Search Results for: Linee guida sull’osteoartrite negli adulti di età superiore ai 16 anni

Objectives
COVID-19 in children is generally of short duration, but some may take longer to recover. This study investigated the time to symptom resolution following SARS-CoV-2 infection among children in a community setting on the outskirts of an urban centre in Brazil.

Design
Prospective cohort study.

Setting
This is a community-based cohort of children living in Manguinhos, a favela in Rio de Janeiro. The cohort was followed through home visits and telephone monitoring of symptoms. The analysis focused on symptomatic children from this cohort with confirmed SARS-CoV-2 infection. Recovery time was defined as the interval between the first date with symptoms and the first date without symptoms following a positive SARS-CoV-2 test.

Participants
A total of 1276 children (boys and girls aged 2–

Introduction
There is a need for early, non-invasive and inexpensive biomarkers for Alzheimer’s disease (AD), which could serve as a proxy measure in prevention and intervention trials that might eventually be suitable for mass screening. People with Down syndrome (DS) are the largest patient group whose condition is associated with a genetically determined increased risk of AD. The REVEAL study aims to examine changes in the structure and function of the eye in individuals with DS compared with those with mild cognitive impairment (MCI) and cognitively healthy control (HC) individuals. REVEAL will also explore whether these changes are connected to inflammatory markers previously associated with AD.

Methods and analysis
The protocol describes a cross-sectional, non-interventional, single-centre study recruiting three cohorts, including (1) participants with DS (target n=50; age range, 6–60 years), (2) participants with MCI (target n=50; age range, 50–80 years) and (3) HC participants (target n=50; age range, 50–80 years). The primary research objective is to profile retinal, choroidal and lenticular status using a variety of eye imaging modalities and retinal functional testing to determine potential associations with cognitive status. The REVEAL study will also measure and compare established blood markers for AD and proteomic and transcriptomic marker profiles between DS, MCI and HC groups. Between-group differences will be assessed with an independent sample t-test and 2 tests for normally distributed or binary measures, respectively. Multivariate regression analysis will be used to analyse parameters across all three cohorts. Data collection began in October 2023 and is expected to end in October 2025.

Ethics and dissemination
The study gained a favourable opinion from Health and Social Care Research Ethics Committee A (REC reference 22/NI/0158; approved on 2 December 2022; Amendment 22/0064 Amend 1, 5 April 2023; Amendment 22/0064 Amend 2; 23 May 2024; Amendment 22/0064 Amend 3; 25 June 2024; Amendment 22/0064 Amend 4; 16 January 2025; Amendment 22.0064 Amend 5; 9 May 2025; Amendment 22.0064 Amend 6; 9 June 2025). The study has also been reviewed and approved by the School of Biomedical Sciences Research Ethics Filter Committee within Ulster University. Findings from the REVEAL study will be presented to academic audiences at international conferences and peer-reviewed publications in targeted high-impact journals after data collection and analysis are complete. Dissemination activities will also include presentations at public events.

Objective
To develop and validate an interpretable machine learning (ML)-based frailty risk prediction model that combines real-time health data with validated scale assessments for enhanced decision-making and targeted health management in integrated medical and older adult care institutions (IMOACIs) in central China.

Design
Mixed-methods, cross-sectional study.

Setting
13 IMOACIs across seven cities in Hunan province, central China, from 8 to 16 July 2022.

Participants
Five healthcare experts and two data scientists participated in the requirements analysis stage. A total of 586 older adults were included in the assessment data collection stage, and 15 participants (10 healthcare professionals and five data scientists) were involved in the model evaluation stage.

Methods
A collaborative requirements analysis involving healthcare professionals and data scientists guided the design of an interpretable frailty risk prediction model. Five machine learning models were developed and evaluated: logistic regression, support vector machines (SVM), random forest, extreme gradient boosting (XGBoost) and a multimodel ensemble approach. Hyperparameter optimisation was performed using stratified fivefold cross-validation with grid search, incorporating class-weighted loss functions to address class imbalance and model-specific regularisation techniques to maximise performance while preventing overfitting. To enhance interpretability, the model incorporated Shapley Additive Explanations. The final model was integrated into a user-facing platform and validated using cross-sectional standardised assessment data collected from 13 IMOACIs. A mixed-methods evaluation approach combined quantitative performance metrics with qualitative user experience assessments.

