bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relevance of citizen involvement in Health Technology Assessment. A concrete application in the assessment of HPV co-testing in the Autonomous Province of Trento
Authors: Dalle Fratte Chiara Francesca , Passerini Adriano , Vivori Cinzia , Dalla Palma Paolo , Guarrera Giovanni Maria 
Published: April 2023

Background
Specific programs have been developed in the latest decades to involve patients in Health Technology Assessments (HTAs). However, there are no structured practises in Italy and citizen’ perspective is rarely included in HTA reports. Aim of this study is to explore citizen’ opinions about cervical cancer screening with Human Papillomavirus (HPV) co-testing in the Autonomous Province of Trento (PAT).
Methods
Two focus groups were conducted: one with representatives of patients’ associations, the other one with women between 31 and 64 years and their family members. Following aspects were investigated: the importance of cervical cancer screening programs; the impact of HPV test on women’ and their partners’ life; needs, expectations, and critical aspects of the new screening method.
Results
Organised screening programs are very important for all participants. HPV co-testing screening is preferred to cytology for its higher sensitivity, but different opinions came out regarding the longer screening interval after normal HPV and Pap test results. Citizen stressed that correct, clear, and unambiguous information have to be provided to the whole population (men included). A cardinal role plays the patient-doctor relationship in informing and taking care, also emotionally, of women, their partners and relatives in case of positive HPV test.
Conclusion
In order to facilitate the introduction of the new screening method, various media must be used to spread clear and unambiguous information, as well as informative and educational meetings with doctors and caregivers. Citizen perspective was included in the report for the Health Trust and played an important role in the decision process.
Bayesian Age-Period-Cohort Model of Lung Cancer Mortality
Authors: Tharu Bhikhari P. , Kafle Ram C. , Tsokos Chris P. 
Published: April 2023

Background
The objective of this study was to analyze the time trend for lung cancer mortality in the population of the USA by 5 years based on most recent available data namely to 2010. The knowledge of the mortality rates in the temporal trends is necessary to understand cancer burden.Methods
Bayesian Age-Period-Cohort model was fitted using Poisson regression with histogram smoothing prior to decompose mortality rates based on age at death, period at death, and birth-cohort.Results
Mortality rates from lung cancer increased more rapidly from age 52 years. It ended up to 325 deaths annually for 82 years on average. The mortality of younger cohorts was lower than older cohorts. The risk of lung cancer was lowered from period 1993 to recent periods.Conclusions
The fitted Bayesian Age-Period-Cohort model with histogram smoothing prior is capable of explaining mortality rate of lung cancer. The reduction in carcinogens in cigarettes and increase in smoking cessation from around 1960 might led to decreasing trend of lung cancer mortality after calendar period 1993.
Prevalence of double burden of malnutrition among urban school going Bodo children aged 5-11 years of Assam, Northeast India
Authors: Mondal Nitish , Basumatary Bardoi , Kropi Junali , Bose Kaushik 
Published: April 2023

Background: Overweight, obesity and thinness are major important determinants of adverse public health issues, which lead to the development of several preventable non-communicable disease and ill-health conditions.
Aims and objectives: The objectives of the present study were to assess the prevalence and certain socioeconomic and demographic factors affecting the double burden of malnutrition among urban children of Assam, Northeast India.
Materials and Methods: The present cross-sectional study was undertaken among 1017 (528 boys; 489 girls) the tribal Bodo children aged 5-11 years of Udalguri district of Assam, Northeast India by using the stratified random sampling method. Height and weight were obtained using standard anthropometric procedures and Body Mass Index (BMI=weight/height2, kg/m2) was calculated. The prevalence of thinness, overweight and obesity was assessed by using recently proposed age-sex specific BMI based international classification/reference of Cole et al.
Results: The overall prevalence of overweight (boys 13.45%; girls 11.04%) was found slightly greater than obesity (boys 11.93%; girls 10.02%). The result showed that 10.23% and 11.04% were suffering from thinness among boys and girls, respectively. Binary logistic regression analysis showed that the odds were found to be significantly associated with ≤ 10th standard mothers' education, 1st earning head and Rupees <10000 income households (p<0.05) for thinness. Similarly, greater risks were observed in 5-6 years, 7-9 years, ≥7 household members and a lower association with ≤ 10th standard mothers’ education for being overweight-obesity (p<0.05).
Conclusion: The emergence of overweight-obesity with higher degree of thinness, hence the prevalence of ‘double burden of malnutrition’ in this population. Appropriate nutritional intervention programmes, dissemination of nutrition related awareness among parents and community level are necessary to reduce the future possibility of double malnutrition burden among other ethnic populations of India.
Catastrophic Health Expenditure and Household Impoverishment: a case of NCDs prevalence in Kenya
Authors: Mwai Daniel , Muriithi Moses 
Published: April 2023

