Search Results for: Sviluppo di un test meno invasivo per la malattia infiammatoria intestinale

Objectives
This meta-analysis aimed to evaluate the association between the Geriatric Nutritional Risk Index (GNRI) and survival outcomes in patients with urological cancer.

Design
Systematic review and meta-analysis of observational studies.

Data sources
A comprehensive literature search was conducted in Medline, EMBASE, Google Scholar and the Cochrane Library from inception to 7 July 2024.

Eligibility criteria
Studies were included if they examined the correlation between the GNRI and long-term survival outcomes in adult patients (≥18 years old) with urological cancers.

Data extraction and synthesis
Two researchers independently extracted data and assessed study quality using the Newcastle-Ottawa Scale and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. Publication bias was evaluated using funnel plots and Egger’s test for outcomes with more than 10 studies. Pooled HRs and 95% CIs were calculated using a random-effects model. Subgroup analyses, meta-regression and sensitivity analyses were performed.

Results
17 studies involving 8816 patients were included. Study quality assessment showed that 15 studies had a low risk of bias (scores 7–9) and two had a high risk (scores 5–6). Low GNRI was significantly associated with poor overall survival (OS) (HR: 2.6, 95% CI: 2.0 to 3.38, p

Objectives
Sepsis-associated hypotension or shock is a critical stage of sepsis, and a current clinical emergency that has high mortality and multiple complications. A new restrictive fluid resuscitation therapy has been applied, and its influence on patients’ renal function remains unclear. The purpose of this study is to evaluate the influence of restrictive fluid resuscitation on incidence of severe acute kidney injury (AKI) in adult patients with sepsis hypotension and shock compared with usual care.

Design
Systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

Data sources
PubMed, Embase, Web of Science and Cochrane Library were searched through 1 November 2024.

Eligibility criteria
We included randomised controlled trials that compared restrictive fluid resuscitation with liberal fluid therapy on patients with sepsis-associated hypotension and shock, to find out their effect on the incidence of severe AKI. Severe AKI was defined as the AKI network score 2–3 or Kidney Disease Improving Global Outcomes stages 2 and 3.

Data extraction and synthesis
Two independent reviewers used standardised methods to search, screen and code included trials. Risk of bias was assessed using the Cochrane Systematic Review Handbook for randomised clinical trials. Meta-analysis was conducted using random effects models. Sensitivity and subgroup analyses, trial sequential analysis (TSA), Egger’s test and the trim-and-fill method were performed. Findings were summarised in GRADE evidence profiles and synthesised qualitatively.

Results
Nine trials (3718 participants) were included in this research and the analysis was conducted in random effects model. There was a significant difference in the incidence of severe AKI (risk ratio 0.87, 95% CI 0.79 to 0.96, p=0.006; I2=0%) and the duration of mechanical ventilation (mean difference –41.14, 95% CI –68.80 to –13.48; p=0.004; I2=74%) between patients receiving restrictive fluid resuscitation and patients receiving liberal fluid resuscitation. TSA showed that the cumulative amount of participants met the required information size, the positive conclusion had been confirmed. The GRADE assessment results demonstrated moderate confidence in the incidence of severe AKI, as well as the results of all second outcomes except the Intensive Care Unit length of stay (ICU LOS), which received limited confidence. The result of incidence of worse AKI was rated as of high certainty.

Conclusions
It is conclusive that fluid restriction strategy is superior to usual care when it comes to reducing the incidence of severe AKI in sepsis-associated hypotension and shock. Shorter duration of ventilation is concerned with fluid restriction as well, but the heterogeneity is substantial. GRADE assessments confirmed moderate and above certainty. Traditional fluid resuscitation therapy has the potential to be further explored for improvements to be more precise and appropriate for a better prognosis.

PROSPERO registration number
CRD42023449239.

Background
Pregnant women experiencing food insecurity often compromise the quality of their nutrition by consuming a monotonous diet. Food insecurity and dietary monotony, defined as lack of variety in one’s diet, are two importan vt factors that cause undernutrition. Different studies focused on the factors associated with minimum dietary diversity, and there is limited evidence regarding the relationship between minimum dietary diversity and household food insecurity. Therefore, this study aims to assess the relationship between household food insecurity and minimum dietary diversity among pregnant women at health facilities in Fiche town.

Objective
To determine whether there was a relationship between the household food insecurity and minimum dietary diversity among pregnant women in Fiche town health facilities in Oromia region, Central Ethiopia.

Design
A facility-based cross-sectional study was conducted in September 2022, involving 422 pregnant women.

Setting
The study was conducted in Fiche town, located in the North Showa Zone of Oromia region in Ethiopia. The town is home to one specialised hospital and two health centres.

Methods
A structured questionnaire administered by an interviewer was used to collect data. Data were gathered using KoboToolbox V.2022.2.0 and analysed with SPSS V.23. A 2 test and binary logistic regression analyses were employed to examine the relationship between household food insecurity and minimum dietary diversity (defined as consuming at least 5 out of 10 specified food groups in the previous day or night). Bivariable and multivariable logistic regression analyses were conducted to identify the predictors of minimum maternal dietary diversity.

