bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-world assessment of healthcare provided by the National Health Service: The network of regional Beaver research platforms
Authors: Rea Federico , Pugni Pietro , Pescini Dario , Palmieri Luigi , Giampaoli Simona , Carle Flavia , Corrao Giovanni 
Published: April 2023

Real-world evidence can provide answers on healthcare utilization and appropriateness, post-marketing drugs safety and comparative effectiveness, and cost-effectiveness profiles of healthcare pathways. Healthcare utilization databases, possibly integrated with drug and disease registries, electronic medical records, survey and cohort data (i.e. real-world data), allow to trace healthcare ‘footprints’ left from beneficiaries of National Health Service.
Beaver is a research platform available on demand to Italian regions which we developed for computing indicators of healthcare utilization and clinical outcomes, as well as for generating evidence on effectiveness and cost-effectiveness profile. Two distinct solutions may be adopted. One, the so-called Beaver Light front-end allows to automatically compute health indicators of adherence to official guidelines. Two, the so-called Beaver Full front-end involves an eight-step procedure entirely driven by the study protocol.
In order to fulfil the directives recently issued by the European Parliament and Council and the Italian Authority for the protection of individual data, the platform resides in each region’s infrastructure, so limiting the free movement of electronic health data. Indeed, regional authorities should be responsible for data safety and for allowing data accessibility. The use of standardized and validated algorithms enables to obtain regional estimates that, being obtained by employing regional platforms containing data extracted with standardized procedure, may be compared and possibly summarized by using common meta-analytic techniques.
In conclusion, the Beaver regional platform is a promising tool which may contribute to stimulate healthcare research in Italy.
Quality Assessment of Healthcare Databases
Authors: Carle Flavia , Di Minco Lidia , Skrami Edlira , Gesuita Rosaria , Palmieri Luigi , Giampaoli Simona , Corrao Giovanni 
Published: April 2023

The assessment of data quality and suitability plays an important role in improving the validity and generalisability of the results of studies based on secondary use of health databases. The availability of more and more updated and valid information on data quality and suitability provides data users and researchers an useful tool to optimize their activities.
In this paper, we have summarized and synthesized the main aspects of Data Quality Assessment (DQA) applied in the field of secondary use of healthcare databases, with the aim of drawing attention to the critical aspects having to be considered and developed for improving the correct and effective use of secondary sources.
Four developing features are identified: standardizing DQA methods, reporting DQA methods and results, synergy between data managers and data users, role of Institutions. Interdisciplinarity, multi-professionality and connection between government institutions, regulatory bodies, universities and the scientific community will provide the "toolbox" for i) developing standardized and shared DQA methods for health databases, ii) defining the best strategies for disseminating DQA information and results.
Socio-Economic Determinants of Household access to Health Services in Selected District of Punjab
Authors: Iftikhar Ayesha , Naqvi Syed Asif Ali 
Published: April 2023

Background: Sound health is basic right of every individual and access to health care is necessary. The right to use health services (HS) is a multifarious idea. In Pakistan provision of basic health facilities of health are inadequate. Current study was aimed at highlighting the primary reasons behind it.
Methods: This study used cross sectional data from Pakistan Social and Living Standard Measurement (PSLM) to determine the social and economic determinants of health care services in selected districts of province Punjab. Logistic regression technique is used to measure the impact of selected variables on health access.
Results: Results of the study showed that the health access services in the district of Faisalabad are greater as compared to the Rawalpindi and Layyah districts. Moreover, people were using private health facilities as compared to government health facilities.
Conclusion: The study indicated that the education level, household (HH) head gender, work status, region and place of residence, and economic situation, affect the health access services in selected regions. Measures should be taken to reduce the monopoly of private health sector by providing better government health facilities.
Parents Knowledge, attitude and practice of antibiotic use for upper respiratory tract infections in children: a cross-sectional study in Ras Al khaimah, United Arab Emirates
Authors: Salama Rasha Aziz , Bader Kussai Nidam , Rahmen Abeer Sharmen , Hashmi Fatima 
Published: April 2023