ntroduction and problem: Non-Communicable Diseases (NCDs) have become one of the leading causes of morbidity and mortality in Kenya. Their claim on financial and time resources adversely affects household welfare. Health care cost for NCDs in Kenya is predominantly paid by households as OOP. Health expenditure on NCD stands at 6.2% of Total Health Expenditure which is 0.4 % of the total gross domestic product of the country. This expenditure scenario could have implications on household welfare through catastrophic expenditure in Kenya. Most studies done on catastrophic expenditure in Kenya have not looked at the effect of NCD on poverty. Methodology: The paper has investigated the determinants of catastrophic health spending in a household with special focus on the NCDs. It has also investigated the effect of catastrophic expenditure on household welfare.A National household level survey data on expenditure and utilization is used. Controlling for endogeneity, the results revealed that NCDs and communicable diseases contribute significantly to the likelihood of a household incurring catastrophic expenditure. Results: Although all types of sicknesses have negative effects on household welfare, NCDs have more severe impacts on impoverishment. Policy wise, government and development partners should put in place a health financing plan entailing health insurance and resource pooling as a mean towards social protection.
Key words: ,
Psychological symptoms and quality of life in a population living in the "New Towns" of L'Aquila after he 2009 earthquake
Authors: Grappasonni Iolanda , Petrelli Fabio , Traini Enea , Grifantini Giuliana , Mari Massimo , Signorelli Carlo 
Published: April 2023

Background: Following the earthquake in L'Aquila of 04.06.2009 more than 65,000 people lost their homes. In order to provide rapid accommodation to those people, the Italian Government implemented the CASE project (Complex Anti-seismic Sustainable Environment-friendly), with the construction of 19 "New town" in the surrounding areas of the city. The New towns are built in rural areas, far from the center of the city, without many basic services. The purpose of this study was to evaluate the prevalence of mental disorders, the levels of psychological symptoms and quality of life in a sample of the population living in such reality.
Methods: Brief Symptom Inventory (BSI), the Impact of Events Scale-Revised (IES-R), and the Manchester Short Assessment of Quality of Life (MANSA), were used.
Results: 107 people were interviewed. The mean scores of the GSI of the BSI were 0.70 (SD=0.55). The total score of the IES-R scale was used and the cut-off represented by the 33 value, was exceeded by 59.81% of the sample. The average value was 37.85 (SD=19.49) (range 0-83). 14 people of them (21.88%) obtained an average value ≥ 60. The mean score on the MANSA was 4.5 (SD=0.98), range 1.8-6.3.
Conclusion: From the results, it appears that this housing solution could be an additional element of trauma that overlaps with that suffered during the quake.
The Comparison of Hookah Smoking Prevalence in Medical Students between 2009 and 2014
Authors: Nakhostin-Roohi Babak 
Published: April 2023

