Search Results for: Report aggiornato sulla qualità dell’aria in Europa (2015)

Background
Traditionally, intramuscular vitamin B12 injections were considered by patients and clinicians the most effective treatment option for B12 deficiency. The improving understanding of the condition paired with the restricted National Health Service (NHS) resources, resulted in a shift from injections towards tablets. The COVID-19 pandemic accelerated this change, while healthcare services were adapted to reduce COVID-19 transmission. This included new guidelines on vitamin B12 prescribing where injections were substituted by tablets.

Objective
We investigated changes between 2015 and 2024 in prescribing B12 injections and tablets including the effect of the COVID-19 pandemic.

Design, population and setting
This was an observational study of general practice in England covering 100% of the population.

Methods
We used prescribing data published by the NHS Business Service Authority. Monthly prescription counts and rates per 100 000 patients were visualised in longitudinal plots from 1 January 2015 to 30 September 2024. We stratified the analysis by regions in England. Changes in yearly counts and rates were summarised using descriptive statistics. Linear regression and data from before the COVID-19 pandemic were used to model trends from 2020 to 2024 as if the pandemic had not occurred. The predicted values and their 95% CI were used to assess the effect of the pandemic.

Results
The number of prescriptions for B12 formulations doubled in the last 10 years from 2.5 million to 5 million per year. The prescriptions for tablets increased from half a million in 2015 to 2 million in 2024. While the prescriptions for injections increased from 2 million to 3 million. In 2020, there was a sharp drop in prescriptions for injections and a simultaneous rapid increase in prescriptions for tablets coinciding with the onset of the pandemic. There were 806 031 (27%) less than expected prescriptions for injections (2 171 924 observed vs 2 977 956 predicted, 95% CI 2 905 348 to 3 050 565) and 299 834 (27%) more prescriptions for tablets (1 415 315 observed vs 1 115 481 predicted, 95% CI 1 094 350 to 1 136 612). After the 2020 drop, by 2024, injections returned to the prepandemic levels of 3 million prescriptions per year and tablets doubled from 1 million in 2019 to 2 million prescriptions in 2024.

Conclusions
In this study, we document important changes to vitamin B12 prescribing in England over the last 10 years. Before the pandemic, injections were the medication of choice for B12 deficiency but there had been an ongoing debate about the benefits and cost of injections over tablets. The pandemic accelerated the switch from injections to tablets. However, these changes in the pandemic were driven by the availability of resources and not necessarily clinical evidence or patient preference. To establish best practices, more evidence is needed comparing the safety and effectiveness of injections and tablets specific to the condition being treated.

Objective
This study aimed to evaluate the human papillomavirus (HPV) vaccination status among a representative sample of young adults (YAs) with a special focus on the catch-up vaccination uptake among the male population in Switzerland.

Design and setting
Data were extracted from an online self-administered questionnaire survey, conducted as a representative cross-sectional study in 2017. To understand correlations between vaccination uptake and sociodemographic characteristics, sexual health, and sexual behaviour, we performed bivariate analysis and multivariate regression analysis.

Participants
Out of a total of 7142 participants, 2155 female and 996 male cisgender participants remained for statistical evaluation after excluding homosexual/bisexual study participants, those with gender dysphoria or those without knowledge of their vaccination status.

Outcomes
The primary outcome of this study was to investigate HPV vaccination rates among female and male YAs in Switzerland. As secondary outcomes, we assessed uptake of catch-up vaccination and identified key factors influencing HPV vaccination uptake.

Results
Vaccination rates were significantly higher in the female group (40.9%), while not wanting to be vaccinated and doubting benefits and necessity of the vaccine were main reasons for non-vaccination. Vaccination coverage among male YAs was very low (7.8%), primarily due to insufficient information. Parents not being Swiss-born, a higher family socioeconomic status and having had a gynaecological visit at a younger age correlated with HPV vaccination uptake for female YAs. In the male group, participants with a higher number of lifetime partners and a younger age at first steady partnership were more likely to report a positive vaccination status. Knowledge about the benefits of catch-up vaccination was very limited among both genders.

