Search Results for: Nuovo test per distinguere tra infezioni virali e batteriche

Introduction
Regular physical activity (PA) and good motor performance are essential for children’s physical and mental health. However, historical trends suggest that levels of PA and motor performance in children and adolescents are at a low point. The relationships between PA, motor performance, health and their respective determinants, as well as their individual development throughout childhood and adolescence, are not yet fully understood. Therefore, continuous monitoring of PA, motor performance and health is needed to identify vulnerable subpopulations and provide data for policy-makers and health promotion professionals. The Motorik Monitoring 2.0-Study aims to analyse the developmental, historical and periodic trends in motor performance and PA, as well as the underlying determinants, in children and adolescents in Germany.

Methods and analysis
A representative sample of children and adolescents aged 4–17 years is drawn across 195 sample points in Germany. The assessment, carried out by test instructors, includes (1) a PA questionnaire covering different settings, including determinants, (2) anthropometric measures, (3) fine and gross motor performance tests focusing on coordination, flexibility, strength and endurance, (4) 24 hours device-based measured physical behaviour by accelerometry for 1 week and (5) a health interview focusing on health behaviour, physical and mental health as well as socioeconomic status. In addition, external data may be linked to the study using geographical information systems (eg, area deprivation, access to sports facilities). Analyses will be conducted using mixed-effects models to account for the nationwide structure of the study.

Ethics and dissemination
Ethical approval was obtained from the Ethics Committee of the Karlsruhe Institute of Technology. Results will be published in open-access scientific journals and disseminated at congresses for scientists, policy-makers and stakeholders.

Trial registration number
The study was registered in the NFDI4health database (https://csh.nfdi4health.de/resource/1034). The NFDI4health database is a central platform of the National Research Data Infrastructure for Personal Health Data. It is used to collect, manage and provide health data for scientific research and facilitates access to high-quality data for epidemiological and clinical studies.

Objective
Diabetic peripheral neuropathy (DPN) is a common and serious complication of diabetes, which can lead to foot deformity, ulceration, and even amputation. Early identification is crucial, as more than half of DPN patients are asymptomatic in the early stage. This study aimed to develop and validate multiple risk prediction models for DPN in patients with type 2 diabetes mellitus (T2DM) and to apply the Shapley Additive Explanation (SHAP) method to interpret the best-performing model and identify key risk factors for DPN.

Design
A single-centre retrospective cohort study.

Setting
The study was conducted at a tertiary teaching hospital in Hainan.

Participants and methods
Data were retrospectively collected from the electronic medical records of patients with diabetes admitted between 1 January 2021 and 28 March 2023. After data preprocessing, 73 variables were retained for baseline analysis. Feature selection was performed using univariate analysis combined with recursive feature elimination (RFE). The dataset was split into training and test sets in an 8:2 ratio, with the training set balanced via the Synthetic Minority Over-sampling Technique. Six machine learning algorithms were applied to develop prediction models for DPN. Hyperparameters were optimised using grid search with 10-fold cross-validation. Model performance was assessed using various metrics on the test set, and the SHAP method was used to interpret the best-performing model.

Results
The study included 3343 T2DM inpatients, with a median age of 60 years (IQR 53–69), and 88.6% (2962/3343) had DPN. The RFE method identified 12 key factors for model construction. Among the six models, XGBoost showed the best predictive performance, achieving an area under the curve of 0.960, accuracy of 0.927, precision of 0.969, recall of 0.948, F1-score of 0.958 and a G-mean of 0.850 on the test set. The SHAP analysis highlighted C reactive protein, total bile acids, gamma-glutamyl transpeptidase, age and lipoprotein(a) as the top five predictors of DPN.

Conclusions
The machine learning approach successfully established a DPN risk prediction model with excellent performance. The use of the interpretable SHAP method could enhance the model’s clinical applicability.

