bluuebunny/crossref_metadata_2025_split huggingface dataset:
The economic burden of tuberculosis in Cyprus. A probabilistic cost of illness study.
Authors: Zannetos Savvas , Zachariadou Theodora , Adamidi Tonia , Georgiou Andreas 
Published: April 2023

Background: Tuberculosis remains a major public health problem with considerable economic burden worldwide. The aim of this study was to estimate the economic burden of tuberculosis in Cyprus during 2009.
Methods: A retrospective probabilistic incidence-based cost of illness model was developed to calculate, from the societal perspective, the economic burden of the disease including direct medical costs, direct non-medical costs and indirect costs. The bottom-up approach (person-based data) was used for the calculation of direct costs while for the calculation of indirect costs the approach of human capital was employed. In addition, probabilistic sensitivity analysis with 1000 Monte Carlo simulations was performed in order to calculate a 95% Confidence Interval (CI).
Results: Mean per patient cost of tuberculosis in Cyprus in 2009 was estimated at €12,882 (95% CI: €12,747.35 – €12,964.32). Direct medical costs accounted for 83.07% of the overall expenses, €10,675 per patient (95% CI: €10,462.07 – €10,780.59). Total direct non-medical costs of €355 (95% CI: €353.04 – 364.29) accounted for 2.77% of the overall expenses whereas 14.16% of the overall expenses were associated with the indirect cost of €1,820 (95% CI: €1,815.20 – €1,873.65).
Conclusion: For the first time in Cyprus, the cost of tuberculosis was estimated using a probabilistic incidence-based cost of illness model. Our study confirms that tuberculosis is an expensive disease for the society. In addition, it provides important information to policy makers for the comprehension of the economic consequences of tuberculosis so as they can draft the national health policy accordingly and strengthen surveillance of the disease.
Differential item functioning analysis using the SF-36 in patients with lumbar disc herniation: A quality of life research
Authors: Dehesh Tania , Mahmoodi Marzieh , Iranmanesh Farhad , Dehesh Paria , Farvahari Arash 
Published: April 2023

Background: Differential item functioning (DIF) presents when individuals from different groups perceive the meaning of items differently in health-related quality of life (HRQoL) questionnaires. The aim of this study is to distinguish DIF in the SF-36 questionnaire and to determine its effect on comparison of HRQoL scores of lumbar disc herniation (LHD) patients and a healthy population.
Methods: A total of 137 patients with LHD and 691 healthy individuals filled out the Persian version of the SF-36 questionnaire. The Rasch model was used to assess DIF for patients with LDH and a healthy population.
Results: The presence of DIF was determined in 6 of 8 (75%) domain scores between patients with LDH and healthy individuals. Although half of the DIF was categorized as either negligible (3 out of 8; 37.5%), high DIF was observed in 3 out of 8 domains (37.5%). Gender was not flagged as important to DIF, with only 3 of 8 (37.5%) categorized as negligible.
Conclusion: Because the use of the SF-36 questionnaire in HRQoL assessment between groups may not be invariant, caution should be used during comparison of HRQoL scores between heterogeneous groups.
Analysing outcome variables with floor effects due to censoring: a simulation study with longitudinal trial data
Authors: Spriensma Alette . , Eekhout Iris , De Boer Michiel R. , Luime Jolanda J. , De Jong Pascal H. , Bahçecitapar Melike Kaya , Heymans Martijn W. , Twisk Jos W.R. 
Published: April 2023

