Risultati per: Report aggiornato sulla qualità dell’aria in Europa (2015)

Objectives
To estimate the antibiotic prescription rates for typhoid in India.

Design
Cross-sectional study.

Setting
Private sector primary care clinicians in India.

Participants
The data came from prescriptions of a panel of 4600 private sector primary care clinicians selected through a multistage stratified random sampling accounting for the region, specialty type and patient turnover. The data had 671 million prescriptions for antibiotics extracted from the IQVIA database for the years 2013, 2014 and 2015.

Primary and secondary outcome measures
Mean annual antibiotic prescription rates; sex-specific and age-specific prescription rates; distribution of antibiotic class.

Results
There were 8.98 million antibiotic prescriptions per year for typhoid, accounting for 714 prescriptions per 100 000 population. Children 10–19 years of age represented 18.6% of the total burden in the country in absolute numbers, 20–29 year age group had the highest age-specific rate, and males had a higher average rate (844/100 000) compared with females (627/100 000). Ten different antibiotics accounted for 72.4% of all prescriptions. Cefixime–ofloxacin combination was the preferred drug of choice for typhoid across all regions except the south. Combination antibiotics are the preferred choice of prescribers for adult patients, while cephalosporins are the preferred choice for children and young age. Quinolones were prescribed as monotherapy in 23.0% of cases.

Conclusions
Nationally representative private sector antibiotic prescription data during 2013–2015 indicate a higher disease burden of typhoid in India than previously estimated. The total prescription rate shows a declining trend. Young adult patients account for close to one-third of the cases and children less than 10 years account for more than a million cases annually.

New England Journal of Medicine, Volume 387, Issue 15, Page 1430-1431, October 2022.

This systematic review to support the 2022 US Preventive Services Task Force Recommendation Statement on screening for anxiety in children and adolescents summarizes published evidence on the benefits and harms of screening for and treatment of anxiety in children and adolescents 18 years or younger.

Objective
To examine factors associated with accrual rate in industry sponsored clinical trials supporting US Food and Drug Administration (FDA) cancer drug approvals from 2015 to 2020.

Design, setting and participants
Retrospective cross-sectional study included 194 pivotal trials supporting cancer drug approvals by the US FDA from 2015 to 2020.

Interventions
Clinical trials were analysed for the type of blinding, primary endpoint, whether crossover was specified in the publication, study phase, line of therapy, response rate, investigational sites, manufacturer and randomisation ratio.

Main outcome measures
The main outcome was the rate of accrual, which is the number of patients accrued in the study per open month of enrolment.

Results
The study consisted of 133 randomised (68%) and 61 (32%) non-randomised clinical trials. In randomised studies, we found the accrual rate was higher in trials investigating first and second line drugs (adjusted rate ratios (aRR): 1.55, 95% CI 1.18 to 2.09), phase III trials (aRR: 2.13, 95% CI 1.48 to 2.99), and for studies sponsored by Merck (aRR: 1.47, 95% CI 1.18 to 2.37), adjusting for other covariates. In contrast, the primary endpoint of a study, presence of crossover, single agent response rate, the number of investigational sites, population disease burden and skewed randomisation ratios were not associated with the rate of accrual. In the non-randomised adjusted model, the accrual rate was 2.03 higher (95% CI 1.10 to 3.92) for clinical trials sponsored by manufacturer, specifically Merck. Primary endpoint, crossover, trial phase, response rate, the number of investigational sites, disease burden or line of therapy were not associated with the rate of accrual.

Conclusion
In this cross-sectional study, line of therapy, study phase and manufacturer were the only factors associated with accrual rate. These findings suggest many proffered factors for speedy trial accrual are not associated with greater enrolment rates.

Objectives
To describe the development and application of methods to optimise the design of case report forms (CRFs) for clinical studies evaluating surgical procedures, illustrated with an example of abdominal stoma formation.

Design
(1) Literature reviews, to identify reported variations in surgical components of stoma formation, were supplemented by (2) intraoperative qualitative research (observations, videos and interviews), to identify unreported variations used in practice to generate (3) a ‘long list’ of items, which were rationalised using (4) consensus methods, providing a pragmatic list of CRF items to be captured in the Cohort study to Investigate the Prevention of parastomal HERnias (CIPHER) study.

Setting
Two secondary care surgical centres in England.