Results
The dataset (n=586) was randomly split into training (n=468) and validation (n=118) sets (4:1 ratio). Among models, XGBoost demonstrated superior performance, achieving an accuracy of 0.89 and an area under the receiver operating characteristic curve (AUC) of 0.89 on the training set. On the validation set, the XGBoost model achieved a precision of 0.76, recall of 0.72, F1 score of 0.74, accuracy of 0.83 and AUC of 0.80, outperforming other models. User experience surveys yielded high mean ratings for satisfaction (4.20/5), perceived accuracy (4.20/5), interpretability (4.30/5) and application value (4.10/5). Qualitative analysis of user feedback identified six key themes: practical and application value, performance and data analysis, interpretability and comprehensibility, impact and integration into practice, limitations and areas for improvement, and future development and innovation prospects, highlighting the model’s strong potential for practical implementation.

Conclusions
This novel, interpretable ML-based frailty risk prediction model can enhance decision-making in the care of older adults by providing transparent predictions and identifying crucial factors associated with frailty. It establishes a foundation for targeted management and broader ML applications in healthcare systems, such as IMOACIs, particularly in developing regions.

Introduction
Social accountability is a key value and aspirational goal of many medical institutions. While much has been studied on social accountability in the context of medical education and institutions, less research has examined how social accountability influences research. In light of this absence, the objective of our scoping review is to research the following questions: (1) What characterises socially accountable research (SAR), and how is it expressed and experienced? (2) How do language, positionality, and worldview influence SAR?, and (3) What structures and considerations are necessary to support successful SAR in local and global contexts?

Methods and analysis
To answer the above research questions, the Arksey and O’Malley, Levac et al, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and Joanna Briggs Institute (JBI) guidelines will be followed. The search strategy was adapted and applied to MEDLINE, Embase, ERIC, and CINAHL databases. A total of n=5289 eligible articles were identified. Articles were excluded if they were published before 1995, were in a language other than English, or were duplicates, leaving n=2840 articles for title/abstract screening.

Ethics and dissemination
Ethical approval is not required to complete this study. We will take an integrated knowledge translation approach. Throughout the project, results will be disseminated to knowledge users (ie, consultations, following Arksey and O’Malley). Our findings will be presented to the larger academic community, policymakers, and healthcare practitioners through presentations, reports, newsletters, and an online repository.

Trial registration number
Open Science Framework 16 July 2024. osf.io/mvhnu.

Objectives
We aimed to explore the changes in oculomotor deficiencies during the follow-up of patients with multiple system atrophy (MSA) and Parkinson’s disease (PD), and to investigate the value of dynamic eye movement examination in their differential diagnosis.

Design
This was a cohort study conducted from 2017 to 2023.

Setting
The Movement Disorders Clinic at a tertiary hospital in Beijing, China.

Participants
56 patients with PD and 13 patients with MSA from an initial cohort of over 1100 with parkinsonism were included in the final longitudinal analysis.

Outcome measures
Multisystem evaluations were performed at baseline. Videonystagmography (VNG) was repeated to assess oculomotor dysfunction at baseline and during follow-up. Abnormalities in the fixation and gaze-holding test, without-fixation test, reflexive and memory-guided saccade tests, smooth pursuit test and optokinetic test were qualitatively and quantitatively recorded and statistically analysed.

Results
The median follow-up time of MSA (16 months) was significantly shorter than that of PD (27 months). In MSA, the incidence of abnormalities in fixation and gaze-holding tests (0% vs 30.8%, p=0.030), reflexive saccade tests (46.2% vs 84.6%, p=0.039, with slow saccades increasing from 7.7% to 46.2%, p=0.027) and smooth pursuit tests (38.5% vs 76.9%, p=0.047) increased significantly from baseline to the end of follow-up. In PD, no significant changes were revealed during follow-up.

Conclusions
MSA exhibited more rapid and prominent changes in fixation and gaze-holding tests, reflexive saccades and smooth pursuit tests than PD. Dynamic observation of oculomotor function may aid in the differential diagnosis of Parkinson’s syndrome.