Background: Upper respiratory tract infections are common in children and represent a significant cause of antibiotic abuse. Parents’ knowledge and attitudes often contribute to inappropriate prescription of antibiotics and promoting antibiotics resistance. The study aimed at exploring parental knowledge, attitudes and practices towards antibiotic use in children with URTI along with identifying the reasons behind self-medication and abuse of antibiotics
Methods: A cross sectional survey was conducted at pediatric outpatient clinics of Saqr Hospital in the emirate of Ras Al Khaimah,United Arab Emirates A structured interview questionnaire was used to collect data from 239 parents of children aged less than7 years, between February to March 2016
Results: More than half (54.4%) of the respondents had a poor level of knowledge. About (66.1%) were not aware that antibiotics are indicated to treat bacterial infection. However, 67.2 % of the respondents incorrectly identified that antibiotics are used to treat viral infections. Nearly 44.5 % of the respondents were aware of antibiotic resistance in relation to its overuse. With regard to attitude, 68.2% of the respondents believed that they would be satisfied if physicians did not prescribe antibiotics for common cold. Yet, 63% would request it if physicians did not prescribefor frequent URTIs. Nearly 43.5% of respondents gave self-medication to their children mostly because of repeated similar attacks and over the counter acquisition of antibiotics. Most (82.2%) of them declared that, physicians did not provide sufficient information regarding diagnosis and therapy More than half (54.4%) of the respondents had a poor level of knowledge. About (66.1%) were not aware that antibiotics are indicated to treat bacterial infection. However, 67.2 % of the respondents incorrectly identified that antibiotics are used to treat viral infections. Nearly 44.5 % of the respondents were aware of antibiotic resistance in relation to its overuse. With regard to attitude, 68.2% of the respondents believed that they would be satisfied if physicians did not prescribe antibiotics for common cold. Yet, 63% would request it if physicians did not prescribe for frequent URTIs. Nearly 43.5% of respondents gave selfmedicationto their children mostly because of repeated similar attacks and over the counter acquisition of antibiotics. Most (82.2%) of them declared that, physicians did not provide sufficient information regarding diagnosis and therapy
Conclusions: Educational programs are needed to raise awareness and correct expectations about judicious use of antibiotics
An inverse probability weighting method for estimating the net benefit in survival analyses in observational studies
Authors: Chiba Yasutaka 
Published: April 2023

Background: Recently, in the context of randomized trials, a measure on the difference scale called the net benefit was developed for survival analysis. As this measure does not require the assumption of proportional hazards, it is an attractive new measure of the treatment effect to apply instead of the hazard ratio calculated under this assumption. However, no method for estimating it has been presented in observational studies. Therefore, we describe a simple method to estimate the net benefit adjusted for confounding.
Methods: We reviewed a method for estimating the net benefit in a randomized trial and extended it to a method that adjusts for confounding using inverse probability of treatment weights.
Results: We performed Monte Carlo simulations to test the performance of our method. The results show that our method estimated adjusted net benefits in an unbiased manner regardless of whether the assumption of proportional hazards held. In addition, we illustrated our method using data from an observational study evaluating disease-free survival of Ewing’s sarcoma patients. Our method yielded an adjusted net benefit of –0.032, whereas an existing method, used to analyze data from randomized trials, yielded an unadjusted net benefit of 0.284.
Conclusions: In observational studies with a time-to-event outcome, the net benefit adjusted for confounding can readily be estimated using inverse probability of treatment weights.
Correction for potentially inappropriate prescribing can increase specificity when using drug prescriptions as an adjunct to diagnostic codes to assess comorbidities in older patients
Authors: Fiorini Gianfrancesco , Castagna Alberto , Cerri Cesare , Rega Vincenzo , Rigamonti Antonello E. , Cella Silvano G. 
Published: April 2023