ackground: Randomised controlled trials (RCTs) are the gold standard to estimate treatment effects. When patients receive effective treatment over time they may reach the limit of a certain measurement scale. This phenomenon is known as censoring and lead to skewed distributions of the outcome variable with an excess of either low (floor effect) or high values (ceiling effect). Applying traditional methods such as linear mixed models to analyse this kind of longitudinal RCT data may result in bias of the regression parameters. To deal with floor effects due to censoring, a tobit mixed model can be used. The objective of this study was to compare the results of longitudinal linear mixed model analyses with longitudinal tobit mixed model analyses.Methods: First, a simulation study was performed in which several situations of RCTs with floor effects were simulated. Second, data from an empirical RCT was analysed with both methods.Results: Although all analyses underestimated the intervention effects, the tobit mixed model performed much better than the linear mixed model in handling floor effects. However, with an increasing number of follow-up measurements in combination with a strong floor effect estimates from the tobit mixed model were also not accurate.Conclusion: tobit mixed model analysis should be used to estimate treatments effects in longitudinal RCTs with floor effects due to censoring.
Intermediate care units in progressive patient care model: a systematic literature review
Authors: Colamesta Vittoria , Dugo Valentina , La Milia Daniele Ignazio , Sommella Lorenzo , Orsi Giovanni Battista , Bucci Roberto , De Vito Corrado , La Torre Giuseppe , Laurenti Patrizia , Mancinelli Sandro , Maurici Massimo , Damiani Gianfranco , Palombi Leonardo , Villari Paolo , De Vito Elisabetta , Ricciardi Walter 
Published: April 2023

Background: Progressive patient care (PPC) has been defined as a systematic classification and segregation of patients based on their medical and nursing needs. Aim of the present research was to perform a systematic literature review about existing medical intermediate care unit organizational models and their performance strengths and weaknesses with a specific focus on Italian implementation, respect to US model.
Methods: Databases PubMed, Cinahl, Google and Google Scholar were searched until September 2017. The search was limited to Italian and English studies. All study design are included in the review.
Results: Ten studies were included in the review. The American studies showed, after the PPC reorganization, an increase in level of satisfaction and nursing care, a reduction in average length of stay, costs and tensions between nurses and an improvement in nurse-physician communication. An Italian study reported the results of a project carried out in three case studies (Forlì, Foligno and Pontedera hospital), redesigning hospital patient flow logistics around the concept of intensity of care: in all three cases, after the reorganization, an increase in bed occupancy rate (before: 71%,81%,65%; after: 78%,84%,82%, respectively) and in hospital case-mix complexity (average DRG weight - before: 0.99,1.07,1.12; after: 1.19,1.09,1.61, respectively) and a reduction in turn-over ratio (before: 2.5,1.4,2.8; after: 1.5,1.2,1.7, respectively) was recorded. Considering Italian healthcare professionals’ point of view, majority of internists supported a hospital remodeling according to PPC model.
Conclusions: The PPC model, theorized in US, has found several applications in Italian regional realities. Improvements in quality of care, appropriateness and productivity in healthcare facilities, that adopted the PPC program, were observed.
Effect of the Irish Civil War 1922-1923 on suicide rates in Ireland: a retrospective investigation of the archives of the registrar-general for Saorstát Éireann
Authors: Osman Mugtaba , Parnell Andrew C , McCauley MacDara 
Published: April 2023

Introduction: Emile Durkheim differentiated between two types of wars: National and Civil Wars in terms of effect on suicide mortality. This study investigates Durkheim’s assertion by examining the effect of Irish Civil War on the 1882-1928 suicide rates trend.
Method: We used Auto-Regressive Integrated Moving Average with Explanatory variables (ARIMAX) design adopting Bayesian approach.
Results: The odds for death by suicide for the total Irish population during the civil war period were calculated as 0.932 (95% CI: 0.753 to 1.125). This translates to a reduction in the suicide rates by 6.7% (95% CI: 24.7% to -12.5%). The odds for death by suicide for the total Irish population during the First World War period were calculated as 0.872 (95% CI: 0.754 to 0.997). This indicates to a reduction in the suicide rates by 12.8% (95% CI: 24.6% to 0.3%).
Conclusion: Evidence from this study support a significant drop in terms of the intensity of suicidal behaviour in the Irish population during World War I more so than during the Irish Civil War.
Conflict of interest: none
Predictors of medication use during pregnancy: a cohort study
Authors: Pisa Federica , Romanese Federico , Palese Francesca , Barbone Fabio 
Published: April 2023

Background
Sociodemographic characteristics and health behaviours are associated with medication use in pregnancy, but it is unclear if they are independent predictors because women´s health status has hardly been accounted for. We aimed to identify predictors of use of medications and of iron/folic acid.
Methods
This cohort included pregnant women recruited in a prenatal clinic in Trieste, Italy, from 2007 to 2009. Dispensations were obtained from the regional outpatient dispensation database through record linkage. We calculated the Odds Ratio (OR), with 95% confidence interval (95%CI), of ≥ 1 dispensation of (a) any medication and (b) iron/folic acid, using unconditional logistic regression. The final model adjusted for age, partner education, housing size, comorbidities.