Background: Hookah smoking is increasing worldwide. It is estimated the worldwide prevalence of daily hookah smoking is 100 million. The aim of this study was to compare hookah smoking prevalence in Islamic Azad University medical students in the city of Ardabil between 2009 and 2014.
Method: Of 2956 Islamic Azad University medical students, Ardabil branch, almost 25% of students {737 students (226 males vs. 511 females; 436 subjects at 2009 vs. 301 subjects at 2014)} were randomly selected to participate in this survey. An anonymous self-administered questionnaire was used after verbal informed consent according to the Review Committee of Ardabil Branch Islamic Azad University Medicine School approved protocol. A cluster sampling technique was used. The questions focused on gender, hookah smoking status, and students’ replies for the following issues: (1) Kind of hookah (2) Frequency of smoking (3) Motivation of hookah use (4) Place of smoking use (5) and Second-hand exposure to hookah.
Results: Hookah use showed significant decrease in male students compared with five years ago (P<0.05). Frequency of molasses (tobacco with sweetened fruit flavors and mild aromatic smoke) use has significantly enhanced among both genders in 2014 compared with 2009 (P<0.05). Furthermore, second-hand exposure to hookah was significantly higher among both nonsmoker genders at 2014 compared with 2009 (32.7% at 2014 vs. 13.2% at 2009). Conclusion: Unfortunately, in spite of knowledge promotion among medicine school students in recent years, hookah use is still prevalent among medical students. Molasses use has significantly increased and second hand exposure to tobacco has escalated since 2009.
Analysis of the role of General Practice in preventing Avoidable Hospitalisation through a multilevel approach
Authors: Rosano Aldo , Ricciardi Walter , Van der Zee Jouke 
Published: April 2023

Objective. To examine the relationship between Avoidable Hospitalisation (AH) and the activities of General Practitioners (GPs). The study was carried out in the Lazio Region (Italy) within different organizational models of primary care (PC) delivery.
Methods: Secondary data of a set of GP activities delivered to the Lazio population as listed in the Lazio GPs in 2008, were used. For each GP a set of health services delivered to the patients on their practice lists were measured. The relation between the rates of AH, acute and chronic conditions separately, and the rates of such health services were analyzed through the use of a multilevel Poisson regression model, adjusted according to patients’ health status.
Results: The study included data from all the active GPs (4,837) in the Lazio Region and their 4,666,037 registered patients. The overall AH rate of the registered patients was 7.7 per 1,000, 2.2 for acute and 5.5 for chronic conditions. The diagnostics prescription by GPs is associated with a 7% (IRR=0.93;95% C.I.:0.89-0.97) reduction of the chronic AH rate. Patients registered at GPs working within a team practice resulted in a hospitalisation rate decrease of 5% (IRR= 0.95; 95% C.I.:0.91-0.99) for avoidable acute conditions.
Conclusion: The study showed that the role of GPs in preventing AH is substantial, particularly when team practice is performed and specifically when additional diagnostics are prescribed. The study is further evidence in favor of the validity of AH as an outcome measure of quality and accessibility of primary care.
Salad Consumption in Relation to Daily Dietary Intake and Diet Quality among U.S. Adults, 2003-2012
Authors: An Ruopeng , Khan Naiman 
Published: April 2023

Backgrounds: This study examined salad consumption in relation to daily dietary intake and diet quality among U.S. adults.
Methods: Nationally representative sample came from the National Health and Nutrition Examination Survey 2003-2012 waves. Salad consumption was identified through both Food and Nutrient Database for Dietary Studies codes for salad items and combination code for components of and/or additions to salads. First-difference estimator addressed confounding bias from time-invariant unobservables (e.g., eating habits, taste preferences) by using within-individual variations in salad consumption between 2 nonconsecutive 24-hour dietary recalls.
Results: Approximately 28.7% of U.S. adults consumed salad on any given day. Among salad consumers, salad consumption occupied 12.5% of daily total energy, 62.8% vegetable, 11.9% fruit, 18.4% fiber, 9.1% sugar, 20.3% total fat, 14.7% saturated fat, 14.9% cholesterol, and 17.7% sodium intake. Compared to no salad consumption on a dietary recall day, salad consumption was associated with increased daily intake of total energy by 461.5 kJ (110.3 kcal), vegetable 85.0 g, fiber 1.0 g, sugar 5.7 g, total fat 10.0 g, saturated fat 1.3 g, cholesterol 18.7 mg, and sodium 216.3 mg. Salad consumption was associated with an increase in the Healthy Eating Index-2010 score by 4.2.
Conclusion: Salad consumption is related to better overall diet quality but also higher total energy, sugar, fat, cholesterol, and sodium intake. Interventions that promote salad consumption should provide low-energy-dense, nutrient-rich salad products. Salad consumers should prudently evaluate the caloric and nutrient content of salad in order to make informed and more healthful diet choices.
Suicide Mortality Risk in Kermanshah Province, Iran: A County-level Spatial Analysis
Authors: Rostami Mehran , Jalilian Abdollah , Ghasemi Shadi , Kamali Artin 
Published: April 2023