Quanti anni mi dai? La domanda può assumere valenze diverse, in base a quanto la persona si sente bene e in forma. Perché l’età biologica può non corrispondere esattamente a…

Tra anziani 1 su 4 ne ha almeno 2. Incide status socio-economico

Lo studio di Nursing up, ‘all’estero 41 anni, manca ricambio’

Objectives
Endocrine disorders, such as hypo/hyperthyroidism and diabetes, affect over 5% of the world’s population, with an additional 5% of cases remaining undiagnosed. Despite the increasing prevalence of endocrine disorders, especially in low- to middle-income countries (LMICs), limited research offers comprehensive guidance on treating this complex medical field. This scoping review aims to provide evidence-based recommendations for efficient, effective and accessible treatment of paediatric thyroid conditions and diabetes in LMICs.

Design
Scoping review guidelines outlined by the Preferred Reporting Items for Systematic and Meta-Analysis Extension for Scoping Reviews, using the Joanna Briggs Institute (JBI) methodology to analyse healthcare administration approaches in LMICs.

Data sources
PubMed, Google Scholar, MEDLINE, EconLit, Science Direct and Scopus were searched using a set of search terms from 19 December 2023 to 16 January 2024. An additional high-level search was performed in May 2025.

Eligibility criteria
Selection of a variety of peer-reviewed publications with a setting in LMICs. Articles were included if they described an intervention strategy related to select paediatric chronic diseases, endocrine conditions or non-communicable diseases. The treatment strategies in question were government initiatives, mobile health, specialised programmes and primary care.

Data extraction and synthesis
One reviewer manually reviewed articles and documented findings on Microsoft Excel. In accordance with JBI methodological guidelines, no risk of bias assessment or quality appraisal of included studies was conducted.

Results
After reviewing primary care, specialised care, government intervention programmes and mobile care initiatives within developing countries, primary care with an emphasis on task shifting emerged as the best approach for treating paediatric endocrine disorders.

Conclusion
Despite recommendations favouring specialised care or government interventions, primary care proves to be the optimal method for treating endocrine conditions. Given limited healthcare funding in LMICs, implementing primary care initiatives can achieve significant health outcomes while maximising resources.

La guida dell’Istituto sui cibi e le regole da rispettare

Importance
Access to healthy and affordable foods may play a role in reducing inflammation and in healthy pulmonary immune system development.

Objective
To investigate the association between residing in a low-income and low-food-access (LILA) neighbourhood and risk of childhood asthma. A positive association was hypothesised.

Design, setting and participants
This prospective cohort study consists of 16 012 children from 35 longitudinal studies in the Environmental influences on Child Health Outcomes programme (children born 1998–2021) from across the contiguous USA. We conducted survival analyses adjusted for child sex, race/ethnicity, maternal education, gestational smoking, and parental history of asthma.

Exposure(s)
Several commonly used geospatial food access metrics were linked to residential locations including: LILA census tracts where the nearest supermarket is >1 mile in urban and >10 miles in rural areas (LILA1 and 10), >1 mile in urban and >20 miles in rural areas (LILA1 and 20), >0.5 mile in urban and >10 miles in rural areas (LILA0.5 and 10), and >0.5 mile without a vehicle or >20 miles (LILAvehicle). Each metric was linked to lifetime residential history timelines then dichotomised according to whether the child had spent at least 75% of their life living in a LILA area separately for birth through age 5 years (cumulative early childhood) and birth through age 11 years (cumulative middle childhood).

Main outcomes(s) and measure(s)
Asthma incidence in cumulative early and middle childhood.

Results
Residing in a LILA0.5 and 10 and LILAvehicleneighbourhood was associated with a higher asthma incidence in cumulative early and middle childhood. The LILA0.5 and 10 and LILAvehicle associations were stronger for asthma during cumulative early childhood, where we observed hazard ratios of 1.13 (95% CI 1.02 to 1.24) and 1.13 (95% CI 1.01 to 1.27), respectively. The associations were higher among children who were Hispanic, were female and had lower maternal education.

Conclusion and relevance
Limited residential food access was associated with higher childhood asthma incidence, especially among female and Hispanic children and those with lower maternal education. Our findings support multipronged efforts to increase access to healthy and affordable food options and lower food insecurity in LILA neighbourhoods.

