bluuebunny/crossref_metadata_2025_split huggingface dataset:
Towards a More Competitive Italy in Clinical Research: The Survey of Attitudes towards Trial sites in Europe (The SAT-EU Study TM)
Authors: Gehring Marta , Jommi Claudio , Tarricone Rosanna , Cirenei Mariapia , Ambrosio Giuseppe 
Published: April 2023

Background
Italy is Europe’s third largest pharmaceutical market, yet it ranks only ninth in the number of NIH-registered clinical trials per capita. The aim of our study was to explore stakeholders’ perception of Italy as place to undertake clinical trials, and to estimate the potential economic impact of selected reforms in terms of incremental trial activity.
Methods
The Survey of Attitudes towards Trials in Europe (SAT-EU Study) was an anonymous, web-based survey which systematically assessed factors impacting clinical trial site selection in Europe. Estimates of Italian economic impact were developed in collaboration with AICRO (Association of Italian Contract Research Organisations).
Results
Responses were obtained from 485 professionals in 34 countries (15% residing in Italy) representing over 100 institutions, spanning BioPharma Clinical Research Organizations (CROs), and Academic Clinical Trial Units (CTUs). Italy ranked tenth of twelve in terms of accessibility and transparency of information required to run clinical trials, and last with respect to predictability and speed of Ethics Committees. Costs of running clinical trials were not considered critical, whereas, fragmented and slow approval process was. Streamlined centralized trial authorization would translate into an estimated 1.1 billion Euros of incremental trial investments over three years.
Conclusions
Clinical trial professionals consider Italy’s governance of clinical research suboptimal, among the worst in Europe, and indicate that much could be done to make Italy more attractive for clinical trial investments. The present study also provides evidence about stakeholders’ willingness to invest in trials and its economic consequences provided effective reforms are put in place.
Obsessive-Compulsive Disorder and quality of life outcomes: protocol for a systematic review and meta-analysis of cross-sectional case-control studies
Authors: Coluccia Anna , Fagiolini Andrea , Ferretti Fabio , Pozza Andrea , Goracci Arianna 
Published: April 2023

Background. Obsessive-compulsive Disorder (OCD) is a chronic disabling psychological condition, which can severely affect quality of life (QOL). Growing interest has been dedicated to assessing which domains of QOL are more severely affected in patients with OCD. However, research yielded conflicting findings. Investigating QOL in OCD could suggest the need for integration of interventions aimed at improving those specific domains more severely impaired by obsessions and compulsions.
Methods. We will conduct a systematic review of cross-sectional case-control studies according to PRISMA guidelines, where patients with a primary OCD diagnosis were compared on QOL outcomes with healthy controls. Primary objectives will be to examine differences in QOL outcomes between patients with OCD and healthy controls, and to assess which QOL domains are more severely impaired in patients compared with controls, particularly subjective well-being, social and interpersonal functioning, work functioning, and family functioning. Subsequently, the study will investigate potential moderators of QOL in OCD, including participants characteristics (age, sex, presence of comorbid personality disorders, OCD symptom severity, severity of concurrent depressive symptoms, duration of OCD symptoms, and generational cohort), and study characteristics (date of publication and methodological quality of the studies). Online databases will be searched (PsycINFO, PubMED, Science Direct, Cinahl, Biological Abstracts, Psyclit, Embase, The Cochrane Central Register of Controlled Trials, and Google Scholar). To locate unpublished records, conference abstracts, doctoral dissertations and theses will be handsearched, and experts will be contacted. Statistical analyses will be performed though random effect model meta-analysis. Risk of bias assessments will be conducted using the instrument Methodological Index for Non-Randomized Studies.
Further Studies of Bolivian Crocidolite –Part IV: Fibre Width, Fibre Drift and their relation to Mesothelioma Induction: Preliminary Findings
Authors: Ilgren Edward B. , Van Orden Drew R. , Lee Richard J. , Kamiya Yumi M. , Hoskins John A. 
Published: April 2023

Background
The hypothesis that fibre width is a major determinant of mesothelioma induction has been examined by comparative studies of two crocidolites from different sources. Fine fibres fromCapesouthAfricaand the thicker fibre found and used similarly inBolivia.