Conclusions
The lack of knowledge about benefits of HPV vaccination contributes to low vaccine uptake, especially occurring among the male population, must be addressed. Given the number of people who reported not knowing whether they were vaccinated or not, it is crucial to ensure that there is a thorough discussion about HPV and the protection the vaccine provides when presenting for vaccination.

Report Gimbe, nel 2022 è stato di oltre 26 milioni di euro

Objectives
Primary care clinicians are especially prone to burn-out. The primary objective of this study was to investigate factors contributing to burn-out and moral distress and their relationship among practising family physicians (FPs) in California early in the COVID-19 pandemic.

Design
Cross-sectional study, online survey evaluating burn-out, moral distress and associated factors.

Setting
California FPs between July and August 2020 practising in community health centres, hospital systems, private clinics and university systems were surveyed with a 22-item online questionnaire.

Participants
FPs practising in California were eligible. The final sample included 218 physicians.

Primary and secondary outcome measures
The primary independent variable was frequency of moral distress and the primary outcome variable was worsening burn-out. Moderator variables included gender and employer support.

Results
FPs experiencing higher burn-out and moral distress were more likely to report concerns regarding personal COVID-19 risk and lack of personal protective equipment. Practising self-care and personal wellness were associated with decreased moral distress. Female physicians were 3.86-fold more likely to report worsening burn-out compared with male physicians. Employer support was associated with a 59% reduced burn-out risk and 54% reduction in frequent moral distress. Frequent moral distress was associated with a 3.12- fold higher burn-out risk. Gender moderated the relationship between moral distress and burn-out. Moral distress was associated with a 3.55-fold increase in burn-out risk among females.

Conclusions
Female FPs experienced greater levels of moral distress and burn-out than male physicians. Moral distress was differentially associated with increased burn-out among female physicians. Employer support was a protective factor against moral distress and burn-out.

In this issue of JAMA, Rademaker and colleagues report the results of a randomized noninferiority trial comparing 2 pharmacotherapy approaches for gestational diabetes: a sequential oral medication strategy vs an insulin-first strategy. Recent data suggest that more than 8% of pregnant individuals in the United States are diagnosed with gestational diabetes; of these, more than 40% may need medication to achieve recommended intensive pregnancy glycemic targets. These estimates imply that more than 100 000 pregnant people in the US will require pharmacotherapy for gestational diabetes yearly. It is well established that treatment of even “mild” gestational diabetes with lifestyle measures, self blood glucose monitoring, and (if needed) medication reduces the risk of fetal overgrowth, a canonical complication of hyperglycemia in pregnancy linked to perinatal morbidity, including birth injury and neonatal hypoglycemia.

This Viewpoint discusses changes needed at local, state, and national levels to improve child health care.

Objectives
Incontrovertible evidence surrounds the need to support healthcare professionals after patient safety incidents (PSIs). However, what characterises effective organisational support is less clearly understood and defined. This review aims to determine what support healthcare professionals want for coping with PSIs, what support interventions/approaches are currently available and which have evidence for effectiveness.

Design
Systematic research review with narrative synthesis.

Data sources
Medline, Scopus, PubMed and Web of Science databases (from 2010 to mid-2021; updated December 2022), reference lists of eligible articles and Connected Papers software.

Eligibility criteria for selecting studies
Empirical studies (1) containing information about support frontline healthcare staff want before/after a PSI, OR addressing (2) support currently available, OR (3) the effectiveness of support to help prevent/alleviate consequences of a PSI. Study quality was appraised using the Quality Assessment for Diverse Studies tool.

Results
Ninety-nine studies were identified. Staff most wanted: peer support (n=28), practical support and guidance (n=27) and professional mental health support (n=21). They mostly received: peer support (n=46), managerial support (n=23) and some form of debrief (n=15). Reports of poor PSI support were common. Eleven studies examined intervention effectiveness. Evidence was positive for the effectiveness of preventive/preparatory interventions (n=3), but mixed for peer support programmes designed to alleviate harmful consequences after PSIs (n=8). Study quality varied.