Background: Comorbidities are a growing problem in older patients in many clinical settings, but electronic records may give an unsatisfactory picture of this complexity. Analysis of drug prescriptions can add further diagnostic information to that gathered from billing diagnostic codes, but the risk exhists that potentially inappropriate prescriptions may lead to over-estimating comorbidities.
Methods: We analysed the administrative records and drug prescriptions of the 304 patients discharged during 2016 from a neurological rehabilitation unit. International Classification of Diseases – 9th revision diagnostic codes were matched with prescriptions at discharge, coded according to the Anatomical Therapeutic Chemical classification. The codes of the prescriptions not explained by the diagnostic codes were recorded, grouped, corrected for potential inappropriate prescribing, and analysed.
Results: Of the 304 patients, 295 had at least one prescribed drug not inferable from their diagnostic codes. The mean number of these prescriptions was 3.5 ± 1.9 per patient, and that of prescriptions remaining after correction for potentially inappropriate prescribing was 2.0 ± 1.5. The more frequent groups of potentially inappropriate medications were anti-acids, psychotropic drugs, laxatives, potassium supplements, cardiovascular drugs and lipid modifying agents. Administrative databases underestimate the complexity of older patients in neurological rehabilitation wards. More reliable data can be obtained by adding the analysis of drug prescriptions, but correction for potentially inappropriate prescription seems necessary to avoid an over-estimation of comorbidities.
Social Media’s Influence on Parents’ Decision-Making Process of Child Vaccinations
Authors: Wachob David , Boldy Amanda 
Published: April 2023

Background: This study examined parent perceptions towards child vaccinations, and sources used leading to inoculation decisions.
Methods: A survey was electronically dispersed to parents to examine their perceptions of vaccinations, what source they used to form their decisions, and whether or not they have their children vaccinated.
Results: Significant differences on perceptions about vaccinations, those who followed the recommended vaccination schedule, and what sources of information they used were found. There was a significant relationship between parents who ranked using social media as their primary source and reports that they did not, or will not, vaccinate their children.
Conclusions: Where parents obtain health-related information was shown to be a significant factor on vaccine perceptions and whether children were inoculated or not.
The role of coffee consumption in breast and ovarian cancer risk: updated meta-analyses
Authors: Bamia Christina , Turati Federica , Guha Neela , Van den Brandt Piet , Loomis Dana , Ferraroni Monica , La Vecchia Carlo , Tavani Alessandra , Guercio Valentina 
Published: April 2023

Background: Coffee consumption in relation to female hormone-related cancers has been investigated but metaanalyses regarding breast and ovarian cancer include studies published up to 2012 with inconsistent results for ovarian cancer.
Methods: We conducted two updated meta-analyses of studies published up to June 2016 to quantify the association of coffee intake with breast and ovarian cancer risk with random effects models. We used the dataset developed by the International Agency for Research on Cancer Working Group for Monograph 116 meeting (May 2016). We additionally performed a PubMed search in June 2016.
Results: Summary relative risks (RRs) (95% confidence intervals (CI)) for the study-specific highest vs. lowest coffee consumption were for breast and ovarian cancer respectively: 0.97 (0.93–1.00, Ι2 5.5%, 40 studies, 76,728 cases) and 1.03 (0.93–1.14, Ι 2 31.9%, 31 studies, 13,111 cases). For decaffeinated coffee the corresponding RRs were: 1.00 (0.93-1.08, I2 32.2%, 13 studies) and 0.83 (0.71-0.96, I2 about 0%, 9 studies). The association of coffee with ovarian cancer risk was higher among publications before (RR=1.37, 1.12–1.69) compared to after 2000 (RR=0.96, 0.86-1.06).
Conclusion: Our meta-analyses provide strong, quantitative evidence that coffee consumption is not related to breast cancer risk and appears to be unrelated to ovarian cancer risk.
Improving Homecare Risk Management and Patient Safety
Authors: Lauta Enrico , Abbinante Crescenza , Maiellaro Lorenza , Rizzi Ruggiero , Dormio Pietro , Defilippis Vincenzo 
Published: April 2023