Stroke, Ahead of Print. BACKGROUND:Nonverbal cognitive deficits in poststroke aphasia remain poorly understood. They may result from direct stroke damage or disconnections of preserved cortical regions due to white matter injury, which may be worsened by white matter hyperintensities (WMH). Here, we examined the prevalence of nonverbal cognitive deficits in chronic poststroke aphasia and whether WMH-related disconnections contribute to these deficits beyond those caused by stroke lesions.METHODS:Individuals with chronic left hemisphere ischemic or hemorrhagic stroke were enrolled between 2012 and 2021. Nonverbal cognition was assessed using the Matrix Subtest of the Wechsler Adult Intelligence Scale Version IV, the Pyramids and Palm Trees Test, and the Kissing and Dancing Test. Stroke lesions and WMH masks were derived from structural magnetic resonance imaging scans. Disconnection severity from stroke lesions and WMH was quantified across association, commissural, and projection fibers using the Lesion Quantification Toolbox. Hierarchical regression models examined whether WMH-related disconnections explained additional variance in nonverbal cognitive deficits.RESULTS:Among 73 participants (mean age, 59.1±11.9 years; 61.6% male; mean time poststroke, 47.3±52.4 months), nonverbal cognitive deficits were common (Wechsler Adult Intelligence Scale, 27/58 [46.6%]; Pyramids and Palm Trees Test, 44/73 [60.3%]; Kissing and Dancing Test, 32/61 [52.5%]). Lesion-related commissural disconnections were associated with worse Kissing and Dancing Test performance (r[61]=−0.378;P=0.004), whereas WMH-related disconnections across all fiber types were linked to lower Pyramids and Palm Trees Test scores (r[73]=−0.392 to −0.462;P

Objectives
To assess the prevalence of SARS-CoV-2 antibodies in the residents of Kibera informal settlement in Nairobi, Kenya, before vaccination became widespread, and explore demographic and health-related risk factors for infection.

Design
A cross-sectional study.

Setting
Kibera informal settlement, Nairobi, Kenya.

Participants
Residents of Kibera informal settlement between October 2019 and August 2021, age 1 year and above who reported no current symptoms of COVID-19.

Main outcome measures
Associations were determined between SARS-CoV-2 positive tests measured with one rapid test and two ELISAs and demographic and health-related factors, using Pearson’s 2 test. Crude OR and adjusted OR were calculated to quantify the strength of associations between variables and seropositive status.

Results
A total of 438 participants were recruited. Most (79.2%) were age 18–50 years; females (64.2%) exceeded males. More than one-third (39.1%) were unemployed; only 7.4% were in formal, full-time employment. Less than one-quarter (22.1%) self-reported any underlying health conditions. Nearly two-thirds (64.2%) reported symptoms compatible with COVID-19 in the previous 16 months; only one (0.23%) had been hospitalised with a reported negative COVID-19 test. 370 (84.5%) participants tested positive in any of the three tests. There was no significant difference in SARS-CoV-2 seropositivity across age, sex, presence of underlying health conditions, on medication or those ever tested for SARS-CoV-2. Multiple logistic regression analysis showed that COVID-19 symptoms in the previous 16 months were the only significant independent predictor of seropositivity (p=0.0085).

Conclusion
High SARS-CoV-2 exposure with limited morbidity was found in the residents of Kibera informal settlement. The study confirms other reports of high SARS-CoV-2 exposure with limited morbidity in slum communities. Reasons cited include the high infectious disease burden on the African continent, demographic age structure and underreporting due to limited testing and lack of access to healthcare services; genetic factors may also play a role. These factors require further investigation.

