Search Results for: Approccio farmacologico al trattamento della stipsi indotta da oppioidi: focus su naldemedina

Objectives
In the context of demographic structure and disease spectrum changes: to study the role of the medical insurance system in providing protection and risk resilience for middle-aged and elderly vulnerable groups who are prone to impoverishment by medical expenses (IME), identify the vulnerable points and propose recommendations for improving the medical insurance system.

Setting
The research used data from the 2018 China Health and Retirement Longitudinal Study.

Participants
9184 households were included in the research ultimately.

Primary and secondary outcome measures
We use the WHO’s recommended composite measure of disease-related poverty and algorithm to determine the occurrence of IME in households. Instrumental variable probit regression model was used to target the characteristics of vulnerable groups and the influencing factors with strong correlation with IME.

Results
The overall incidence of IME is 8.25% and the high incidence is concentrated in rural populations (9.79%). The risk of IME from stroke (13.17%) has been higher than cancer (7.38%). The incidence of IME is higher in families with five types of non-communicable diseases enrolled in Urban-Rural Integrated Medical Insurance (URRMI) (min 10.00%–max 14.29%) and New Rural Cooperative Medical Insurance Scheme (NRCMS) (min 8.97%–max 15.24%) health insurance than the overall IME incidence (8.25%).

Conclusions
The medical insurance system has achieved the inclusive economic protection function for most people, but the risk resistance function for the middle-aged and older adults with multiple vulnerabilities still needs to be strengthened.,the.Finally, to address the benefit gap of the NRCMS, the next stage of medical insurance development should focus on improving the top-level design of the reimbursement framework for urban and rural resident medical insurance.

Objectives
Parkinson’s disease (PD) has become a public health concern with global ageing. With a focus on PD, this study sought to project its burden and trends at the national, regional and worldwide levels between 1990 and 2021.

Study design
Population-based study.

Methods
The Global Burden of Disease (GBD) 2021 provided the PD burden data. The GBD data are considered globally and regionally representative, as it integrates multiple data sources and employs standardised estimation methods. The age-standardised rate (ASR) and estimated annual percentage change (EAPC) were used to estimate trends in the incidence, prevalence, mortality and disability-adjusted life years (DALYs) of PD from 1990 to 2021. ASR was used to calculate the EAPCs using a linear regression model. A Bayesian age-period-cohort model was used to predict future trends up to 2046.

Results
Globally, the overall ASR of PD incidence, prevalence, DALYs and mortality increased from 1990 to 2021. The EAPCs were 1.09 (95% CI: 1.07 to 1.11) for incidence, 1.52 (95% CI: 1.49 to 1.54) for prevalence, 0.32 (95% CI: 0.28 to 0.36) for DALYs and 0.18 (95% CI: 0.13 to 0.23) for mortality. The incidence, prevalence, mortality and DALYs of PD in 2021 were higher in men than in women. The age-standardized incidence rate (ASIR) was 18.52 per 100 000 in men and 12.92 per 100 000 in women (EAPC: 1.11, 95% CI: 1.09 to 1.13 vs 1.07, 95% CI: 1.05 to 1.09). The age-standardized prevalence rate (ASPR) was 157.42 per 100 000 in men and 121.84 per 100 000 in women (EAPC: 1.70, 95% CI: 1.67 to 1.73 vs 1.25, 95% CI: 1.22 to 1.27). The ASMR was 6.57 per 100 000 in men and 3.59 per 100 000 in women (EAPC: 0.21, 95% CI: 0.14 to 0.28 vs –0.01, 95% CI: –0.04 to 0.03). The ASDR was 97.12 per 100 000 in men and 81.23 per 100 000 in women (EAPC: 0.37, 95% CI: 0.33 to 0.42 vs 0.14, 95% CI: 0.10 to 0.18). From 1990 to 2021, the burden of PD remained consistently higher in men than in women, with the gender difference widening with age. The prevalence, incidence, DALYs and mortality rates of PD increased with age before declining, peaking in the 80–84 age group for prevalence and incidence, while peaking in the 90–94 age group for mortality. DALY rates peaked in the 85–89 age group. The ASR of incidence and prevalence increased significantly in Norway (EAPC=3.39, 95% CI: 3.15 to 3.64; EAPC=5.04, 95% CI: 4.65 to 5.43). Lesotho was the nation with the highest rise in age-standardised DALYs for PD (EAPC=1.67, 95% CI: 1.41 to 1.93). The United Arab Emirates had the fastest increase in age-standardised mortality for PD (EAPC=1.98, 95% CI: 1.24 to 2.71). The global ASPR of PD is projected to show a continuous upward trend.