Background: Risk management in the domiciliary healthcare setting is a harder challenge than in a hospital environment. Many, not always predictable, variables related to the patient, the caregiver, the health professionals and the home environment make it impossible to guarantee complete safety in homecare. The first aim of the study was to verify that the Electrical Medical Devices (EMD) and medical Consumables Supplies (CS) provided to mechanically ventilated and artificially fed patients at home comply with requirements for safe homecare.
Methods: We conducted a Failure Modes, Effects and Criticality Analysis (FMECA) on two processes, mechanical ventilation and artificial feeding at home, and defined a local institutional list of the requirements for safe home healthcare; a checklist containing all the items in the list was administered to ventilated and artificially fed patients at home.
Results: The checklist was used for 92 home patients, sex M/F=52/40, mean age 59,8±22 years (range 2÷102 years). Many failures were highlighted when the checklist was applied and problems affecting AMBU resuscitator bags, tracheostomy tubes, ventilators in patients being mechanically ventilated around-the-clock and ventilator circuits were identified as the most critical potential vulnerabilities for homecare patients.
Conclusion: The checklist is a simple and valid tool for implementing proactive clinical risk management initiatives in homecare. Although it is impossible to guarantee complete safety in any healthcare environment, scheduling periodic checks with checklists to assess the quantitative and qualitative adequacy of EMD and CS provided to the patient could contribute to the homecare risk reduction.
Determinants of vitamin D deficiency among Bangladeshi children: A hospital based case-control study
Authors: Hawlader Mohammad DH , Zaman Sanjana , Rahman Moshiur , Khan Mohammad NM , Hossain Aazia , Ahsan Gias U 
Published: April 2023

Background: Risk factors of vitamin D deficiency among children have been identified in many developed countries but not yet in some developing countries like Bangladesh. Therefore, the aim of this study was to identify the determinants of vitamin D deficiency among Bangladeshi children.
Methods: This case-control study was conducted at 2 paediatric hospitals in Dhaka city from January to June 2017. We recruited 198 vitamin D deficient cases and 198 apparently healthy controls. Data were analyzed using IBM SPSS, where quantitative variables were analyzed using descriptive statistics. The association between vitamin D deficiency with different lifestyle and dietary factors were analyzed by using Chi-square test. A 2-tailed p-value less than 0.05 were considered as statistically significant. Univariate and multivariate logistic regression analysis were performed to confirm the association.
Results: The study revealed that not playing outdoor games (OR=3.09; 95% CI 1.46, 6.54), playing video/ TV/mobile games (OR=4.14; 95% CI 1.97-8.67), no sun exposure (OR=2.42; 95% CI 1.25-4.67), no milk consumption (OR=3.01; 95% CI 1.38-6.57), no sea fish consumption (OR=2.20; 95% CI 1.19-4.08) and not exclusively breastfeeding (OR=2.03; 95% CI 1.14-3.63) were significantly associated with vitamin D deficiency.
Conclusion: We concluded that improper lifestyles and nutritional habits are the key determinants of Vitamin D deficiency among Bangladeshi children. Strategy for hypovitaminosis D prevention should be implemented immediately, which includes vitamin D supplementation of breastfed infants and ensuring adequate maternal vitamin D status during pregnancy. Also an awareness program should be initiated to promote a healthy lifestyle and to improve nutritional habits.
Teaching medical statistics to undergraduate medical students: what is taught and what is really useful for a medical professional? A report of the Education Committee of the Italian Society of Medical Statistics and Clinical Epidemiology (SISMEC)
Authors: Gallo Ciro , Cavallo Franco , Bossi Anna 
Published: April 2023