Findings
Of 767 women, 70.5% had ≥ 1 dispensation of any medication and 46.1% of iron/folic acid. Use of any medication was predicted by immigrant status of the woman (OR 1.21; 95%CI 0.57–2.53) or of her partner (1.51; 0.67–3.40), ≤ high school degree of the woman (1.11; 0.61–2.03) or of her partner (1.21; 0.75–1.95), unemployment (1.47; 0.72–2.98), smoking (1.25; 0.65–2.40), alcohol consumption (≥5 drinks/week: 2.78; 1.78–4.34), and obesity (1.33; 0.59–2.99). Use of iron and/or folic acid was predicted by ≤ high school degree (0.65; 0.40–1.08), smoking (0.80: 0.47–1.37), and obesity (0.62; 0.31–1.25).
Discussion
In this cohort, characteristics including education, immigrant and employment status, smoking, alcohol consumption, and obesity independently predicted medication use. Interventions to promote safe use of medications should carefully consider women´s characteristics.
Handling missing continuous outcome data in a Bayesian network meta-analysis
Authors: Azzolina Danila , Baldi Ileana , Minto Clara , Bottigliengo Daniele , Lorenzoni Giulia , Gregori Dario 
Published: April 2023

Background: A Bayesian network meta-analysis (NMA) model is a statistical method aimed at estimating the relative effects of multiple interventions against the same disease. The method has recently gained prominence, leading to the synthesis of the evidence regarding rank probabilities for each treatment. In several cases, an NMA is performed excluding incomplete data of studies retrieved through a systematic review, resulting in a loss of precision and power.
Methods: There are several methods for handling missing or incomplete data in an NMA framework, especially for continuous outcomes. In certain cases, only baseline and follow-up measurements are available; in this framework, to obtain data regarding mean changes, it is necessary to consider the pre-post study correlation. In this context, in a Bayesian setting, several authors suggest imputation strategies for pre-post correlation. In other cases, a variability measure associated with a mean change score might be unavailable. Different imputation methods have been suggested, such as those based on maximum standard deviation imputation. The purpose of this study is to verify the robustness of Bayesian NMA models concerning different imputation strategies through simulations.
Results: Simulation results show that the bias is notably small for every scenario, confirming that rankings provided by models are robust concerning different imputation methods in several heterogeneity-correlation settings.
Conclusions: This NMA method seems to be more robust to missing data imputation when data reported in different studies are generated in a low-heterogeneity scenario. The NMA method seems to be more robust to missing value imputation if the expectation of the prior distribution, defined on the heterogeneity parameter, approaches the true value of the variability across studies.
A framework for assessing the impact of health research from a broad population perspective
Authors: Buja Alessandra , Bertoncello Chiara , Claus Mirko , Demiraj Kreald , Castoro Massimo , Baldovin Tatjana , Baldo Vincenzo , Damiani Gianfranco , Cocchio Silvia 
Published: April 2023

Abstract

Background: research in the health sector is an activity associated with an uncertain return on investment. This study aims to outline a multidimensional framework for assessing the imact of research funded by public (or mixed public and private) sponsors.
Methods: a focus group representing different stakeholders was created to develop a sense of purpose that would be shared by the intended beneficiaries of the research assessment process, and others with a direct or indirect interest in a program’s implementation.
Results: a framework was designed that takes a holistic approach to the impact of research in which not only technical, but also economic, social and political dimensions are interrelated with the results achieved for the population and health services.
Conclusions: the framework reflected the views of different stakeholders, favoring the development of the positive, proactive relationships essential to orienting the process of transforming the evidence emerging from research into action for health.
Accreditation and Quality in the Italian National Health Care System: a 10 years long review
Authors: Lazzeri Giacomo , Troiano Gianmarco , Centauri Federica , Mezzatesta Vincenzo , Presicce Giorgio , Porchia Barbara , Matarrese Daniela , Dori Fabrizio , Gusinu Roberto 
Published: April 2023