Stima l’età del cuore e il rischio di infarto e ictus usando ECG

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Stroke, Ahead of Print. BACKGROUND:Chronic cerebral hypoperfusion-induced white matter lesions are an important cause of vascular cognitive impairment in aging life. TGF-β1 (transforming growth factor β1) is widely recognized as a multifunctional cytokine participating in numerous pathophysiological processes in the central nervous system. In this study, we aimed to evaluate the neuroprotective potentials of TGF-β1 in ischemic white matter lesions.METHODS:A mouse model of bilateral common carotid artery stenosis was established to imitate the ischemic white matter lesions. The agonist of the TGF-β1 pathway was continuously applied via intraperitoneal injection. The Morris water maze test and gait analysis system were used to assess the cognitive and gait disorders in modeling mice. The Luxol fast blue staining, immunofluorescence, and electron microscopy were conducted to determine the severity of demyelinating lesions, microglial activation, and dysfunction of the autophagy-lysosomal pathway in microglia. Furthermore, primary cultured microglia were exposed to extracted myelin debris and TGF-β1 in vitro to explore the underlying mechanisms.RESULTS:As evaluated by behavioral tests, TGF-β1 significantly alleviated the cognitive dysfunction and gait disorder in bilateral common carotid artery stenosis-modeling mice. The demyelinating lesion and remyelination process were also found to be highly improved by activation of the TGF-β1 pathway. The results of immunostaining and electron microscopy showed that TGF-β1 could ameliorate microglial activation and the dysfunction of lipid metabolism in myelin-engulfed microglia. Mechanistically, in primary cultured microglia exposed to myelin debris, administration of TGF-β1 notably mitigated the inflammatory response and accumulation of intracellular lipid droplets via promoting the lipid droplets degradation in the autophagy-lysosomal pathway, as quantified by flow cytometry, immunostaining, Western blot, etc. Yet, the application of autophagy inhibitor (3-methyladenine) significantly reversed the above anti-inflammatory effects of TGF-β1.CONCLUSIONS:TGF-β1 relieved cognitive deficit, demyelinating lesions, and microglia-mediated neuroinflammation in bilateral common carotid artery stenosis modeling by reducing abnormal lipid droplet accumulation and dysfunction of the autophagy-lysosomal pathway in microglia. Clinically, staged activation of the TGF-β1 pathway may become a potential target and promising treatment for ischemic white matter lesions and vascular cognitive impairment.

‘Registrato un incremento dalle 4 alle 10 volte’

Test clinici la promuovono. L’esperto: ‘Mai come sostitutivo del medico’

Stroke, Ahead of Print. BACKGROUND:Fluid-attenuated inversion recovery vascular hyperintensities (FVH) are high signal intensities on magnetic resonance imaging resulting from sluggish or stagnant flow through vessels. This investigation describes the prevalence, risk factors, and outcomes associated with FVH in pediatric arterial ischemic stroke (AIS).METHODS:Retrospective review of children aged 29 days to 18 years in a single institution stroke registry from 2006 to 2022 with AIS. Magnetic resonance imaging were assessed for large vessel occlusion (LVO), FVH score, modified Alberta Stroke Program Early Computed Tomography Score, and AIS volume. The association between demographic and imaging factors with the presence of and high FVH burden was assessed using Fisher exact, Pearson χ2, or Kruskal-Wallis tests. Wilcoxon rank-sum test evaluated the association of FVH score with the presence of LVO and poor outcome. The relationship between FVH score and age, time to magnetic resonance imaging, stroke volume, modified Alberta Stroke Program Early Computed Tomography Score, Pediatric National Institutes of Health Stroke Scale, and Pediatric Stroke Outcome Measure score were assessed using Spearman correlation. A multivariable logistic regression was used to evaluate predictors of FVH.RESULTS:In total, 273 patients with AIS were screened, and 83 met the inclusion criteria. Patients were a median age of 11.6 years (range, 1 month–18 years) and 37% were female. FVH were present in 53% of the cohort. Median FVH score was 0 (interquartile range, 0–2) in those without LVO and 5.5 (interquartile range, 3–7) in those with LVO (P

Introduction
Although many efforts have been made to reduce racial pain disparities over decades, the pain of black patients is still undertreated. Previous work has identified a host of patient and provider factors that contribute to racial disparities in healthcare in general, and consequently, may contribute to disparities in pain care in particular. That said, there has been limited clinically meaningful progress in eliminating these disparities. This lack of progress is likely because prior research has investigated the influence of patient and provider factors in isolation, rather than examining their interaction. Successful pain care requires constructive patient-provider communication, and constructive communication is both dyadic and dynamic. One well-accepted operationalisation of such dyadic processes is behavioural coordination. We hypothesise that the pain of black patients continues to be undertreated because black patients are more likely than white patients to participate in racially discordant medical interactions (ie, seeing other-race providers) and experience disruptions in behavioural coordination. We further hypothesise that disruptions in behavioural coordination will reflect patient and provider factors identified in prior research. We propose to test these hypotheses in the planned surgical context.