Results
The study found that only 34.6% of the participants met the minimum dietary diversity criteria. A significant relationship was identified between household food insecurity and minimum dietary diversity, 2 (2, n=32.43, p value=0.001). The variables that were found to be significant included being severely food-insecure (adjusted OR (AOR)=4.25, 95% CI: 1.26 to 14.38), having a history of illness in the last 2 weeks prior to assessment (AOR=2.14, 95% CI: 1.04 to 4.57) and lacking nutritional counselling during antenatal care (ANC) follow-up (AOR=9.24, 95% CI: 4.92 to 17.36). These factors were found to be significantly associated with both household food insecurity and minimum dietary diversity.

Conclusion
The study underscores the importance of addressing household food insecurity and enhancing dietary diversity among pregnant women. It recommends interventions such as improving access to nutritious food, providing support during illness and offering comprehensive nutritional counselling during ANC visits.

Cruciale per questa neoplasia gravata dalla diagnosi tardiva

Fabi, possibile un potenziamento delle Case della Comunità

Psichiatri e oncologi: ‘Da Balti a Fedez, messaggio di coraggio’

Objectives
To evaluate the effectiveness of 18 different host biomarkers in differentiating bacterial from non-bacterial acute febrile illness (AFI) in resource-limited settings, specifically in Brazil, Malawi and Gabon.

Design
Multinational, cross-sectional study.

Setting
The study was carried out across multiple primary healthcare facilities, including urban and rural settings, with a total of three participating centres. Recruitment took place from October 2018 to July 2019 in Brazil, May to November 2019 in Gabon and April 2017 to April 2018 in Malawi.

Participants
A total of 1915 participants, including children and adults aged 21–65 years with a fever of≤7 days, were recruited through convenience sampling from outpatient clinics in Brazil, Gabon and Malawi. Individuals with signs of severe illness were excluded. Written consent was obtained from all participants or their guardians.

Intervention
This is not applicable as the study primarily focused on biomarker evaluation without specific therapeutic interventions.

Primary and secondary outcome measures
The primary outcome measure was the ability of each host biomarker to differentiate between bacterial and non-bacterial AFI, as evaluated by area under the receiver operating characteristic (AUROC) curves. Secondary outcomes included the performance of individual biomarkers across the different study sites and in a multivariable setting.

Results
A Kruskal-Wallis test, adjusted by Benjamini-Hochberg, was performed for each biomarker to identify covariates with a significant difference in the distribution of biomarker values. The analysis revealed that country of origin (Brazil, Gabon, Malawi), age, sex and malaria status significantly impacted biomarker distribution (p≤0.001). The most widely known biomarkers, such as white blood cell (WBC) count and C-reactive protein (CRP), demonstrated the best performance in distinguishing between bacterial and non-bacterial infections, with AUROCs reaching up to 0.83 (0.77–0.88) for WBC count and 0.71 (0.59–0.82) for CRP. However, none of the evaluated novel host biomarkers exhibited high performance (AUROC

Introduction
Tuberculosis (TB) continues to be a significant public health issue, particularly in low-income and middle-income countries. Globally, the End TB Strategy targets an 80% reduction in TB incidence by 2030. Despite this strategy, there remains limited evidence on the incidence of TB among HIV-infected children after the test-and-treat strategies in Amhara Region. Hence, this study aimed to assess the incidence of TB and its predictors among children on antiretroviral therapy (ART) in Amhara Region, which is the second largest region in Ethiopia and located in the northwestern, northeastern and north-central parts of Ethiopia.

Methods
A multicentre institution-based retrospective follow-up study was conducted on 421 HIV-infected children receiving ART from July 2014 to March 2022. The study participants were selected using simple random technique. National antiretroviral intake and follow-up forms were used to gather data through the KoBo Toolbox. Stata V.17 was used for data analysis. The Kaplan-Meier curve was applied to estimate failure time, and the log-rank test was employed to compare groups of predictors. To identify TB predictors, Gompertz regression models, both bivariable and multivariable, were constructed. Ultimately, a 95% CI adjusted HR (AHR) was calculated, and variables with a p value less than 0.05 were considered statistically significant.

Results
A total of 421 children with a record completeness rate of 97.9% were analysed in the study. The TB incidence rate in children on ART was 2.16 (95% CI 1.52, 3.05) per 100 child-year observations. Anaemia at baseline (AHR: 3.83; 95% CI 1.46, 10.04), never taking TB preventive treatment (TPT) (AHR: 3.78; 95% CI 1.44, 9.94), wasting (AHR: 2.53; 95% CI 1.19, 5.38) and not initiating ART within 7 days (AHR: 2.35; 95% CI 1.15, 4.78) were significant predictors of TB in children.

Conclusion
The incidence of TB in children on ART was relatively high. HIV-positive children presenting with anaemia, those who never took TPT, wasted children and those with late initiation of ART were prone to the occurrence of TB. Therefore, prioritising anaemia treatment, TB preventive therapy, nutritional counselling and timely initiation of ART are essential to curb the TB burden.