Conclusions
From 1990 to 2021, there were rising trends in the prevalence and burden of PD in most areas and nations worldwide. Our research indicates that the management and control of PD need significant improvement, particularly in light of the ageing population.

Introduction
Perinatal depression and anxiety (PDA) is associated with a high risk of maternal mortality. Existing data shows that 95% of maternal mortality in low- and middle-income countries (LMICs) is due to resource constraints and negligence in addressing perinatal mental health (PMH). Research conducted in more developed countries has demonstrated the potential of artificial intelligence (AI) to assist in predicting, identifying, diagnosing and treating PDA. However, there is limited knowledge regarding the utilisation of AI in LMICs where PDA disproportionately affects women. Therefore, this study aims to investigate the role of AI in predicting, identifying, diagnosing and treating PDA among pregnant women and mothers in LMICs.

Methods and analysis
This systematic review will use a patient and public involvement (PPI) approach to systematically investigate the role of AI in predicting, identifying, diagnosing, and treating PDA among pregnant women and mothers in LMICs. The study will combine secondary evidence from academic databases and primary evidence from focus group discussions and a workshop and webinar to comprehensively analyse all relevant published and reported evidence on PDA and AI from the period between January 2010 and May 2024. To gather the necessary secondary data, reputable interdisciplinary databases in the field of maternal health and AI will be used, including ACM Digital Library, CINAHL, MEDLINE, PsycINFO, Scopus and Web of Science. The extracted data will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, ensuring transparency and comprehensiveness in reporting the findings. Finally, the extracted studies will be synthesised using the integrative data synthesis approach.

Ethics and dissemination
Given the PPI approach to be employed by this study which involves multi-stakeholders including mothers with lived experience, ethical approvals have been sought from the University of Ghana and University of Alberta. Additionally, during the review process, to ensure that the articles included in this study uphold ethical standards, only peer-reviewed articles from reputable journals/databases will be included in this review. The findings from this systematic review will be disseminated through workshops, webinars, conferences, academic publications, social media and all relevant platforms available to the researchers.

PROSPERO registration number
PROSPERO (10/06/24) CRD42024549455.

Background
The proverbial gap between research and translation to the real world is a complex and multi-factorial issue that persists and threatens the impact of research. Dissemination and implementation science emerged as significant contributors to knowledge translation. Much attention has been focused on implementation, with less developed methods and work dedicated on dissemination. Our academic research centre identified the need to better understand the intersection of ageing research and dissemination science for impactful and equitable dissemination of ageing research beyond the academic audience.

Objective
We describe the purpose, deliverables, and plans of the Dissemination Special Interest Group (SIG) as a model for academic research centres to support and advance the dissemination efforts of their members.

Summary of key arguments
In the long term, achieving robust dissemination will require restructuring academic and research incentives, alongside developing infrastructure and methods to assess the impact of dissemination efforts on the translation of ageing research findings. However, actionable efforts can be taken immediately for meaningful impact.

Conclusion
Our Dissemination SIG can serve as a model for advancing and supporting dissemination within other research centres, regardless of content and focus areas. More work is needed to develop infrastructure capable of assessing the reach and impact of dissemination efforts on the adoption of research findings.

A Padova riuniti i maggiori esperti nel 37/o congresso Emsos

Introduction
Childbirth-related perineal trauma (CRPT) is the most common complication of childbirth, affecting 80% of women after a vaginal birth. However, there is a lack of evidence regarding the care of women following CRPT. Specifically, there is a lack of understanding regarding appropriate postnatal CRPT management, wound assessment and treatment of complications. To improve maternal outcomes, this qualitative study aims to explore women’s and healthcare professionals’ (HCPs) views and experiences of current CRPT wound management and healing to understand what they would want from an assessment tool and related care pathway being developed by the Chapter programme of research.