Background: Kermanshah province has one of the highest suicide rates in Iran. The aim of this study is to explore spatial variations in the relative risk of suicide across the counties of Kermanshah province.
Methods: This is an applied ecological study in which county-level counts of suicide deaths recorded by the forensic medicine organization of Kermanshah province during the period March 21, 2006 to March 20, 2013 have been used. Following a Bayesian approach, Besag, York and Mollie's (BYM) model was fitted to the number of suicide deaths of males, females and all persons to make inference about the relative risk of suicide across the counties of the province.
Results: Over the study period and based on 95% credible intervals, Kangavar, Harsin and Sonqor counties had significantly lower relative risks of suicide for both males and females, Slas-Babajani, Paveh, Javanrud and Ravansar counties had significantly lower relative risks of suicide only for males and Kermanshah county had a significantly higher relative risk of suicide only for males. The relative risk of suicide for the other counties were not significantly different from the province’s overall risk neither for males nor females.
Conclusion: The counties of Kermanshah province can be classified into four categories by the level of relative risk of suicide: low relative risk for both males and females, low relative risk only for males, high relative risk only for males and average relative risk. Findings from this study could be used to specify priority counties for suicide prevention initiatives.
The accuracy of currently used WHO´s Body Mass Index cut-off points to measure Overweight and Obesity in Syrian women: A correlation study
Authors: Bakir Mohammed A , Al-Bachir Mahfouz M , Hammad Kholoud B , Habil Khuzama M , Ahmad Husam H 
Published: April 2023

Purpose: Obesity is a common health problem in both developed and developing countries. BMI is commonly used to identify obesity. However, there is increasing evidence that the relationship between BMI and BF% differs among various ethnicities. The main objectives of this study are (1) to evaluate the correlation between BF% as determined by BIA, DEXA, Deuterium oxide (D2O) and BMI, (2) to assess the accuracy of currently used WHOÅLs BMI cut-off points to identify overweight and obesity among Syrian women.
Material and Methods: A total of 908 healthy Syrian women aged 18-60 years participated in this study. Weight, height, BMI, BF% assessed by BIA and DEXA, and D2O have been determined.
Results: BF% results obtained by BIA and DEXA, and D2O revealed strong correlations. BMI showed a statistically significant correlation with BF% determined by BIA, DEXA and D2O. Obesity when defined as BMI ≥ 30 and as BF% > 35% (derived from BIA, DEXA and D2O) classified 43%, 52.5%, 75.9% and 72.7% of women as obese, respectively. ROC analysis defined BMI cut-off points for overweight and obesity of 22.5 and 25.7, respectively. Using the new BMI cut-off point, the prevalence of obesity among Syrian women was increased by 24%.
Conclusions: The current BMI cut-off points recommended by WHO underestimate the prevalence of overweight and obesity among Syrian women. Our data suggests that it is important to lower the proposed WHOÅLs BMI cut-off points for the Syrian women.
Medical Students Knowledge and Attitude Towards Direct-To-Consumer Genetic Tests
Authors: Giraldi Luca , Colotto Marco , Pastorino Roberta , Arzani Dario , Vayena Effy , Ineichen Christian , Boccia Stefania 
Published: April 2023