Background: There is a large heterogeneity among the courses of medical statistics in Italian Medical Schools.
Aims: (1) To describe issues that are dealt with in the statistics undergraduate medical courses in Italian medical Schools. (2) To investigate which methodological topics are deemed as more useful for the education of undergraduate medical students by clinical teachers.
Methods: (1) An online questionnaire, covering the qualifying teaching issues of medical statistics, was sent to all academic biostatisticians, asking what they were teaching to undergraduate medical students. The reference year was 2015-2016. Undergraduate medical courses were the statistical units. (2) A second survey involved teachers of other medical disciplines with institutional roles, asking to score the usefulness for medical education of a number of topics concerning medical statistics, on a 5-point Likert scale. Only descriptive analyses were performed.
Results: Fifty-two (96%) case report forms (CRF) were returned from teachers of medical statistics. Most statistical and epidemiological topics were taught except comparison of >2 groups, impact of biases and standardization of rates. Conversely, issues of clinical epidemiology were neglected in about half of degree courses.
Thirty-three (31%) CRFs were returned from clinical teachers. The percentage of issues deemed very useful or essential ranged from 57% to 94%, with higher scores for those referring to critical assessment of the literature.
Conclusions: More extensive coverage of clinical epidemiology issues is needed to meet the demand of physicians, as responsible consumers of quantitative research. As biostatisticians we should operate to increase the homogeneity of medical statistics teaching in medical undergraduates’ education
Factors associated with Autism Spectrum Disorder: a case-control study in the Lebanese population
Authors: Bitar Tania , Gerges Perla , Kassab Maria-Cristina , Hallit Souheil , Mattar Hanna , Soufia Michel , Andres Christian R. 
Published: April 2023

Background: Genetic factors represent the major etiological contributor in Autism Spectrum Disorders (ASD) but several studies also support the involvement of environmental factors. This last hypothesis is reinforced by the evident increase in the prevalence of this disorder in the last decades. Thus, in our study, we aimed to identify the correlation between factors related to sociodemographic elements, to child and mother’s health and ASD in order to dress a best detailed profile of the patients.
Methods: We conducted a case-control study including 64 Lebanese patients with ASD and 67 matched controls recruited from all the Lebanese districts. Our data has been analyzed by SPSS 23.0 and the statistical tests carried out were the Independent Sample t-test and the Chi-Square test. In addition, a multivariate logistic regression analysis has been carried out using variables that showed a p<0.05 in the bivariate analysis.
Results: Our findings suggest that consanguinity (OR=4; 95% CI [1.3-12.04]), familial history of ASD (6.7 [1.1- 39.3]), stress during pregnancy (3.6 [1.5 8.2]) and fetal prematurity (6.3 [1.2-33.01]) were significantly associated with increased odds of ASD. However, our results have shown no association between siblings suffering from diseases such as mental retardation, child’s infections and ASD.
Conclusion: This pilot study carried out in all the regions of Lebanon allowed us to shed the light on factors associated with ASD which might be preventable.
Effectiveness of clinical pathway in subjects with heart failure: A real-world study from Italian health claims
Authors: Rea Federico , Corrao Giovanni , Comoretto Rosanna Irene 
Published: April 2023

Background: Several process-of-care indicators have been developed and implemented to improve the quality of heart failure (HF) patients care. The aim of this study is to assess the relationship between a set of recommendations for HF care with measurable clinical outcomes, also in terms of outcomes that could be avoided.
Methods: A retrospective cohort study was carried out on subjects with at least one hospitalization with a primary diagnosis of HF in 2007. Data were retrieved from healthcare utilization databases of Lombardy region (Italy). Exposure to selected recommendations (periodic control of echocardiogram and use of blockers of the renin-angiotensin system and beta-blockers) was recorded. All cause mortality and hospitalization with primary diagnosis of HF were considered as outcomes. Multivariable Cox models and Poisson model were fitted to estimate the exposure-outcome association.
Results: Among 8207 cases of HF, those who adhered to none, one or all recommendations during the first year after diagnosis were 11%, 60% and 30%, respectively. Compared to patients who adhered to no recommendation, a significant mortality risk reduction of 24% (95% CI 17-31%) and 44% (36 52%) were observed for those who adhered to one and all recommendations, respectively. A significant reduction in the rate of re-hospitalizations in subjects adhered to at least one recommendation was also observed. A decreased trend in Population Attributable Fraction for death cases according to follow-up time was observed.
Conclusion: A strict control of patients with HF through regular clinical examinations must be considered as fundamental for the reduction of mortality and re-hospitalizations.