Methods and analysis
A qualitative study guided by an interpretive descriptive approach will be undertaken to explore the views and experiences around CRPT. This will be conducted through individual interviews and focus groups with women (n~40 participants) who have experienced CRPT within the last 12 months and individual interviews with HCPs (n~25) who care for women who have experienced CRPT. Supported by specialist interpreters where needed, data collection will be audio recorded and transcribed. Data will initially be analysed using codebook thematic analysis for targeted analysis and then using the Framework Method to facilitate a systematic and flexible exploration of themes within and between groups.

Ethics and dissemination
This study has received ethical approval from the University of Birmingham Science, Technology, Engineering and Mathematical Ethics Review Committee (ERN_23–0666). Supported by a Patient Advisory Group, this study will contribute to the overall outputs and dissemination of the Chapter programme of research, including a core outcome set for trials investigating the care of women experiencing CRPT, the development of a Wound Assessment Tool, professional resources and guidelines for best practice and patient resources. Findings will be disseminated via conference presentations, peer-reviewed publications, the National Institute for Health and Care Research Journals Library, relevant media platforms and plain language summaries, including infographics.

ISRCTN registration number
45172.

Introduction
The human papillomavirus (HPV) vaccine can effectively prevent cervical cancer, yet HPV vaccine uptake is particularly low in some low-income settings, due to supply and vaccine confidence barriers. HPV vaccine confidence has also been found to be lacking among healthcare workers in some countries, including Nigeria. Nigeria has a long history of low vaccine confidence in some parts of the country. HPV vaccine rumours and concerns have been observed throughout the country, including among healthcare workers. Interventions that specifically address healthcare workers’ vaccine confidence are limited, since vaccine confidence is often assumed among this group. The aim of our pilot cluster randomised control trial (cRCT) is to evaluate the feasibility of conducting a trial that evaluates codesigned interventions to improve HPV vaccine confidence in healthcare workers and the acceptability and feasibility of delivering this intervention.

Methods and analysis
This is a 3-arm pilot cRCT, using a mixed-methods approach to assess the feasibility of the trial design, alongside the feasibility and acceptability of intervention delivery in two states in Nigeria (Jigawa and Oyo). We will implement two interventions: one with a focus on digital delivery, and one with an HPV champion present at a health facility. Both will be compared with a control arm, providing standard information on HPV vaccine only. Overall, 12 trial clusters (six in Jigawa and six in Oyo), defined as government primary healthcare facilities, will be randomised using a 1:1:1 ratio, stratified by state. All healthcare workers within these facilities will be eligible to take part in the intervention and evaluation. The primary outcome of interest will be intervention uptake, as a measure of subsequent trial feasibility given concerns around contamination in control clusters. This will be assessed through an endline healthcare worker survey. Intervention feasibility and acceptability will be assessed through quantitative intervention monitoring and qualitative interviews with healthcare workers.

Ethics and dissemination
We received approval from Jigawa State Ethics Committee (ref: JGHREC/2023/151), Jigawa Ministry of Health (ref: MOH/PH/PHRAT/MN/23/003), Oyo State Research Ethics Review Committee (ref: AD/13/479/362A), The University of Ibandan and University College Hospital Research Ethics Committee (UI/UCH Ethics Committee) (ref: UI/EC/23/308) and from the Swedish National Ethics Review Board (2023-04772-01-471058). Data will be presented in manuscript form and submitted to relevant conferences for dissemination.

Registration details
The pilot trial has been registered with ISRCTN—the UK’s Clinical Study Registry, registration number ISRCTN37847119.

Introduction
The prevalence of type 2 diabetes (T2D) within sub-Saharan Africa (SSA) is increasing. Despite the pathophysiology of T2D differing by ethnicity and sex, risk stratification and guidelines for the prevention of T2D are generic, relying on evidence from studies including predominantly Europeans. Accordingly, this study aims to develop ethnic-specific and sex-specific risk prediction models for the early detection of dysglycaemia (impaired glucose tolerance and T2D) to inform clinically feasible, culturally acceptable and cost-effective risk management and prevention strategies using dietary modification in SSA and European populations.