Conclusions
Beyond peer support, organisational support for PSIs appears to be misaligned with staff desires. Gaps exist in providing preparatory/preventive interventions and practical support and guidance. Reliable effectiveness data are lacking. Very few studies incorporated comparison groups or randomisation; most used self-report measures. Despite inconclusive evidence, formal peer support programmes dominate. This review illustrates a critical need to fund robust PSI-related intervention effectiveness studies to provide organisations with the evidence they need to make informed decisions when building PSI support programmes.

PROSPERO registration number
CRD42022325796.

Introduction
All grade 2/3 gliomas are incurable and at the time of inevitable relapse, patients have significant unmet needs with few effective treatments. This study aims to improve outcomes by molecular profiling of patients at relapse, then matching them with the best available drug based on their molecular profile, maximising the chances of patient benefit while simultaneously testing multiple novel drugs.

Methods and analysis
Low & Anaplastic Grade Glioma Umbrella Study of MOlecular Guided TherapieS (LUMOS-2) will be an international, phase 2, multicentre, open-label, biomarker-directed, umbrella clinical trial for recurrent isocitrate dehydrogenase mutant, histologically grade 2/3 gliomas. Investigational treatment will be assigned based on molecular profiling of contemporaneous tissue obtained at disease relapse using next-generation sequencing. LUMOS-2 will begin with three therapeutic treatment arms: paxalisib, cadonilimab and selinexor. Patient molecular profiles will be assessed by an expert, multidisciplinary Molecular Tumour Advisory Panel. Patients whose molecular profile is considered suitable for a targeted agent like paxalisib will be allocated to that arm, others will be randomised to the available arms of the trial. The primary endpoint is progression-free survival at 6 months. Secondary objectives include assessment of overall survival, response rate, safety and quality of life measures. Two additional therapeutic arms are currently in development.

Ethics and dissemination
Central ethics approval was obtained from the Sydney Local Health District Ethics Review Committee, Royal Prince Alfred Hospital Zone, Sydney, Australia (Approval: 2022/ETH02230). Other clinical sites will provide oversight through local governance processes, including obtaining informed consent from suitable participants. A report describing the results of the study will be submitted to international meetings and peer-reviewed journals.

Trial registration number
ACTRN12623000096651.

Objectives
Administrative database research is pivotal for developing guidelines in cardiovascular surgery and valvular heart disease. However, validation studies specific to Asia are lacking. This study validated the coding of valvular heart repair and replacement surgeries in Taiwan’s National Health Insurance (NHI) Research Database using International Classification of Diseases, Clinical Modification (ICD-CM) codes.

Methods
This retrospective observational study used data from the Chang Gung Research Database between 2015 and 2018, identifying 1171 patients using Taiwanese NHI reimbursement codes. The gold standard was defined as a blinded retrospective review of operation notes. Claims data, including ICD diagnostic codes, ICD procedural codes and NHI supply codes for surgical materials, were validated. Positive predictive values (PPVs) were calculated as the number of true positives divided by the total claims data.

Results
The PPVs (95% CI) for aortic valve (AV) surgery aetiologies were as follows: infectious endocarditis (IE), 94.1% (87.6%–97.7%); rheumatic heart disease (RHD), 88.2% (67.3%–97.5%); bicuspid AV, 93.3% (83.3%–98.1%); and degeneration, 91.7% (85.3%–95.8%). For mitral valve surgery, the surgery aetiologies and PPVs were IE, 93.2% (87.9%–96.6%); RHD, 94.9% (88.3%–98.2%); ischaemic mitral regurgitation, 87.5% (73.0%–95.6%); and degeneration, 88.4% (83.9%–92.0%). Surgical types generally exhibited higher PPVs, except for mechanical prostheses (

Objectives
Alzheimer’s disease (AD) poses a significant challenge for individuals aged 65 and older, being the most prevalent form of dementia. Although existing AD risk prediction tools demonstrate high accuracy, their complexity and limited accessibility restrict practical application. This study aimed to develop a convenience, efficient prediction model for AD risk using machine learning techniques.