Psichiatri e oncologi: ‘Da Balti a Fedez, messaggio di coraggio’

Introduction
Becoming a parent presents profound changes and numerous challenges, notably the necessity for reliable information regarding their child’s health. Given the overabundance of information available today, it is important for parents to acquire the skills necessary to find, understand, evaluate and apply health information. Research demonstrates that this ability, known as parental health literacy (PHL), is crucial for developing and maintaining a healthy lifestyle during childhood. However, there is currently no reliable instrument for measuring PHL in the field of prevention and health promotion. This paper presents the development and validation of a new questionnaire designed to assess parents’ ability to process health-related information to support the healthy development of their children aged 3–6 years.

Methods and analysis
The development of the item pool is based on Sørensen et al’s conceptualisation of general health literacy (finding, understanding, evaluating and applying health information). Empirical findings suggest that communication with healthcare providers and the social network represents another important skill area for parents and is therefore included as an additional subscale. The questionnaire will be developed in four stages, including a literature search and analysis, expert consultations via Delphi study, cognitive interviews with parents and a validation study. The validation study uses exploratory (EFA) and confirmatory factor analysis (CFA) for construct validity, first identifying test dimensions through EFA, then confirming these dimensions with CFA to ensure the factor structure aligns with theoretical expectations. This methodology, alongside reliability and correlational analyses, seeks to assess the questionnaire’s validity and reliability, expecting strong correlations with existing related constructs.

Ethics and dissemination
Ethical approval was obtained from the Ethics Committee of Fulda University of Applied Sciences. All participants receive a consent form together with the study information, in which they give their written consent to the storage, processing and linking of all data collected. The results of the study will be presented at national and international conferences and published in specialist journals.

Trial registration number
DRKS00033482.

Objectives
In this study, we explore the use of physical activity intervention referrals in primary care in England and compare their use with the rate of cardiovascular disease (CVD) risk factors in England from 2017 to 2020. We also explore variation and inequalities in referrals to these interventions in England across the study period.

Design
Retrospective cohort study.

Setting
England primary care via the Royal College of General Practitioners Research Surveillance Centre.

Participants
The Royal College of General Practitioners Research Surveillance Centre, a sentinel network across England covering a population of over 15 000 000 registered patients, was used for data analyses covering the 2017–2020 financial years and including patients with long-term conditions indicating CVD risk factors.

Outcome measures
An existing ontology of primary care codes was used to capture physical activity interventions and a new ontology was designed to cover long-term conditions indicating CVD risk factors. Single factor analysis of variance, paired samples t-test and two-tailed, one proportion z-tests were used to determine the significance of our findings.

Results
We observed statistically significant variation in physical activity intervention referrals for people with CVD risk factors from different ethnic groups and age groups across different regions of England as well as a marked decrease during the COVID-19 pandemic. Interestingly, a significant difference was not seen for different socioeconomic groups or sexes. Across all attributes and time periods (with the exception of the 18–39 group, 2017–2019), we observed a statistically significant underuse of physical activity intervention referrals.

Conclusions
Our findings identified statistically significant variation and underuse of physical activity referrals in primary care in England for individuals at risk of CVD for different population subgroups, especially different ethnicities and age groups, across different regions of England and across time, with the COVID-19 pandemic exerting a significant negative impact on referral rates.

Introduction
Appropriate use of pesticides minimises harm to human health and the environment. Despite regulations and restrictions on use, however, many farmers still use highly toxic pesticides in ways that endanger their health and the environment. Many pesticide users know little about the health effects of these chemicals or how to handle them safely. A systematic review will collate evidence of the effectiveness of educational interventions among farmers regarding health hazards and the safe handling of pesticides. The review aims to summarise the impact of educational interventions on knowledge and reported behaviour of pesticide users and to identify characteristics of more effective interventions.

Methods and analysis
We will search MEDLINE, LILACS, AGRICOLA, IMBIOMED, SciELO, Web of Science, Scopus, Embase databases and from the grey literature, Open Grey and WHO to identify potentially eligible studies. We will consider randomised and non-randomised controlled trials that evaluated the impact of educational interventions among farmers about the safe use of pesticides. We will include studies published between 2000 and 2024 in English, Spanish and Portuguese and consider outcomes of knowledge about pesticide health effects, knowledge about safe handling of pesticides and reported behaviour when handling pesticides. A meta-analysis of eligible studies, using a random-effects model, will estimate the impact of educational interventions on the outcomes as the difference between the intervention group and the control group at the last point of measurement. We will assess heterogeneity using the 2 test and I2 statistic, conduct a sensitivity analysis by removing each study from the meta-analysis and evaluate publication bias with a funnel plot and Begg and Egger tests. Subgroup analyses will examine the impact of different kinds of educational interventions.

Ethics and dissemination
Ethics approval is not required as no information from individuals are collected. The results will be published in a peer-reviewed journal or disseminated at relevant conferences.

PROSPERO registration number
CRD42023413028.