Search Results for: Quotidianosanita.it

Stroke, Ahead of Print. BACKGROUND:It is unknown whether computed tomographic perfusion (CTP) parameters predict ischemic stroke in patients with symptomatic chronic carotid or middle cerebral artery occlusion.METHODS:A post hoc analysis of medically treated patients enrolled in the CMOSS trial (Carotid or Middle Cerebral Artery Occlusion Surgery Study; REGISTRATION: URL:https://www.clinicaltrials.gov; Unique identifier: NCT01758614), a randomized controlled trial conducted at 13 centers in China between June 2013 and March 2018. It aimed to compare extracranial-intracranial bypass surgery to medical therapy in patients with symptomatic carotid or middle cerebral artery occlusion and hemodynamic insufficiency. CTP-derived mean transit time and relative cerebral blood flow were collected. The primary outcome was defined as ischemic stroke in the territory of the qualifying artery within 2 years after randomization. The predictive value of CTP for the primary outcome was analyzed by a Cox regression model. Receiver operating characteristic curves were used to calculate optimal cutoff values of CTP parameters.RESULTS:All 165 per-protocol patients (median age=53.7 years, 81.2% males) treated with medical treatment alone were analyzed. Sixteen (9.7%) patients suffered the primary outcome during the 2-year follow-up. Cutoff values of mean transit time >6.5 seconds (symptomatic side) and relative cerebral blood flow ≤0.5 were associated with recurrent stroke. In multivariate Cox regression, mean transit time (adjusted hazard ratio, 3.50 [95% CI, 1.19–10.30];P=0.02) and relative cerebral blood flow (adjusted hazard ratio, 7.36 [95% CI, 2.27–23.85];P=0.001) were independently associated with the primary outcome.CONCLUSIONS:CTP-based hemodynamic parameters are predictive of recurrent ischemic stroke in symptomatic patients with chronic carotid or middle cerebral artery occlusion. CTP could be used in patient selection for stratified secondary prevention of stroke in future studies.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT01758614.

Introduction
In 2016, the United States Preventive Services Task Force (USPSTF) recommended depression screening for all adults in the public sector, with screening frequency determined by clinical judgement and patient circumstances. This practice aims to enable timely diagnosis and treatment, reducing long-term healthcare costs associated with this chronic health condition. However, the USPSTF offered no written recommendations for primary care settings serving non-English-speaking populations, particularly where providers speak English and patients speak Spanish. While some research exists on depression screening in linguistically diverse settings, the use of validated Spanish-language screenings in primary care settings is underexplored when it comes to implementing the USPSTF’s recommendation. This scoping review addresses this knowledge gap by (1) assessing the extent to which Spanish-speaking patients in the USA receive depression screening in Spanish and (2) using the Consolidated Framework for Implementation Research (CFIR) 2.0 to categorise barriers and facilitators to implementing Spanish-language depression screening tools in USA primary care settings. The findings will identify areas needing further research to improve depression screening guidelines for primary care practices serving Spanish-speaking patients.

Methods and analysis
This scoping review follows the Joanna Briggs Institute Manual for Evidence Synthesis and the Arksey and O’Malley scoping review methodology, updated by Levac and colleagues. The reporting protocol adheres to PRISMA-ScR. A systematic search will be conducted in PubMed, Embase, APA PsycINFO, CINAHL and Web of Science Core Collection for studies on Spanish-language depression screening for adults in non-Veterans Affairs Medical Centers in the USA, excluding those focused on youth or adolescents. We will extract data from qualitative, quantitative and mixed-methods studies on screening. We will also examine studies addressing provider-reported comfort and competency in screening Spanish-speaking patients. We hypothesise that primary care clinics have implemented strategies for screening Spanish-speaking patients for depression driven by healthcare provider initiatives, local policies, research funding or community needs. The review will extract data on sample size, study methodology, primary care settings, patient and provider demographics, depression screeners used, and barriers and facilitators to screening. The quality of the studies will be appraised using the Mixed Methods Appraisal Tool (MMAT).

Ethics and dissemination
At Brown University, scoping reviews that analyse and synthesise existing research do not require Institutional Review Board (IRB) approval, provided they do not involve primary data collection or direct interaction with human subjects. Findings will be disseminated through peer-reviewed journals, conference presentations and community workshops to improve practices and policies addressing language barriers in depression screening and care.

Registration details
This scoping review protocol is registered with the Open Science Framework (OSF) at https://osf.io/dyru5.