Introduction
Prefrailty is common among community-dwelling older adults with diabetes and can lead to adverse health outcomes. With effective exercise interventions, prefrailty is reversible. However, there is a paucity of evidence regarding the effects of exercise interventions for prefrail older adults with diabetes. This study presents a study protocol for evaluating the effectiveness of an exercise intervention based on the Capacity, Opportunity and Motivation Behaviour (COM-B) model among community-dwelling prefrail older adults with diabetes.

Methods and analysis
Using a randomised controlled trial design, a total of 100 community-dwelling prefrail older adults with diabetes will be allocated to either an intervention or a control group in a 1:1 ratio. Participants in the intervention group will receive a 16-week multicomponent exercise intervention based on the COM-B model, while those in the control group will receive usual diabetes care and general advice on physical activity. The primary outcome is frailty status, and the secondary outcomes include physical function, quality of life, depressive symptoms, self-efficacy for exercise and fasting blood glucose. Assessments will be conducted at baseline, week 8 and week 16.

Ethics and dissemination
This study has been approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (approval number: K2023-320). The findings will be submitted to a peer-reviewed journal for publication.

Trial registration number
ChiCTR2400082831.

Introduction
Exercise training is recommended as a complementary treatment in postural orthostatic tachycardia syndrome (POTS) according to international guidelines. However, less is known regarding how exercise training could successfully be implemented in clinical practice in patients with POTS. Thus, in the current study, we aim to assess the effect of a 16-week tailored exercise training programme in POTS.

Methods and analysis
A total of 200 patients diagnosed with POTS will be recruited. The study will be conducted as a randomised cross-over study. POTS symptoms will be evaluated using the Malmö POTS Symptom Score, Orthostatic Hypotension Questionnaire and 36-item Short Form Health Survey. Haemodynamic parameters will be evaluated by orthostatic tests and maximum working capacity evaluated by bicycle exercise test. Symptoms, haemodynamic parameters and exercise capacity will be assessed before and after a 16-week training programme.

Ethics and dissemination
The study was approved by the Swedish ethical review authority (2022-03186-01) and all procedures will be performed in accordance with the Helsinki Declaration. Results will be made available to patients with POTS, healthcare professionals, the funders and other researchers in publicly available (open access) medical journals.

Trial registration details
NCT05554107, registered on 26 September 2022.

Objectives
To identify distinct profiles among elderly patients in primary care so that general practitioners (GPs) can develop more targeted care strategies.

Design
A cross-sectional analysis of baseline data from the French nationwide ‘Elderly Appropriate Treatment in Primary Care’ trial.

Setting
Primary care in France: 277 GPs included patients.

Participants
The study participants were aged 75 or over, living at home, and taking five or more prescription medications. Of the 2724 patients included, 2651 were analysed.

Primary and secondary outcome measures
To identify specific patterns of multimorbidity, polypharmacy and frailty, we applied an unsupervised clustering analysis with self-organising maps.

Results
Seven clusters were identified: cluster 1 (16% of the patients) comprised frail men and women with cardiovascular, respiratory, musculoskeletal and endocrine diseases and marked polypharmacy; cluster 2 (9.3%, mainly men) comprised frail patients with cancer and cardiovascular or urogenital/renal diseases; cluster 3 (15.5%, mainly men) comprised not-very-frail patients with cardiovascular and urogenital/renal diseases; cluster 4 (18.1%) comprised not-very-frail men and women with cardiovascular diseases; cluster 5 (13.5%, mainly women) comprised mainly lonely, very frail patients with hypertension and endocrine, musculoskeletal and neuropsychiatric disorders; cluster 6 (19.1%, mainly women) comprised frail, socially isolated patients with digestive, musculoskeletal and neuropsychiatric diseases; lastly, cluster 7 (8.6%, mainly women) comprised frail, socially isolated patients with hypertension, cancer, or musculoskeletal, psychological and digestive disorders.

Conclusion
Our phenotypic classification of elderly patients might facilitate efforts to align healthcare services with the care needs that are encountered by GPs in their everyday practice.

Trial regestration number
(NCT03298386).