It is well established that ‘thin’ fibre crocidolite fromCapeSouth Africais extremely mesotheliomagenic. Bolivian crocidolite has a much wider width distribution and relatively little mesothelioma inducing potential.

Methods
We analysed the mesothelioma demography inBoliviawhere local crocidolite has been used for decades This was compared with the mesothelioma demography in theItalianCityof Casale Monteferrato whereCapecrocidolite was processed for many decades in the Eternit Asbestos Cement plant producing numerous cases of mesothelioma.
We also conducted a limited downwind study from the fiberizing part of the historical operating plant where products containing Bolivian crocidolite were made for sale and use inCochabamba.

Results
The demographic study confirmed the absence of a significant mesothelioma excess inBolivia.
Despite the extremely high fibre concentrations measured in the plant, no significant fibre levels were detected 100 meters away.

Conclusion
These preliminary findings undermine claims such as those made at Casale that crocidolite fibre can drift up to 15 km and remain airborne in quantities sufficient to contribute significantly to mesothelioma induction.

We propose the difference in thickness and the attendant reduction in the percentage ofStantonfibres provides an explanation for the difference in mesothelioma patterns found in each city.
Bias in regression coefficient estimates when assumptions for handling missing data are violated: a simulation study
Authors: Van Kuijk Sander MJ , Viechtbauer Wolfgang , Peeters Louis L , Smits Luc 
Published: April 2023

Background
The purpose of this simulation study is to assess the performance of multiple imputation compared to complete case analysis when assumptions of missing data mechanisms are violated.
Methods
The authors performed a stochastic simulation study to assess the performance of Complete Case (CC) analysis and Multiple Imputation (MI) with different missing data mechanisms (missing completely at random (MCAR), at random (MAR), and not at random (MNAR)). The study focused on the point estimation of regression coefficients and standard errors.
Results
When data were MAR conditional on Y, CC analysis resulted in biased regression coefficients; they were all underestimated in our scenarios. In these scenarios, analysis after MI gave correct estimates. Yet, in case of MNAR MI yielded biased regression coefficients, while CC analysis performed well.Conclusion
The authors demonstrated that MI was only superior to CC analysis in case of MCAR or MAR. In some scenarios CC may be superior over MI. Often it is not feasible to identify the reason why data in a given dataset are missing. Therefore, emphasis should be put on reporting the extent of missing values, the method used to address them, and the assumptions that were made about the mechanism that caused missing data.
Knowledge and attitude of general pratictioners towards direct-to-consumer genomic tests: a survey conducted in Italy
Authors: Baroncini Anna , Calabrese Olga , Colotto Marco , Pelo Elisabetta , Torricelli Francesca , Boccia Stefania 
Published: April 2023

Background: Personal genomic tests (PGT) offered directly-to-consumers (DTC) for complex disease risk assessment have raised several concerns regarding their potential adverse impact. To mitigate worries continuing professional education has been advocated and the central gatekeeper role of family physicians has been highlighted. Nevertheless, to date, only few studies have been published on awareness, involvement and attitudes of primary healthcare providers on DTC marketing of PGT and, to the best of our knowledge, none in Italy.
Methods: An exploratory survey to achieve information about knowledge and attitudes towards DTC-PGT of a selected group of family physicians participating to courses on predictive medicine and public health genomics was conducted.

Results: A total amount of 114 partially or fully filled questionnaires was obtained. The majority of the primary care providers (68,4%) expressed that they are unaware that companies are selling genomic tests directly to consumers, while 31,6% was aware. In terms of attitudes toward testing 61,1% of the aware respondents deemed the DTC-PGT for chronic complex diseases to be ‘‘not clinically useful.’’ The overwhelming majority of our respondents (95,6%) felt unprepared to answer patients’ questions on DTC-PGT. If only aware respondents are considered this percentage results obviously lower (86,1%), though still very high.