Design and setting
We conducted a cross-sectional study with participants aged 60 and older from the National Alzheimer’s Coordinating Center. We selected personal characteristics, clinical data and psychosocial factors as baseline predictors for AD (March 2015 to December 2021). The study utilised Random Forest and Extreme Gradient Boosting (XGBoost) algorithms alongside traditional logistic regression for modelling. An oversampling method was applied to balance the data set.

Interventions
This study has no interventions.

Participants
The study included 2379 participants, of whom 507 were diagnosed with AD.

Primary and secondary outcome measures
Including accuracy, precision, recall, F1 score, etc.

Results
11 variables were critical in the training phase, including educational level, depression, insomnia, age, Body Mass Index (BMI), medication count, gender, stenting, systolic blood pressure (sbp), neurosis and rapid eye movement. The XGBoost model exhibited superior performance compared with other models, achieving area under the curve of 0.915, sensitivity of 76.2% and specificity of 92.9%. The most influential predictors were educational level, total medication count, age, sbp and BMI.

Conclusions
The proposed classifier can help guide preclinical screening of AD in the elderly population.

Objectives
The primary objectives were to identify the predictors of new permanent pacemaker implantation in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). The secondary objectives were to investigate the temporal changes in permanent pacemaker implantation following TAVI and its impact on long-term prognosis.

Design
Prospective observational cohort study of patients with AS undergoing TAVI.

Setting
Single-centre study conducted at a tertiary hospital in Western Norway between 2012 and 2019.

Participants
Among 600 consecutive patients with severe AS who were treated with TAVI, 52 patients with permanent pacemaker prior to TAVI were excluded. The remaining 548 patients were included in the present study.

Baseline measures
An evaluation of baseline risk factors, 12-lead ECG and echocardiography.

Primary outcome measures
The need for a new pacemaker implantation ≤30 days following TAVI and all-cause death.

Results
The mean age was 80.6±6.7 years, and 50% were males. Among the 548 eligible patients, 173 (31.6%) underwent pacemaker implantation ≤30 days following TAVI, evenly distributed between females and males (29.6% vs 33.6%, p=0.317), with higher implant rates at low-volume phase (2012–2015) and lower implant rates at high-volume phase (2016–2019) (45.8% vs 23.9%, p

Introduction
Sustaining evidence-based care is challenging in all clinical settings. Acute care settings have a unique set of contextual factors that may impact sustainability (eg, fast-paced, regular staff turnover). Much of the previous research explores sustainability across undifferentiated healthcare settings making it difficult to determine factors that influence sustainability in acute care settings. The aim of this review is to identify facilitators and barriers that influence the delivery of sustained healthcare interventions (eg, integration of clinical guidelines) within adult and paediatric hospital-based acute care settings.

Methods and analysis
A mixed methods systematic review updating Cowie et al’s (which included studies from 2008 to 2017) previously published systematic review will be conducted. The following databases will be searched: Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL and Allied and Complementary Medicine (AMED), from November 2017 to the present for studies published in English. Relevant reference lists of included studies will be manually searched. Empirical quantitative and qualitative studies that report the sustainability of an intervention or programme in acute care settings using a theoretical framework(s), model(s) or theory(ies) to explore facilitators and barriers, will be included. Studies will be exported into Covidence (Melbourne) and pairs of reviewers will independently screen abstracts and full-text studies. The discussion will be used to resolve any disagreements and a third coauthor enlisted should a consensus not be reached. Two independent coauthors will extract key study characteristics and assess each study’s quality. Data will be extracted using Covidence (Melbourne). Evidence tables will be used to present descriptive data. Facilitators and barriers will be mapped to the Consolidated Framework for Sustainability Constructs in Healthcare and a narrative approach will be used to present key findings.

Ethics and dissemination
No primary data will be collected so formal ethical approval is not required. Findings will be disseminated through peer-reviewed publications, presented at international conferences and on social media.

PROSPERO registration number
PROSPERO CRD42024547535.

Objectives
To estimate the levels and trends of maternal and child healthcare (MCH) service utilisation in India across subsidised and unsubsidised health sectors and to explore total market approach to identify geographies where the private sector has potential to improve MCH services in India.