Background: Italian accreditation and OECI accreditation are recognized as tools to ensure an adequate level of quality in healthcare setting. The aim of our study was to review the scientific literature about these topics looking for original experiences of accreditation.
Methods: In March-April 2019 we conducted a search on original peer-reviewed papers in the electronic database PubMed (MEDLINE). The key search terms were “accreditation AND Italy”, “hospital accreditation AND Italy”. We looked for studies published between 2009 and 2019, reporting information about Accreditation experiences. 13.
Results: The literature search yielded 562 publications. Finally, we identified 16 manuscripts eligible for the review. The studies were published between 2010 and 2016; they were conducted from 2007 to 2015; they involved a minimum of 1 to a maximum of 183 centres located in different Italian regions and cities. They concerned different fields such as oncology, haematology, health physics, health direction, paediatrics, and surgery. Accreditation led to a general enhancement of quality, and offered suggestions for further improvement.
Conclusion: Each healthcare system should achieve the best possible levels of quality and safety.
Accreditation, combined with further strategies could ensure the highest level of quality.
Drug resistance patterns of Mycobacterium tuberculosis complex and risk factors associated with multidrug-resistant tuberculosis in the upper southern part of Thailand
Authors: Boonrod Tum , Ingsrisawang Lily , Pungrassami Petchawan , Sengsong Supattra , Bromnavej Arisa , Waseewiwat Pinkamon , Sreevijit Natthapakam , Bunsanong Bunrit , Bunsin Chusri 
Published: April 2023

Background: this study aimed to assess the drug resistant pattern of Mycobacterium tuberculosis complex (MTBC) and the risk factors associated to multidrug-resistant tuberculosis cases (MDR-TB) in upper part of southern Thailand.
Methods: a total of 3238 TB cases was retrieved from a database of the office of prevention and control disease region 11. Only 1008 cases were confirmed by culture growth for Mycobacterium tuberculosis and drug-susceptibility testing (DST) during a period of 4 years (January 2013 to December 2016). The risk factors, including gender, age group, residence place, and history of treatment were analysed using multivariate logistic regression to predict the MDR-TB cases.
Results: among 1008 TB cases included in study, 77.4% of them were males, 31.5% lived in rural area with median age of 45.0 years (IQR = 23.0), 27.6% were retreatment for tuberculosis, 25.9%, 10.8%, 3.0%, 10.7% and 9.1 were determined to be resistant to isoniazid, rifampicin, ethambutol, streptomycin and MDR-TB, respectively. Adjusted odds ratios (95% confidence interval) of MDR-TB were 5.4 (2.68-11.03), and 4.2 (2.10, 8.45) for retreatment patients, and on treatment patients, respectively.
Conclusions: drug resistance tuberculosis is considerable problem in upper part of southern Thailand. Major risk factors involved previous history of TB treatment. Thus, it emphasizes on patients who had a history of previous TB treatment.
Strategies to achieve HPV-related disease control in Italy: results from an integrative approach
Authors: Acampora Anna , Grossi Adriano , Barbara Andrea , Causio Francesco Andrea , Calabrò Giovanna Elisa , Cicchetti Americo , De Waure Chiara 
Published: April 2023