Introduction
A substantial portion of the 3.6 million births per year in the USA (approximately 25%–30%) occur in the context of adverse pregnancy outcomes (APOs), including preterm birth (PTB), hypertensive disorders of pregnancy (HDP) and small-for-gestational-age (SGA) birth. Black individuals have a 2–3-fold higher risk of APOs and a similarly increased risk of maternal morbidity and mortality compared with White individuals. Adverse social determinants of health (SDoH) are at the root of this disparity and contribute to it through multiple mechanisms. Maternal anaemia is an upstream factor associated with severe maternal morbidity, maternal mortality and other APOs and is also associated with adverse SDoH. Effectively and efficiently addressing social needs arising from adverse SDoH in the obstetric setting can be difficult due to varying patient preferences, resource accessibility and clinic workflows. The Better Birth Outcomes Through Technology, Education and Reporting (BETTER) intervention attempts to account for these barriers by encouraging patients to address social needs through motivational interviewing and by sending recurring text messages that provide links to multiple kinds of social service resources.

Methods and analysis
We will use a two-arm randomised controlled trial to evaluate the effects of providing patients with a motivational interviewing session and text messages with links to multiple resources to address their social needs compared with patients receiving usual care. We will recruit 550 pregnant individuals less than 21 weeks of gestation from two university prenatal clinics that primarily serve Medicaid-covered individuals in an urban city in the Midwestern USA. We will assess whether the intervention reduces the primary outcome of maternal anaemia measured as haemoglobin

Estupiñán-Romero F, Pinilla Dominguez J, BernalDelgado E, et al. Differences in acute ischaemic stroke inhospital mortality across referral stroke hospitals in Spain: a retrospective, longitudinal observational study. BMJ Open 2023;13:e068183. doi:10.1136/ bmjopen-2022-068183. This article has been corrected since it was published online. The funding statement has been updated from ‘This study was partially funded by grants from CONCEPT-STROKE: Effectiveness and efficiency of acute ischaemic stroke care pathways in five Spanish Regions (PI19/00154); REDISSEC: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (RD16/0001/0007); and RICCAPS: Red de Investigación en cronicidad, atención primaria y promoción de la salud (RD21/0016/0023).’ to ‘This study was partially funded through the projects CONCEPT-STROKE: Effectiveness and efficiency of acute ischaemic stroke care pathways in five Spanish Regions (PI19/00154) REDISSEC: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (RD16/0001/0007) and RICCAPS: Red de Investigación en cronicidad, atención primaria y promoción de la salud…

Objectives
We aimed to analyse the disease burden and trends related to household air pollution (HAP) from 1990 to 2021 and to assess the correlation between development status and HAP burden using the Sociodemographic Index (SDI).

Design
Observational study using data from the global burden of disease (GBD) 2021.

Main outcomes and measures
The GBD results tool provided comprehensive data on disability-adjusted life years (DALYs) attributable to HAP, stratified by age, sex, year, and geographical location.

Results
A significant reduction of approximately 50% in global HAP-related DALYs was observed between 1990 and 2021. However, a minor increase in HAP-related DALYs was noted between 2020 and 2021. The highest burden was found in children under five. Males generally had higher DALY rates than females. A negative correlation was identified between SDI and HAP-related DALY rates, with the highest rate in Oceania and the lowest in high-income North America. Maternal and neonatal disorders, cardiovascular diseases, respiratory infections and tuberculosis, and chronic respiratory diseases were the leading causes of HAP-related DALYs.

Conclusion
The study highlighted the progress in reducing the global burden of HAP-related diseases, yet it also revealed persistent disparities that require targeted public health interventions. Continued efforts to promote cleaner energy solutions and address regional, age and gender-specific vulnerabilities are essential for further reducing the health impact of HAP. Future research should focus on understanding the contributing factors to these disparities and developing innovative mitigation strategies.

Introduction
Research on therapeutic mobility is abundant but the field of cancer has not yet been investigated thoroughly. This scoping review aims to examine the existing evidence on global therapeutic mobility and cancer, providing a comprehensive overview of the subject.

Methods
We conducted a scoping review and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodological guidelines. We developed a comprehensive search strategy and discussed it with the research team. We searched for peer-reviewed papers on Medline, Embase, ERIC and American Psychological Association via the Dialogue interface and Google Scholar and CAIRN bibliographic database for peer-reviewed articles. We also included grey literature, such as unpublished work and relevant reports from Érudit. We considered studies that employed quantitative or qualitative methods.