Participants
Patients undergoing stoma formation, surgeons undertaking stoma formation and stoma nurses.

Outcome measures
Successful identification of key CRF items to be captured in the CIPHER study.

Results
59 data items relating to stoma formation were identified and categorised within six themes: (1) surgical approach to stoma formation; (2) trephine formation; (3) reinforcing the stoma trephine with mesh; (4) use of the stoma as a specimen extraction site; (5) closure of other wounds during the procedure; and (6) spouting the stoma.

Conclusions
This study used multimodal data collection to understand and capture the technical variations in stoma formation and design bespoke CRFs for a multicentre cohort study. The CIPHER study will use the CRFs to examine associations between the technical variations in stoma formation and risks of developing a parastomal hernia.

Trial registration number
ISRCTN17573805.

Objectives
The Cardiff Model of data sharing for violence prevention is premised on the idea that the majority of injury cases presenting at health facilities as a result of interpersonal violence will not be reported to the police. The aim of this study was to determine the concordance between violent crimes reported to the police with violence-related injuries presenting at health facilities in Cape Town, South Africa.

Methods
We conducted a retrospective analysis of secondary cross-sectional health and police data, from three health facilities and three police stations in the community of Khayelitsha, Cape Town. 781 cases of injuries arising from interpersonal violence seen at health facilities were compared with 739 violence-related crimes reported at police stations over five separate week-long sampling periods from 2013 to 2015. Personal identifiers, name and surname, were used to match cases.

Results
Of the 708 cases presenting at health facilities, 104 (14.7%) were matched with police records. The addition of non-reported cases of violence-related injuries from the health dataset to the police-reported crime statistics resulted in an 81.7% increase in potential total violent crimes over the reporting period. Compared with incidents reported to the police, those not reported were more likely to involve male patients (difference: +47.0%; p

Objective
To test whether providing relevant clinical trial registry information to peer reviewers evaluating trial manuscripts decreases discrepancies between registered and published trial outcomes.

Design
Stepped wedge, cluster-randomised trial, with clusters comprised of eligible manuscripts submitted to each participating journal between 1 November 2018 and 31 October 2019.

Setting
Thirteen medical journals.

Participants
Manuscripts were eligible for inclusion if they were submitted to a participating journal during the study period, presented results from the primary analysis of a clinical trial, and were peer reviewed.

Interventions
During the control phase, there were no changes to pre-existing peer review practices. After journals crossed over into the intervention phase, peer reviewers received a data sheet describing whether trials were registered, the initial registration and enrolment dates, and the registered primary outcome(s) when enrolment began.

Main outcome measure
The presence of a clearly defined, prospectively registered primary outcome consistent with the primary outcome in the published trial manuscript, as determined by two independent outcome assessors.

Results
We included 419 manuscripts (243 control and 176 intervention). Participating journals published 43% of control-phase manuscripts and 39% of intervention-phase manuscripts (model-estimated percentage difference between intervention and control trials = –10%, 95% CI –25% to 4%). Among the 173 accepted trials, published primary outcomes were consistent with clearly defined, prospectively registered primary outcomes in 40 of 105 (38%) control-phase trials and 27 of 68 (40%) intervention-phase trials. A linear mixed model did not show evidence of a statistically significant primary outcome effect from the intervention (estimated difference between intervention and control=–6% (90% CI –27% to 15%); one-sided p value=0.68).

Conclusions
These results do not support use of the tested intervention as implemented here to increase agreement between prospectively registered and published trial outcomes. Other approaches are needed to improve the quality of outcome reporting of clinical trials.

Trial registration number
ISRCTN41225307.

Circulation, Volume 146, Issue 13, Page e185-e185, September 27, 2022.

Vas Narasimhan, ceo della multinazionale svizzera, ha avviato una trasformazione mirata per trasformare la società in una “focus medicine company” concentrata su cinque aree terapeutiche

Objective
To establish the association of the number of meals/day with overweight (Ow), obesity (Ob) and central obesity (CO).

Design
Cross-sectional, nationally representative surveys.

Setting
Colombia.

Participants
A total of 6985 children aged 5–17 years and 7846 adults aged 18–64 years were included.