Conclusion: The low percentage of aware respondents suggests that DTC advertising in the realm of genomic testing is still limited in Italy. Should DTC-PGT become more widely used, a comprehensive education program may be necessary to increase family physicians’ awareness and help them discuss testing with their patients.
Daily physical activity in Finnish adolescents with long term illnesses or disabilities: psychosocial associations with participation in sports club
Authors: Ng Kwok , Rintala Pauli , Välimaa Raili , Tynjälä Jorma , Villberg Jari , Kokko Sami , Kannas Lasse 
Published: April 2023

Background:
Physical activity (PA) in adolescence with long term illnesses or disabilities (LTID) is a public health concern. One way of increasing PA is through participation in sports clubs. Since sports clubs are organised and regular, there are expected to be differences in motivation for physical activity between adolescents that are members and non-members. The purpose of this study is to assess the impact of psychosocial factors on sports club membership and daily PA.
Methods:
Finnish adolescents with self-reported LTID (n=1006) took part in the WHO collaborative Health Behaviour in School-aged Children (HBSC) study in 2002 and 2010. Daily self-reported moderate to vigorous PA (MVPA) was the outcome variable. Psychosocial variables included intention for future PA, self-perceptions, and educational aspirations. Age and sports club membership was included in binary logistic regression analyses Analyses were done separately for boys and girls.
Results:
Adolescents with LTID who were sports club members were two times more likely to be active daily than non-members. However, for girls, there was no significant difference between members and non-members. Moreover, definite intention for future PA, higher self-perceptions, and educational aspirations to other education or training than general upper secondary school were significant predictors.
Conclusions:
Adolescents with LTID need encouragement to be active daily. One possible way to achieve this is through sports club participation. Implementing adaptive motivating techniques in sports clubs is especially important for girls in clubs. More research is needed on the associations of daily MVPA with different educational aspirations for adolescents with LTID.
Closed testing procedure for multiplicity control. An application on oxidative stress parameters in Hashimoto's Thyroiditis
Authors: Alibrandi Angela 
Published: April 2023

Closed Testing procedures represent an effective solution to the need to make inferences on multiple aspects at the same time, controlling the Familywise Error Rate (FWER), that is the error rate of the hierarchical family. Closed Testing procedures have a high degree of adaptability to a wide range of experimental situations, both in parametric than in non-parametric ambit. The attention is focused on the Bonferroni-Holm method, frequently used to counteract the problem of multiple comparisons. The present paper aims to show an original application of the Closed Testing procedures for multiplicity control in medical research, with reference to the oxidative stress; in particular the Min-P Bonferrroni-Holm method was applied to the p-value adjustment, related to three parameters (BAP, D-ROMS, AGEs) of oxidative stress in Hashimoto’s thyroidytis.
Birth cohort trends for breast cancer among women in Europe and North America
Authors: Tarone Robert E. 
Published: April 2023

The birth cohort pattern of risk for breast cancer among European women is remarkably similar to that observed among women in the United States and Canada. A sharp decrease in risk for women born after World War II is particularly intriguing, and warrants further epidemiological investigation in order to identify etiologic factors potentially responsible for the unexpected and unexplained declining risk.
Are smartphones and tablets influencing the quality of sleep? An Italian answer
Authors: Bert Fabrizio , Gualano Maria Rosaria , Giacomelli Sebastian , Martorana Maria , Siliquini Roberta 
Published: April 2023

Background: Electronic media use may affect sleep health. The present study aimed to estimate the association between technological devices usage, especially mobile phone, during the evening/night and self-reported sleep disorders.
Methods: The survey was conducted between June and September 2016. Anonymous self-reported questionnaire was distributed to the Italian general population and investigated demographic data, presence of sleep disorders and the use of electronic devices.
Results: The analysis was based on 597 questionnaires. Mobile phone exposure has been associated with increased difficulty falling to sleep (p= 0.018).
The use of mobile phones at bedtime was significantly related to self-reported sleep disturbance (p <0.001).
Using mobile phone more than 60 minutes before going to sleep, the use of these devices in bed, surfing internet remained statistically significant in the multivariate analysis.
Conclusion: Our results suggest that the use of a mobile phone before going to sleep is associated with reporting sleep disturbances. Public health prevention strategies could comprise promotion of optimum sleep habits and information regarding the effects of an intensive electronic devices use on the sleep status.
Area under the curve-derived measures characterizing longitudinal patient responses for given thresholds
Authors: Allgoewer Andreas , Schmid Manuel , Radermacher Peter , Asfar Pierre , Mayer Benjamin 
Published: April 2023