Methods and analysis
Using a convergent mixed methods research design, we will collect data from at least 15 surgeons and their 150 patients (approximately equal number of black and white patients per surgeon). The data sources will include one surgeon survey, four patient surveys, video- and/or audio-recordings of preoperative consultations and medical chart reviews. The recorded preoperative consultations will be analysed both qualitatively and quantitatively to assess the magnitude and pattern of behavioural coordination between patients and surgeons. Those data will be linked to survey data and data from medical chart reviews to test our hypotheses.

Ethics and dissemination
Ethical approval has been obtained from the Virginia Commonwealth University Institutional Review Board (HM20023574). Findings will be disseminated through presentations at scientific conferences, publications in peer-reviewed journals and speaking engagements with clinician stakeholders. We will also share the main findings from this project with patients via a newsletter on completion of the entire project.

Introduction
Although many efforts have been made to reduce racial pain disparities over decades, the pain of black patients is still undertreated. Previous work has identified a host of patient and provider factors that contribute to racial disparities in healthcare in general, and consequently, may contribute to disparities in pain care in particular. That said, there has been limited clinically meaningful progress in eliminating these disparities. This lack of progress is likely because prior research has investigated the influence of patient and provider factors in isolation, rather than examining their interaction. Successful pain care requires constructive patient-provider communication, and constructive communication is both dyadic and dynamic. One well-accepted operationalisation of such dyadic processes is behavioural coordination. We hypothesise that the pain of black patients continues to be undertreated because black patients are more likely than white patients to participate in racially discordant medical interactions (ie, seeing other-race providers) and experience disruptions in behavioural coordination. We further hypothesise that disruptions in behavioural coordination will reflect patient and provider factors identified in prior research. We propose to test these hypotheses in the planned surgical context.

Methods and analysis
Using a convergent mixed methods research design, we will collect data from at least 15 surgeons and their 150 patients (approximately equal number of black and white patients per surgeon). The data sources will include one surgeon survey, four patient surveys, video- and/or audio-recordings of preoperative consultations and medical chart reviews. The recorded preoperative consultations will be analysed both qualitatively and quantitatively to assess the magnitude and pattern of behavioural coordination between patients and surgeons. Those data will be linked to survey data and data from medical chart reviews to test our hypotheses.

Ethics and dissemination
Ethical approval has been obtained from the Virginia Commonwealth University Institutional Review Board (HM20023574). Findings will be disseminated through presentations at scientific conferences, publications in peer-reviewed journals and speaking engagements with clinician stakeholders. We will also share the main findings from this project with patients via a newsletter on completion of the entire project.

Objective
Malaria is a major public health concern in most developing countries, with children under 5 years being mainly at risk. We investigated the contribution of individual and community-level covariates to the risk of malaria infection (treatment with artemisinin-based combination therapy for fever or tested positive for malaria via a rapid diagnostic test within 2 weeks prior to the survey) in children under 5 years in Ghana.

Design
Population-based secondary cross-sectional study on the 2019 Ghana Malaria Indicator Survey

Setting
Ghana.

Participants and methods
Secondary malaria data on 3004 mothers and their children under 5 years from the recent 2019 Ghana Malaria Indicator Survey were analysed. Bayesian multilevel modelling under Hamiltonian Monte Carlo is applied to malaria data.