Main outcomes and measures
According to the WHO, Ow was defined in children as a body mass index (BMI)-for-age Z-score between >1 and ≤2 and in adults as a BMI between ≥25 and 2 in children and as a BMI ≥30 in adults. CO in children was established by sex and age using cut-off points equivalent to those of adults established by the International Diabetes Federation: ≥90 and ≥80 cm in males and females, respectively. The number of meals/day was estimated with a Food Frequency Questionnaire. Meals/day were grouped into three categories: (reference ≤3, 4 and 5+ meals/day). Crude and adjusted relative prevalence ratios (PRs) and their 95% CIs were calculated. The adjustments included usual energy intake/day and physical activity.

Results
In children, 18.5% had Ow, 6.7% had Ob and 4.0% had CO. The adjusted PRs for five or more meals/day versus three or fewer meals/day were 1.10 (95% CI 0.79 to 1.55) for Ow, 0.95 (95% CI 0.57 to 1.59) for Ob and 1.06 (95% CI 0.72 to 1.55) for CO. In adults, 32.3% had Ow, 13.1% had Ob and 44.8% had CO. The adjusted PRs for five or more meals/day versus three or fewer meals/day were 0.58 (95% CI 0.45 to 0.76) for Ow, 0.51 (95% CI 0.36 to 0.72) for Ob and 0.70 (95% CI 0.54 to 0.92) for CO.

Conclusions
In children, meals/day were not associated with Ow, Ob or CO. In adults, this inverse relationship exists regardless of energy intake/day, whether physical activity goals are met, sex, age and other potentially confounding sociodemographic and environmental variables.

Objective
Development and testing of a comprehensive and social and culturally inclusive child-report measure of resilience factors supporting positive outcomes in the face of adversity.

Design
The measure is based on a socioecological model of resilience and was developed and revised using community-based participatory research methods with Aboriginal and refugee background communities. Pilot testing and validation of the child-report version (Child Resilience Questionnaire-Child report (CRQ- C)) is described in this paper.

Setting
Australia.

Participants
Children aged 7–12 years from culturally and socially diverse backgrounds completed the CRQ- C in the pilot (n=387) and validation study (n=775). Families recruited via hospital clinics, Aboriginal and refugee background communities and nested follow-up of participants in an existing cohort study.

Analysis
The factor structure and construct validity of CRQ-C scales were assessed using exploratory and confirmatory factor analyses. Preliminary assessment of criterion validity was conducted usinghe Strengths and Difficulties Questionnaire (SDQ). Internal consistency of final scales was assessed using Cronbach’s alpha.

Results
Conceptually developed CRQ-C was over inclusive of resilience factors and items. Exploratory factor analyses and confirmatory factor analyses supported 10 subscales reflecting personal resilience factors (positive self/future, managing emotions) and connectedness to family, school and culture. Excellent scale reliability (α=0.7–0.9) for all but one scale (Friends, α=0.6). Significant negative correlation between CRQ-C and SDQ total difficulty score supporting criterion validity (rs=–0.317, p

Objective
Contaminated reprocessed duodenoscopes pose a serious threat to patients in the endoscopy unit. Despite manufacturer changes to reprocessing guidelines, 20% of reprocessed duodenoscopes meet criteria for quarantine-level contamination based on microbiological or ATP testing. We aimed to examine risk factors for postendoscopic retrograde cholangiopancreatography (ERCP) infection.

Design
Retrospective cohort analysis.

Setting
US Medicare Fee-For-Service claims (2015–2021) and all-payer data (2017).

Participants
In the Medicare data, 823 575 ERCP procedures were included. The all-payer five-state data, 16 609 procedures were included.

Interventions
ERCP was identified by Current Procedural Terminology and International Classification of Disease (ICD) procedure codes. We identified inpatient infections using ICD diagnosis codes.

Outcome measures
A logistic regression model predicted risk factors for infections occurring within 7-day and 30-day periods following ERCP. 7-day and 30-day all-cause hospitalisations and post-ERCP pancreatitis were also examined.

Results
Post-ERCP infection occurred within 3.5% of 7-day and 7.7% of 30-day periods in Medicare. Disposable duodenoscopes were billed in 711 procedures, with 1.4% (n=10, 7-day) and 3.5% (n=25, 30-day) post-ERCP infections. Urgent ERCPs were the strongest risk factor for infections in the 7-day period (OR 3.3, 95% CI 3.2 to 3.4). Chronic conditions, sex (male), age (older) and race (non-white) were also risk factors. In the all-payer five-state data, fewer infections (2.4%, 7 days) were observed. No difference arose between Medicare and other payers for 7-day period infections (OR 1.0, 95% CI 0.7 to 1.3).