Results
Among the 1615 references initially selected, 767 duplicates were excluded. Then, 849 studies were screened on title and abstract and 800 were excluded as they did not meet inclusion criteria. 49 studies were fully screened and 21 were excluded as they did not meet inclusion criteria based on full-text assessment. Ultimately, 28 references were included in the data synthesis. This scoping review has shown that publications on therapeutic mobilities have multiplied in recent years, with a turning point in 2019. A range of academic disciplines and research methodologies are currently employed to describe them. A significant proportion of fieldwork is concentrated in Asia, Africa, Europe and North America. Despite the heterogeneity of the approaches and fields, there are certain common features that emerge: first, the decision to migrate for healthcare is primarily made by the patient themselves and is perceived by them as being non-choice; second, the family plays a central role at all stages of the migration; and third, the migration has a catastrophic impact in terms of social and financial burden.

Conclusion
In conclusion, this scoping review highlights the underexplored relationship between global therapeutic mobility and cancer, emphasising the need for increased research efforts to understand the global dynamics of cancer care mobility.

Objectives
Clinical trials are needed to advance interventions such as chemoprevention that have potential to reduce the risk of malignant transformation in individuals with oral potentially malignant disorders. We explored the perspectives of those screened or invited to join an early phase clinical trial (the SAVER trial: Sodium valproate for the epigenetic reprogramming of high-risk oral epithelial dysplasia). Our objectives were to inform the SAVER trial while it was ongoing and to provide insights for future trials and chemoprevention therapy development more broadly.

Design
Qualitative study involving audio-recorded, semistructured interviews. Analysis of transcribed interviews drew on thematic approaches.

Setting
Five UK-based sites involved in SAVER.

Participants
Purposive sample of individuals (n=20) with suspected or diagnosed oral epithelial dysplasia (OED) who were approached about SAVER.

Results
Most interviewees readily accepted that OED warranted preventive treatment and were positive about the potential of chemoprevention. However, they were often concerned about the side effects of the trial medication, and together with a dislike of biopsies and a perception that the trial might disadvantage treatment, these concerns made some hesitant to participate in SAVER. Interviewees indicated that the communication of staff influenced their understanding and experience of the trial and identified several opportunities for enhancing these aspects.

Conclusions
In indicating that individuals at risk of malignant transformation are accepting of chemoprevention in principle, our findings are supportive of future research on chemoprevention for this group. The findings also draw attention to the crucial role of communication in recruitment to chemoprevention trials. We provide recommendations to support staff during recruitment and enhance individuals’ experience of the trial.

Trial registration number
ISRCTN12448611; Pre-results.

Introduction
It is unclear whether routine testing of women for group B streptococcus (GBS) colonisation either in late pregnancy or during labour reduces early-onset neonatal sepsis, compared with a risk factor-based strategy.

Methods and analysis
Cluster randomised trial.

Sites and participants
320 000 women from up to 80 hospital maternity units.

Strategies
Sites will be randomised 1:1 to a routine testing strategy or the risk factor-based strategy, using a web-based minimisation algorithm. A second-level randomisation allocates routine testing sites to either antenatal enriched culture medium testing or intrapartum rapid testing. Intrapartum antibiotic prophylaxis will be offered if a test is positive for GBS, or if a maternal risk factor for early-onset GBS infection in her baby is identified before or during labour. Economic and acceptability evaluations will be embedded within the trial design.

Outcomes
The primary outcome is all-cause early (

Introduction
Undergraduate students report a high level of trait anxiety, which is a risk factor for further psychological decline if unmanaged. Music-based interventions are cost-effective and have been found to improve indices of anxiety. More recently, music with auditory beat stimulation (ABS) has been shown to improve symptoms of anxiety to a greater extent than music alone. While there is limited empirical evidence, music interventions with ABS may also be effective at targeting neurophysiological markers of anxiety. The aim of this study is to evaluate the effectiveness of a novel music with ABS intervention on self-report and neurophysiological indices of anxiety in undergraduate students with trait anxiety. It is hypothesised that relative to a pink noise control, listening to music with ABS will lower self-reported anxiety, reduce salivary cortisol, increase heart rate variability, increase theta and alpha-band electroencephalography (EEG) power and decrease beta and gamma-band EEG power.

Methods and analysis
Fifty Canadian undergraduate students who self-report experiencing anxiety will be recruited for this two-arm randomised controlled trial. Participants will be randomised to a single music session with ABS or pink noise; each intervention ranges from 24 min to 27 min. Outcomes will be assessed at baseline and immediately following the intervention and will be self-reported anxiety and affect (the State-Trait Inventory of Cognitive and Somatic Anxiety and the Self-Assessment Manikin), salivary cortisol, heart rate variability measured by ECG and cortical measures of anxiety (measured by EEG). Repeated measures analyses of covariance will be performed to evaluate the effect of condition assignment on outcome measures.

Ethics and dissemination
This study will be conducted under the Declaration of Helsinki. This study was approved by the Toronto Metropolitan University Research Ethics Board (REB-2020-068) and registered on ClinicalTrials.gov (NCT05442086). The findings of this study will be published in a peer-reviewed journal.