Aims: This study reports on the attitudes of 179 Italian Medical Students to direct-to-consumer genetic test and to participation in research practices.
Methods: Data were collected using a self-completion online questionnaire sent to 380 medical students at the faculty of Medicine of the Università Cattolica del Sacro Cuore in Rome, Italy. Questions pertained issues related to awareness and attitudes towards genetic testing, reactions to hypothetical results, and views about contributing to scientific research.
Results: The response rate was 47.1%. Less than 50% of students were aware of DTC genetic test. Seventy-four percent of the sample were interested in undergoing DTC genetic test, and the main reason was being aware on genetic predisposition to diseases. Among those who were not willing to undergo a genetic test, the main reason was the lack of confidence in the results. In the hypothetical situations of an increased disease risk after undergoing DTC genetic testing, respondents would take actions to reduce that risk, while in the opposite scenario they would feel unaffected because of the probabilistic nature of the test.
Conclusions: We reported a good level of awareness about DTC genetic test and a high interest in undergoing DTC genetic test in our sample. Nevertheless, opinions and reactions are strongly dependent by the hypothetical good or bad result that the test could provide and by the context whereby a genetic test could be performed. Respondents seem to be exposed to the risk of psychological harms, and a strong regulation regarding their use is required.
Cancer Patients Missing Pain Score Information:- Application with Imputation Techniques
Authors: Vishwakarma Gajendra , Bhattacharjee Atanu , Jose Jesna , Kumar V Ramesh 
Published: April 2023

Background: Methods for handling missing data in clinical research have been getting more attentions over last few years. Contemplation of missing data in any study is vital as they may lead to considerable biases and can have an impact on the power of the study.
Objective: This manuscript is dedicated to present different techniques to handle missing observations obtained from repeatedly measured pain score data on palliative cancer.
Methods: This problem caused by subjects drop out before completion of the study. The reason for dropout or withdrawal may be related to study (e.g., adverse event, death, unpleasant study procedures, lack of improvement) or unrelated to the study (e.g., moving away, unrelated disease). The dropout might be very common on studies on palliative cancer patients. The Palliative treatment is designed to relieve symptoms, and improve the quality of life and can be used at any stage of an illness if there are troubling symptoms, such as pain or sickness.
Results: The mean(SD) of observed pain score was 3.638(3.156) whereas the imputed mean values were 3.615(2.980), 3.618(2.954), 3.577(2.892), 3.560(2.999) and 3.627(2.949) respectively for the imputation methods regression, predictive mean matching, propensity score, EM algorithm and MCMC methods for pain score values at visit3.
Interpretation and Conclusion: The EM algorithm shows the least percentage change from observed values in both visits followed by predictive mean matching method and MCMC methods. The multiple imputation techniques have few advantages; the imputed values are drawsfrom a distribution, so they inherently contain some variation by introducing an additional form of error in the parameter estimates across the imputation
Low height-for-age among Limbu and Mech children and adolescents from two districts of West Bengal, India
Authors: Banik Sudip Datta , Bhattacharjee Paramita , Mukhopadhyay Barun 
Published: April 2023

Background: Low height-for-age (stunting) is a state of chronic undernutrition in children and adolescents. Studies reported that India has very high prevalence of stunting in children, particularly from rural and tribal communities. Objective of the present study was to record prevalence of stunting in 6 to 18 year-old boys and girls from two tribal communities (Limbu and Mech) in Darjeeling and Alipurduar districts of West Bengal, India. The study also aimed to compare height-for-age of the participants with standard growth reference curves.
Methods: In this cross-sectional study, the sample comprises 1523 individuals of both sexes from Limbu (377 boys, 379 girls) and Mech (365 boys, 402 girls) communities. Height data was normalized using LMS.
Results: Overall frequency of stunting among 6 to 18 year-old boys (33%) and girls (34.7%) was remarkably high. Prevalence of stunting was higher in Limbu boys (43.5%) and girls (44.6%) than their age-peers from Mech community (boys 22.2%, girls 25.4%). Height data after normalization, shows that all centile curves of height of Limbu and Mech boys and girls are consistently below the standard height-for-age reference curves of the WHO. Limbu and Mech children appear to be taller with respect to their median (50th percentile) height when compared with the median height of children in the dataset of Indian Council of Medical Research.
Conclusion: High frequency stunting in Mech and limbu children was recorded and situation of girls was worse. There was a tendency of decline in prevalence of stunting with advancement of age among children.