Results
The results indicate a weighted malaria prevalence of 29.7% (95% CI: 0.28 to 0.31) among children under 5, and nearly 10% (8.9%) of the risk of malaria infection significantly varied by community differences. The average annual rainfall positively correlates with the prevalence of malaria in a community, while temperature and the built-population index inversely influence it. At the cluster level, the average annual rainfall significantly increased the risk of malaria infection among children under 5 years (adjusted OR (aOR)=17.46, 95% CrI: 1.86 to 167.34). Malaria infections among children under 5 are attributed to household/individual and community-level characteristics. Children from rich households (aOR=0.66, 95% CrI: 0.50 to 0.87), who sleep under insecticide-treated nets (ITNs) (aOR=0.79, 95% CrI: 0.65 to 0.95) and are not anaemic have significantly reduced the risk of malaria infection than those from poor households, children with severe anaemia and those who do not sleep under ITNs at night. Children under 5 years from Gurma (aOR=1.82, 95% CrI: 1.92 to 2.86) ethnic backgrounds are linked to a high risk of contracting malaria, while those from the Mole-Dagbani (aOR=0.70, 95% CrI: 0.51 to 0.98) and Grusi (aOR=0.55, 95% CrI: 0.32 to 0.93) ethnic groups have significantly reduced the risk of malaria infection. All other considered factors were not significantly associated with malaria risk among children under 5 years in this study.

Conclusion
Malaria remains a serious health burden to children under 5 years. These findings call for individual and community-level measures, including improved sanitation and preventive education campaigns, to help reduce malaria infections among children under 5 in Ghana, to mitigate malaria infections among children under 5 in Ghana, thereby promoting their health and quality of life (Sustainable Development Goal 3).

Objective
Malaria is a major public health concern in most developing countries, with children under 5 years being mainly at risk. We investigated the contribution of individual and community-level covariates to the risk of malaria infection (treatment with artemisinin-based combination therapy for fever or tested positive for malaria via a rapid diagnostic test within 2 weeks prior to the survey) in children under 5 years in Ghana.

Design
Population-based secondary cross-sectional study on the 2019 Ghana Malaria Indicator Survey

Setting
Ghana.

Participants and methods
Secondary malaria data on 3004 mothers and their children under 5 years from the recent 2019 Ghana Malaria Indicator Survey were analysed. Bayesian multilevel modelling under Hamiltonian Monte Carlo is applied to malaria data.

Results
The results indicate a weighted malaria prevalence of 29.7% (95% CI: 0.28 to 0.31) among children under 5, and nearly 10% (8.9%) of the risk of malaria infection significantly varied by community differences. The average annual rainfall positively correlates with the prevalence of malaria in a community, while temperature and the built-population index inversely influence it. At the cluster level, the average annual rainfall significantly increased the risk of malaria infection among children under 5 years (adjusted OR (aOR)=17.46, 95% CrI: 1.86 to 167.34). Malaria infections among children under 5 are attributed to household/individual and community-level characteristics. Children from rich households (aOR=0.66, 95% CrI: 0.50 to 0.87), who sleep under insecticide-treated nets (ITNs) (aOR=0.79, 95% CrI: 0.65 to 0.95) and are not anaemic have significantly reduced the risk of malaria infection than those from poor households, children with severe anaemia and those who do not sleep under ITNs at night. Children under 5 years from Gurma (aOR=1.82, 95% CrI: 1.92 to 2.86) ethnic backgrounds are linked to a high risk of contracting malaria, while those from the Mole-Dagbani (aOR=0.70, 95% CrI: 0.51 to 0.98) and Grusi (aOR=0.55, 95% CrI: 0.32 to 0.93) ethnic groups have significantly reduced the risk of malaria infection. All other considered factors were not significantly associated with malaria risk among children under 5 years in this study.

Conclusion
Malaria remains a serious health burden to children under 5 years. These findings call for individual and community-level measures, including improved sanitation and preventive education campaigns, to help reduce malaria infections among children under 5 in Ghana, to mitigate malaria infections among children under 5 in Ghana, thereby promoting their health and quality of life (Sustainable Development Goal 3).

Nei test efficace contro infezioni resistenti