Conclusions
Urgent ERCPs, patient chronic conditions and patient demographics are post-ERCP infection risk factors. Patients with infection risk factors should be targeted for specialised infection control prevention measures, including disposable duodenoscopes.

Objective
Prior studies have reported inequitable global access to essential medicines for cardiovascular disease (CVD) prevention, especially statins. Here we examine recent trends and disparities in statin utilisation at the income group, regional and country levels.

Design
Ecological study. Pharmaceutical sales data were used to examine statin utilisation in high-income counties (HICs) and low/middle-income countries (LMICs) from 2015 to 2020. Population estimates were obtained from the Global Burden of Disease. Fixed-effects panel regression analysis was used to examine associations between statin utilisation and country-level factors.

Setting
Global, including 41 HICs and 50 LMICs.

Participants
Population older than 40 years of age.

Primary and secondary outcome measures
Statin utilisation was measured using defined daily doses (DDDs) per 1000 population ≥40 years per day (TPD).

Results
Globally, statin utilisation increased 24.7% from 54.7 DDDs/TPD in 2015 to 68.3 DDDs/TPD in 2020. However, regional and income group disparities persisted during this period. In 2020, statin utilisation was more than six times higher in HICs than LMICs (192.4 vs 28.4 DDDs/TPD, p

Circulation, Volume 146, Issue 10, Page e141-e141, September 6, 2022.

Objectives
To evaluate variability in life expectancy at birth in small areas, describe the spatial pattern of life expectancy, and examine associations between small-area socioeconomic characteristics and life expectancy in a mid-sized city of a middle-income country.

Design
Cross-sectional, using data from death registries (2015–2018) and socioeconomic characteristics data from the 2010 national population census.

Participants/setting
40 898 death records in 99 small areas of the city of Córdoba, Argentina. We summarised variability in life expectancy at birth by using the difference between the 90th and 10th percentile of the distribution of life expectancy across small areas (P90-P10 gap) and evaluated associations with small-area socioeconomic characteristics by calculating a Slope Index of Inequality in linear regression.

Primary outcome
Life expectancy at birth.

Results
The median life expectancy at birth was 80.3 years in women (P90-P10 gap=3.2 years) and 75.1 years in men (P90-P10 gap=4.6 years). We found higher life expectancies in the core and northwest parts of the city, especially among women. We found positive associations between life expectancy and better small-area socioeconomic characteristics, especially among men. Mean differences in life expectancy between the highest versus the lowest decile of area characteristics in men (women) were 3.03 (2.58), 3.52 (2.56) and 2.97 (2.31) years for % adults with high school education or above, % persons aged 15–17 attending school, and % households with water inside the dwelling, respectively. Lower values of % overcrowded households and unemployment rate were associated with longer life expectancy: mean differences comparing the lowest versus the highest decile were 3.03 and 2.73 in men and 2.57 and 2.34 years in women, respectively.

Conclusion
Life expectancy is substantially heterogeneous and patterned by socioeconomic characteristics in a mid-sized city of a middle-income country, suggesting that small-area inequities in life expectancy are not limited to large cities or high-income countries.

Objectives
To describe the relationships between axial length and intraoperative complications in patients undergoing cataract surgery.

Design
Cohort analysis of the Royal College of Ophthalmologists’ National Ophthalmology Database (RCOphth NOD).

Setting
110 National Health Service Trusts in England, Health Boards in Wales, Independent Sector Treatment Centres and Guernsey.

Participants
820 354 patients, aged 18 years or older, undergoing cataract surgery. Eligible operations were those from centres with at least 50 operations with a recorded axial length measurement and age at surgery between 1 April 2010 and 31 August 2019.

Interventions
Phacoemulsification where the primary intention was cataract surgery alone.

Outcome measures
Posterior capsule rupture (PCR) and other recorded intraoperative complications.

Results
1 211 520 eligible operations were performed by 3210 surgeons. The baseline axial length was 28 mm (long eyes) for 11 837 (1.0%) eyes. The median age at surgery was younger for patients with long eyes than those with short or medium eyes. The rate of any intraoperative complication was higher for short eyes than medium or long with complication rates of 4.5%, 2.9% and 3.3%, respectively (p