Design and setting
This study used three recent rounds of the National Family Health Survey (NFHS), a cross-sectional survey in India, conducted in 2005–2006, 2015–2016 and 2019–2021. Bivariate analysis and multinomial logistic regression were used to estimate the utilisation of key MCH indicators from subsidised and unsubsidised health sectors. Market sustainability of key MCH indicators was assessed by level of MCH services and subsidisation.

Participants
36 850, 190 898 and 176 843 ever-married women aged 15–49 years, 4440, 22 500 and 15 334 children under 5 years of age with diarrhoea before the survey, and 2552, 6960 and 6117 children with symptoms of acute respiratory infections (ARI) in NFHS 2005–2006, 2015–2016 and 2019–2021, respectively.

Outcome measures
The study used three maternal healthcare indicators: women had four or more antenatal care (ANC) visits, had institutional delivery, and received postnatal care (PNC); and two child healthcare indicators: care seeking for ARI and diarrhoea.

Results
In India, utilisation of maternal healthcare services increased over the last 15 years: four or more ANC visits increased from 37% to 58% and PNC of mothers increased from 33% to 78% between 2005–2006 and 2019–2021. The results of the multivariate analysis showed that utilisation of ANC (67% from public vs 18% from private health facilities), institutional delivery (64% from public vs 25% from private health facilities) and PNC (73% from public vs 27% from private health facilities) was significantly higher (p

Objectives
We aimed to provide an overview of the existing knowledge regarding the roles of physiotherapists in primary care teams.

Design
Scoping review based on the methodological framework provided by Arksey and O’Malley (2005) and updated by Levac et al (2010).

Data sources and study selection
A search strategy was carried out across the Medline, CINAHL, Academic Search Complete and AMED databases in June 2023. Selected articles, based on qualitative or mixed design studies, had to report on the roles of physiotherapists working in team-based primary care organisations and be published in the last 10 years.

Data extraction and analysis
Data were extracted by one team member and further validated by a second team member. A mixed thematic analysis based on the Competency Profile for Physiotherapists in Canada was used to identify all the roles undertaken by physiotherapists.

Results
The database search yielded 2324 articles. From the 13 included articles, 6 main themes emerged: conduct client assessment for musculoskeletal conditions, participate in health promotion and prevention, promote self-management support, communicate with patients, collaborate with other primary care providers and partners, and provide holistic care.

Conclusions
The review identified a wide variety of roles, primarily related to the treatment of musculoskeletal patients. In primary care settings, interprofessional collaboration can be hindered by a lack of knowledge regarding the roles of physiotherapists. Future studies should aim to develop effective strategies to ensure that all primary care team members have a comprehensive understanding of the roles of physiotherapists and to explore roles associated with non-traditional forms of physiotherapy practice.

Introduction
Myocarditis is an inflammatory heart disease resulting from infections, toxic exposures or autoimmune reactions. Irrespective of the factors responsible for this disease, cytokines play an important role in regulating the immunological response involved in its development and progression. Accordingly, this protocol aims to conduct a systematic review and meta-analysis summarising previous research on serum and plasma levels of cytokines in patients with myocarditis and inflammatory dilated cardiomyopathy.

Methods and analysis
Four scientific databases: PubMed, Embase, Scopus and Web of Science, will be searched. The estimated date of the search will be 30 March 2024. Each stage of the review, including the study selection, data extraction, risk of bias and quality of evidence assessments, will be performed in duplicate. Studies meeting the following criteria will be eligible for inclusion: (1) studies involving ‘myocarditis’ or ‘inflammatory dilated cardiomyopathy’ and (2) studies are required to report serum levels of any cytokine. Meta-analyses will be used to summarise serum levels of each cytokine if possible. Subgroup analysis will be stratified by age, sex, sample size, New York Heart Association scale, cardiac Troponin T, N-terminal prohormone of brain natriuretic peptide, C reactive protein, number of lymphocytes per mm2 in the endomyocardial biopsy.

Ethics approval and dissemination
This study does not require ethics approval. After completion, the results will be published in a peer-reviewed paper. Data generated during the study will be published in an open access repository.

PROSPERO registration number
CRD42024519625