Background: Calculation of the area under the curve (AUC) is a widely used practice in longitudinal study settings. The AUC values should reflect study participants’ particular trajectories by means of a continuous measure which can be further analysed with ordinary statistical methods. However, its sheer calculation does not necessarily mirror exactly the piece of information one is seeking for.
Methods: Available formulas for the calculation of the AUC as well as their specific advantages and limitations are presented. Furthermore, some approaches are discussed to develop AUC-derived measures for the application in particular analysis situations, especially capturing the extent of undercutting or exceeding a given threshold.
Results: The presented formulas provide an extension of the well-established AUC formulas for respective situations where threshold-dependent subareas of the entire AUC are of interest. To our knowledge, the proposed formulas have been introduced for the first time. Their application to real-world data sets demonstrated the ability to flexibly calculate AUCs of specific interest.
Conclusions: The extended AUC formulas presented in this paper may help to answer research questions more properly in situations where particular thresholds have to be considered in the course of the analysis. Future developments may address the problem of missing values as well as the current limitation of a fixed threshold.
Socio-economic disparities in the appropriateness of diabetes care in an Italian region: findings of AEQUITAS study
Authors: Gesuita Rosaria , Piraccini Francesca , Skrami Edlira , Paolini Italo , Sebastianelli Giuliano , Stramenga Carlo , Bartolucci Dario , Marcobelli Alberico , Romagnoli Fabio , Silvestrini Giulia , Ricciardi Walter , Damiani Gianfranco , Carle Flavia 
Published: April 2023

Background: To evaluate socio-economic disparities in diabetes prevalence and care in Marches (a region of central Italy) in 2003-2010 through a cross-sectional study.
Methods: The databases of 52 general practitioners were mined for people with diabetes (age ≥20 years). These data were linked with records from other regional administrative databases. Healthcare disparities, specifically potentially preventable hospitalizations (PPH) related to diabetes and its complications, were analysed using participants’ gender, age, and education data and the Italian Deprivation Index. Crude, age-specific and gender-specific diabetes prevalence was estimated for each year of observation. A time-trend analysis was performed. Admissions that might have been prevented according to Agency for Healthcare Research and Quality criteria were used to calculate the PPH rate for each level of social condition indicators. Rate ratios and 95% confidence intervals were estimated with a multiple Poisson regression model.
Results: The search found 6,494 participants with diabetes mellitus aged ≥20 years. Disease prevalence ranged from 5.4% (2003) to 7.8% (2010), with a significant 0.31% positive trend. Those aged ≤44 years were at significantly higher risk of PPH than older people. A significant PPH excess was found among people living in socio-economically disadvantaged areas. Education and gender did not significantly affect PPH.
Conclusion. People with diabetes seem to use primary care services appropriately irrespective of socio-economic status. Outpatient services are not equally distributed on the regional territory; this may increase disease severity and/or the risk of diabetes complications and affect appropriateness of diabetes care.
Extent, duration and predictors of exclusive breastfeeding in a longitudinal study: adjusting for missing data using an accelerated failure time model and multiple imputation
Authors: Hayek Samah , Murad Havi , Ifrah Anneke , Shohat Tamy , Freedman Laurence S. 
Published: April 2023