Methods and analysis
This multinational collaboration will include the prospective cohort data from two African cohorts, the Middle-Aged Soweto Cohort from South Africa and the Research on Obesity and Diabetes among African Migrants Prospective cohort from Ghana and migrants living in Europe, and a Swedish cohort, the Pre-Swedish CArdioPulmonary bioImage Study. Targeted proteomics, as well as targeted and untargeted metabolomics, will be performed at baseline to discover known and novel ethnic-specific and sex-specific biomarkers that predict incident dysglycaemia in the different longitudinal cohorts. Dietary patterns that explain maximum variation in the biomarker profiles and that associate with dysglycaemia will be identified in the SSA and European cohorts and used to build the prototypes for dietary interventions to prevent T2D. A comparative cost-effectiveness analysis of the dietary interventions will be estimated in the different populations. Finally, the perceptions of at-risk participants and healthcare providers regarding ethnic-specific and sex-specific dietary recommendations for the prevention of T2D will be assessed using focus group discussions and in-depth interviews in South Africa, Ghana, Germany (Ghanaian migrants) and Sweden.

Ethics and dissemination
Ethical clearance has been obtained from all participating sites. The study results will be disseminated at scientific conferences and in journal publications, and through community engagement events and diabetes organisations in the respective countries.

Objective
This study aimed to assess the pooled prevalence and factors of low birth weight among newborns in the top 20 countries with the highest infant mortality rates.

Design
We conducted a community-based cross-sectional analysis using data from Demography and Health Surveys across these countries. The final analysis included a weighted sample of 82 430 live births. We employed binary logistic regression to identify predictors of low birth weight, allowing for the interpretation of results as probabilities. This approach enhances the understanding of event likelihood, which is particularly valuable for policymakers. Statistical significance was determined at a 95% CI with p values

Objectives
The scaling-up nutrition (SUN) initiative, which was launched in 2010 to eradicate malnutrition in all its forms by 2030, collaborates with a diverse range of stakeholders, such as governments, non-governmental organisations (NGOs), donors, businesses and academia. Given the widespread adoption of this multisectoral approach, it is crucial to explore methods for evaluating the perspectives of multiple stakeholders in child undernutrition topics.

Design
This scoping review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.

Data sources
Six peer-reviewed databases, including PubMed, Web of Science, Cochrane, Embase, CINAHL and PROQUEST ASSIA, were systematically searched.

Eligibility criteria
Original English studies published between 1 January 2010 and 1 June 2023, focusing on undernutrition in SUN countries.

Data extraction and synthesis
Two reviewers independently screened titles, abstracts and full texts for inclusion and extracted data using Rayyan.

Results
Out of the 4533 articles, 19 met the inclusion criteria for the review, and 5 more were added through manual searches. These studies were conducted in 14 SUN countries, with 62% using mixed methods and the remaining using qualitative methods. Six methods were used to gather stakeholder perspectives, including in-depth interviews, focus group discussions, Net-Map, organisational network analysis and Q methodology. Most studies focused on government, development partners and NGOs, while only two studies involved the business network.

Conclusions
Our study indicates that study on stakeholder perspectives in SUN countries focuses mainly on those showing progress in malnutrition/undernutrition reduction. Future research should explore countries with less progress to improve partnership frameworks. The SUN movement should establish a standard method for evaluating stakeholder perspectives, considering both outcomes and processes.

Trial registration number
The final protocol was registered prospectively with the Open Science Framework in July 2023 (https://osf.io/te7cb).

Objectives
Organ procurement coordinators (OPCs) play a pivotal role in navigating end-of-life and second-birth narratives by securing familial consent for solid organ donation. Given the low rates of cadaveric organ donation in Türkiye and worldwide, OPCs are essential in advocating for and facilitating these donations. This study explores the reasons for refusal that OPCs have encountered during the familial consent process.

Design
We gathered the data through semistructured interviews with 30 OPCs. Thematic analysis was used to identify and analyse key themes, with a specific focus on cultural, religious, spiritual and folkloric barriers contributing to the low rates of cadaveric organ donation in Türkiye.

Setting
Hospitals and organ transplant centres operating under the jurisdiction of the Ankara Regional Coordination Centre in Türkiye.

Participants
Participants were recruited using a purposeful random sampling strategy to enhance credibility and reduce bias. Eligible informants included OPCs with at least 2 years of experience in the role. Among the 30 participants, 18 were based in central organ transplant centres associated with Training and Research Hospitals in Ankara, and 12 were from peripheral city hospitals.