Background: achieving Human Papilloma Virus (HPV) - related diseases control is an important challenge in public health. In Italy HPV vaccination uptake does not rise a sufficient level. The aim of this project is to identify strategies to promote HPV vaccination in Italy.
Methods: an integrated approach consisting of a systematic review and a two-step panel consultation was used to identify strategies to increase vaccination uptake among adolescents, population target of the national vaccination program, and to promote vaccination in additional targets. Overall, ten experts in the fields of Gynecology, Public Health, General Practice and Pediatrics were involved along with Patients representatives. Recommendations were elaborated according to a set of criteria drawn from the Evidence to Decision (EtD) framework.
Results: the systematic review led to the identification of three categories of strategies: reminds, education and multicomponent approaches respectively. A strong recommendation was formulated to use reminds tailored to vaccine recipients or their parents, and a moderate recommendation to use reminds directed to health professionals. A moderate recommendation was developed on the implementation of multicomponent interventions. A strong recommendation was yielded with respect to the promotion of HPV vaccination among women already treated for HPV-related diseases, fertile women not previously vaccinated and 25 year-old women undergoing cervical cancer screening. Lastly, a strong recommendation was formulated for catch-up initiatives targeted to women and men turning 18 years of age.
Conclusion: this project led to the identification of several valuable strategies to improve HPV vaccination and strengthen HPV-related diseases control at national level.
Task shifting to enhanced physical therapy in musculoskeletal secondary care. An evidence-based narrative review
Authors: Pennestrì Federico , Banfi Giuseppe 
Published: April 2023

Background: The World Health Organization defines task shifting as the rational redistribution of tasks among the healthcare workforce teams. The transfer of tasks to physical therapy is well suited for musculoskeletal conditions, either where exercise and physical activity are an important part of the treatment, or to sort the flow of emergency patients.
Methods: What are the benefits, limits and implementation challenges associated to the employment of enhanced physical therapy in the redistribution of secondary healthcare workforce? The aim of this narrative review is to collect evidence from the most recent publications, in order to address clinical studies, policy making and further research.
Results: A clear correlation between healthcare system and type of service was not found, supporting that task shifting can be employed to meet different needs. In emergency departments, enhanced physical therapists are employed to improve the flow of musculoskeletal patients, reduce waiting time, length of stay and free up professionals in support of more complex conditions. Otherwise, enhanced physical therapists are employed to sort the flow of chronic musculoskeletal patients, triaging to orthopaedic surgery, and performing follow-up. Clinical outcomes were equal or better than those achieved by other professionals. Appropriate diagnoses and referrals were also demonstrated, despite two studies show enhanced physical therapy to be effective but dependent by medical support. Specific training is therefore fundamental.
Conclusion: Task shifting is a promising innovation which is worthy introducing in the management of chronic musculoskeletal conditions, when most of the treatments may be repeated under the supervision of medical consultants.
CD4 Count Progression of Adult HIV Patients Under Art Follow Up At Mekelle General Hospital, Tigray Region: A Longitudinal Data Analysis Approach
Authors: Gebre Meles Hagazi , Temesgen Haftom , Alemayehu Mussie 
Published: April 2023

Background: The number of people receiving antiretroviral therapy (ART) in low- and middle-income countries continues to show encouraging growth, indicating that the global effort to scale up HIV treatment has exceeded 15 million people by the end of 2015.
Methods: A retrospective cohort study, comprising of the quantitative method of data collection was conducted among randomly selected 210 adult ART users enrolled in the first 6 months of 2011 and followed up to mid-2016 which is a five year follow up. Data were analyzed using a linear mixed model to identify the determinant factors, which importantly incorporates the effect of factors over time.
Results: Ninety-five (45%) were males and 115 (55%) were females. Composition of patients’ WHO clinical stage were; stage I (25 (11.8%)), stage II (30 (14.2%)), stage III (102 (48.8%)), and stage IV (52 (24.6%)). The mean CD4+ count at baseline was 218 cells. The progression of CD4+ count for males is lower than that of female over time (coef. =-0.0779, p-value=0.0062). There was a direct relationship between time in month and CD4+ count progression i.e., the CD4+ count progression of the adult HIV patients was increasing during the subsequent number of times measured or followed up under the ART clinic (coef. = 0.0435, p-value=0.0000). Patients with WHO stage II (coef. = -0.0982, p-value=0.0109) , stage III (coef. = -0.0884, p-value = 0.0010) and stage IV (coef. = 0.0859, p-value = 0.0095) had lower CD4+ count than the reference category WHO clinical stage I over time.
Conclusion: In conclusion, we found that the WHO clinical stage, Time, Weight, Gender and the Interaction effects of Weight with Time were significantly associated with the progression of CD4+ counts over time.