venezia Giulia
Authors: Valent Francesca , Gobbato Michele , Franzo Antonella , Gongolo Francesco 
Published: April 2023

Aims: Colorectal cancer is the most common cancer in Italy, where screening programs are now in place all over the country. We conducted a research to assess whether the use and outcomes of colorectal cancer screening are different between diabetics, who are at increased risk of developing colorectal cancer, and non-diabetics in the Italian Northeastern region Friuli Venezia Giulia.
Methods: This was a retrospective population-based study which used the administrative databases of the regional health information system as the sources of information. For the two screening rounds 2010-2011 and 2012-2013, we compared adherence to the program and the results of the fecal occult blood tests and of the colonoscopy among diabetic and non-diabetic residents.
Results: Overall, more than 300,000 persons were invited for the colorectal cancer screening in each round. Of them, approximately 8.8% were diabetic. In the regional population, adherence to the screening program was significantly lower among diabetics than among non-diabetics. The proportion of positive fecal occult blood tests was higher among diabetics than among non-diabetics. Among diabetics, the detection rate for initial and advanced adenomas was higher than among non-diabetics, whereas no clear pattern was observed for the detection of cancers.
Conclusion: In Friuli Venezia Giulia, efforts should be directed at improving the management of diabetic patients and at reducing the inequalities in access to care due to this comorbidity.
Factors associated with macrosomia among singleton live-birth: A comparison between logistic regression, random forest and artificial neural network methods
Authors: Amini Payam , Maroufizadeh Saman , O Samani Reza , Hamidi Omid , Sepidarkish Mahdi 
Published: April 2023

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

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

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

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

Background: Childhood obesity has been recognized as a major public health concern. The purpose of this study was to determine specific shifting patterns of BMI and skinfold fatness across different age and sex groups between 1985/87 and 2012.
Methods: The data of 9,366 children aged 8-15 years from two nationally representative surveys, i.e., 1985/87 National Children and Youth Fitness Study I & II and 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey, were analyzed. Specifically, changes of BMI-based obesity prevalence and shifting patterns of BMI, height, weight, skinfold body fat percentage (skinfold-fat%), subscapular skinfold, and triceps skinfold from 1985/87 to 2012 were estimated by age and sex using the 1985/87 quartiles as the baseline.
Results: Significantly increased obesity prevalence were reconfirmed for both boys (12.12%, P <.001) and girls (3.53%, P <.001) from 1985/87 to 2012. Except for height, all other measures in 2012 experienced an unbalanced shifting pattern, mainly from other quartiles into the 4th quartile of 1985/87.
Conclusion: The shifting of both boys’ and girls’ BMI and skinfold-fat% were all concentrated in the 4th quartile of 1985/87, indicating not only that there was a significant increase in BMI and skinfold-fat% in the U.S. children from 1985/87 to 2012, but also into the overweight and obese subgroups, which serves as a serious warning for childhood obesity epidemic and public health.
Investigation of breast cancer screening among the women of Khorramabad (west of Iran): A cross-sectional study
Authors: Anbari Khatereh , Ahmadi Seyyed Amir Yasin , Baharvand Parastoo , Sahraei Naser 
Published: April 2023

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

Background and aims:
To estimate sample size for Cohen’s kappa agreement test can be challenging especially when it is expected that the true marginal rating frequencies are not the same. This study aims to present the tables that display a minimum sample size determination for an agreement test when certain assumptions are hold.
Method:
We adopted the sample size formula provided by Flack and colleagues (1988) to calculate the minimum sample sizes required using PASS software. The power is pre-specified to be at least 80% and the alpha to be less than 0.05. The effect sizes were derived from several pre-specified estimates such as the pattern of the true marginal rating frequencies and the difference between the two kappa coefficients in the hypothesis testing.
Results:
When the true marginal rating frequencies are the same, the minimum sample size determination can range from 2 to 698 depending on the actual value of the effect size. When the true marginal rating frequencies are not the same, then the majority of the minimum sample size required for this condition is more than double than that required sample size when the true marginal rating frequencies are the same.
Conclusion:
Concerning that the sample size formula could produce a very extreme small sample size, therefore, the determination of K1 and K2 should be based on reasonable estimates. We recommend for all sample size determinations for Cohen’s kappa agreement test, the true marginal rating frequencies can be assumed the same. Otherwise, it will be necessary to multiple the estimated minimum sample size by two to accommodate if the true marginal rating frequencies is not the same.
Design and validation of a self-administered questionnaire to assess knowledge, attitudes and behaviours about Zika virus infection among general population in Italy
Authors: Gianfredi Vincenza , Bragazzi Nicola Luigi , Nucci Daniele , Zanella Francesca , Martinelli Domenico , Camilloni Barbara , Villarini Milena , Moretti Massimo , Stracci Fabrizio 
Published: April 2023

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