Background: The World Health Organization recommends at least 6 months of exclusive breastfeeding (EBF). Longitudinal studies facilitate estimation of EBF duration, but often suffer from loss to follow-up and missing information. The study estimates the prevalence of EBF, duration and predictors of EBF duration while adjusting for missing data using multiple imputation (MI).
Methods: A longitudinal study was conducted on all women giving birth between September 2009-February 2010 in selected hospitals (N=2119). Data on EBF and socio-demographic and other characteristics were collected at birth, and at 2, 6, 12 and 24 months. Information on EBF status and duration was missing for 29%. To deal with missing data, we generated multiple datasets using logistic regression-based MI to impute missing EBF practice, and an accelerated failure time (AFT) model to impute missing duration of EBF. The latter model also identified factors associated with EBF duration.
Results: The observed 64% of women practicing EBF (95%CI; 62%-66%) was adjusted, after imputation, to 62% (95%CI; 60%-65%). After imputation, the estimated median time of EBF among women practicing EBF was 4.9 months. Predictors of EBF duration were stated intention to breastfeed, religious observance, and giving formula milk while in hospital.
Conclusion: Adjusting estimates of EBF practice and duration using MI is feasible and potentially important. Using an AFT model for EBF duration enables the execution of MI in such studies and allows direct interpretation of the impact of various factors on EBF duration.
Anthropometric predictors of dyslipidemia among adults in Saudi Arabia
Authors: A Saeed Abdalla 
Published: April 2023

Background: dyslipidemia and obesity are key independent modifiable risk factors for many non communicable chronic diseases. Patterns of association between these factors may help prevention and control. This study aims to assess the association between lipids profile and obesity among adults in Kingdom of Saudi Arabia and identify anthropometric predictors of dyslipidemia.
Methods: data were collected and analyzed from a cross-sectional study using WHO STEPwise approach that included 4 990 Saudi adults aged 15- 64 years selected by stratified, multistage, cluster random sampling technique. Lipid profiles (cholesterol categories and triglycerides) were determined spectrophotometrically by colorimetric biochemical methods. Obesity was determined by calculation of body mass index (BMI=Kg/m2), waist and hip circumferences and ratio and waist to height ratio.
Results: the overall prevalence of obesity ranged from 33.8 to 44.4 % and the overall dyslipidemia prevalence ranged from about 25 to 44% depending on type of dyslipidemia and anthropometrics used. Prevalence of dyslipidemia and mean concentration of lipids profile were generally significantly higher in obese than non obese. The indicator waist/height ratio was the significant predictor for all types of dyslipidemia and all levels of serum lipids.
Conclusions: the prevalence dyslipidemia and obesity are high and they are positively associated. Waist/height ratio was the most important predictor of dyslipidemia among adults.
Trends in avoidable hospitalization rates in Italy, 2001-2008
Authors: Rosano Aldo , De Belvis Antonio Giulio , Sferrazza Antonella , Burgio Alessandra , Ricciardi Walter , Van der Zee Jouke 
Published: April 2023

Background: hospitalization for Ambulatory Care Sensitive Conditions (AC SC), also known as avoidable hospitalization (AH) has been proposed as effect measure of the accessibility and effectiveness of primary care. In the last years in developed countries, including Italy, hospitalization rates have decreased as well as the rates of AH. The decline of AH-rates could be just an effect of the general trend of hospitalization. The objective of our study was to examine the adjusted trend of AH rates and to test possible associations with measures of primary care (re)organization.
Methods: hospital discharges from 2001 to 2008 were analyzed. Main outcome measures were hospitalization rates, both as inpatient and day hospital. ACSCs were grouped in acute conditions, preventable through early diagnoses and treatment and chronic conditions, preventable through good ongoing control and management. Expected time-series rates of AH, estimated on the hypothesis of same time trends of Total Hospitalization (TH), were compared with observed ones using a Chi Square test. Adjusted hospitalization rates were analyzed in conjunction with indicators of primary care.
Results: in the studied period, in Italy, the TH rates declined with an average decrease of 19.6%, while the decrease for AH was 16.4%. The rates of AH adjusted for the trend of TH significantly decreased only for chronic conditions. Decreasing trend of AH was correlated with the impact of reorganization of primary care in associative forms.
Conclusions: the presented methodology can be used to evaluate the real effectiveness of policies aimed at reducing hospitalization for ACSCs.