Results
Coordinators identified five main barriers that hinder their ability to secure familial consent for cadaveric organ donation: (1) religion, (2) concerns about the wishes of the deceased, (3) desire to choose recipients, (4) familial dynamics and (5) folklore. Each category was further contextualised through subcategories derived from the frequency and nuances of recurring themes.

Conclusion
OPCs face significant challenges in promoting cadaveric organ donations due to cultural barriers. Their experiences underscore the need for culturally competent approaches in organ donation campaigns and the importance of supporting coordinators in their roles. Enhanced cultural understanding and targeted interventions could improve cadaveric organ donation rates.

Introduction
Around 70% of people with psychosis experience auditory verbal hallucinations (AVHs), which can cause distress and impair the social functioning of the individual. AVATAR therapy works by facilitating a ‘face-to-face’ dialogue between the person and a digital representation (avatar) of their persecutory voice. Although there is cumulative evidence of this way of working with voices, enhancing the therapeutic focus on improved confidence and sense of control of the voices in social situations represents a promising way to boost generalisation of therapy gains into social contexts. We aim to enhance AVATAR therapy by incorporating immersive Virtual Reality (VR) social environments aiming to help the person to deal better with their voices in daily situations.

Methods and analysis
A randomised controlled feasibility trial will be conducted. 40 patients aged 18 or above who are at early stages of psychosis (first episode of psychosis in the last five years) and report distressing and interfering voices will be recruited. Participants will be randomised to receive either a novel, enhanced version of AVATAR therapy (AVATAR_VRSocial) in addition to usual care or usual care alone. Assessor-blinded assessments will be conducted at baseline, 3 months (post-intervention) and 6 months (follow­-up). Key therapeutic targets of AVATAR_VRSocial will be those established by the previous evidence of this approach (ie, power and control, self-esteem and future focus), while introducing exposure and management of distressing voices during social interactions. Analyses will focus on feasibility outcomes (recruitment, retention and completion rates) and preliminary estimates of intervention effects. Qualitative interviews will be carried out with participants allocated to AVATAR_VRSocial to gain a comprehensive understanding of participants’ views on the acceptability of the intervention and research procedures. Thematic analysis of the qualitative interviews will assess the acceptability of the intervention, trial procedures and the new VR technology and software involved.

Ethics and dissemination
The study has received ethical approval from the Ethics Commission at the Faculty of Psychology (Ruhr-Universität Bochum), and there is an independent Trial Steering Committee and Lived Experience Advisory Panel also supporting it. Findings will be disseminated through peer­-reviewed publications, conference presentations and science dissemination events.

Trial registration number
ISRCTN35980117.

Objectives
To investigate the prevalence and risk factors associated with burnout among residents and to explain their experiences with burnout.

Design
Mixed-methods convergent parallel study with an explanatory follow-up.

Settings
One tertiary hospital in Mirebalais and one community hospital in Saint-Marc.

Participants
Of the 127 registered residents in both settings, 26 were excluded because they were on leave. Therefore, 101 were asked to participate. We received responses from 98 residents (response rate 97.02%).

Interventions
Data collection took part in two stages: quantitative data collection was first made over a 2-week period in July 2023 using a questionnaire which included the Maslach Burnout Inventory. We simultaneously conducted a qualitative analysis based on three questions around which stress factors were related to work, personal fulfilment and social issues in the questionnaire. Second, following preliminary data results, one focus group was held with the seven chief residents to bring an in-depth understanding of the quantitative data analysis from the study questionnaire.

Primary and secondary outcomes
Sociodemographic and clinical factors linked to burnout for quantitative data. The themes explored for qualitative data were stress factors related to work, personal fulfilment and social issues. One focus group held with the chief residents explained, based on preliminary results, the main causes of burnout among medical residents, influencing factors, coping strategies and perspectives.

Results
Five major findings emerged from the quantitative data, including the following: (a) burnout prevalence was 79.59%; (b) 43% of the residents estimated working more than 80 hours/week; (c) the group with the highest burnout rates were the second-year postgraduate residents (p=0.01); (d) paediatrics and family medicine residents had the highest mean score of emotional exhaustion (p=0.01); (e) general surgery/orthopaedics and paediatrics had the highest mean score of depersonalisation (p