Trial registration number
NCT05442086.

Objective
To estimate the mortality rate and identify predictors of mortality among under-five children with severe acute malnutrition (SAM) admitted to therapeutic feeding units (TFUs) in Ethiopia.

Methods
We searched PubMed, HINARI, Science Direct, Google Scholar and African Journals Online from 1 March to 30 May 2024. The Joanna Briggs Institute checklist was used to appraise the included studies. Heterogeneity was identified using I2 statistics. Funnel plots and Egger’s tests were used to determine publication bias.

Results
Out of 1085 studies, 15 were included in this analysis. The pooled mortality rate among under-five children with SAM admitted to TFUs in Ethiopia was 8.32 per 1000 person-days of observation (95% CI: 6.25 to 11.06). The mortality rate has not changed over time. HIV infection (HR: 2.84; 95% CI: 1.25 to 6.42), tuberculosis (HR: 1.86; 95% CI: 1.35 to 2.56), intravenous fluid use (HR: 3.37; 95% CI: 2.39 to 4.75), altered body temperature (HR: 4.47; 95% CI: 1.90 to 10.51), impaired consciousness (HR: 2.91; 95% CI: 1.94 to 4.37), not receiving F-100 supplementation (HR: 4.51; 95% CI: 3.25 to 6.26), shock (HR: 4.20; 95% CI: 2.92 to 6.04), and nasogastric tube feeding (HR: 2.02; 95% CI: 1.67 to 2.44) were predictors of mortality.

Conclusion
The pooled mortality rate in Ethiopia was 8.32 per 1000 person-days, and it has not decreased over time. Most of the identified factors are related to comorbidities and complications of SAM, as well as nutritional therapy. Thus, it is essential to strengthen nutrition policies, programme implementation and healthcare services, which focus on the timely management of SAM complications, integrated care for comorbidities and improved F-100 supplementation.

PROSPERO registration number
CRD42024555014.

Objectives
Heated tobacco products (HTPs) are electronic devices that heat tobacco instead of burning it to produce an inhalable aerosol. This study aimed to investigate usage patterns, sociodemographic and socioeconomic factors, as well as co-use characteristics of people who use HTPs within the German population to inform interventions and preventive measures.

Methods
We conducted analysis with pooled cross-sectional data from the German Study on Tobacco Use (DEBRA) from June 2018 till November 2023. We estimated weighted, descriptive and bimonthly data on current and ever HTP usage and descriptive data on user patterns. To analyse the variance between people who ever versus people who never used HTPs in relation to user characteristics, we performed ² tests and calculated percentages and CIs.

Results
The proportions of both people who currently use and people who ever used HTPs have increased from 2018 (current user: 0.1% [95%CI:

Although computed tomography (CT) is a useful tool for detecting tumors and diagnosing other medical conditions, it exposes patients to ionizing radiation, a known carcinogen. If current CT practices persist, the scans could eventually account for an estimated 5% of new cancer diagnoses each year, a new risk model published in JAMA Internal Medicine found.

The term resistant hypertension has been variably applied to patients with high blood pressure (BP) since at least the 1960s. Specific definitions have evolved over time to align with advances in treatment and BP goals. In 2018, the American Heart Association updated its definition of resistant hypertension as uncontrolled BP levels (≥130/80 mm Hg) despite use of 3 different medication classes (typically a calcium channel blocker, renin-angiotensin system inhibitor, and diuretic) at maximal (or maximally tolerated) doses. Patients taking 4 or more medications regardless of BP control are also included in the definition. Determining true resistant hypertension requires the exclusion of white-coat hypertension (ie, uncontrolled clinic-measured BP, with either home or ambulatory readings at goal) and medication nonadherence. Resistant hypertension is a complex multifactorial condition, and it must be acknowledged that basing its definition on a specific BP threshold and number of drugs is inherently subjective in some regards.

Normal circadian rhythm of blood pressure (BP), defined as a BP decline of 10% to 20% at night, is an important predictor of cardiovascular health and an indicator of cardiovascular disease (CVD) risk when absent. For treatment of hypertension, it has been standard practice to dose antihypertensive medications in the morning to address higher daytime BP levels; the effects of altering timing of drug dosing on circadian rhythm have not been convincingly delineated.

Introduction
As the field of radiation oncology continues to evolve with rapidly advancing technologies, the need for innovative educational methods is critical. Extended reality (XR) technologies—including virtual reality, augmented reality and mixed reality—have emerged as transformative tools in medical education. While the potential of XR in healthcare education is recognised, there is a lack of comprehensive exploration specifically in the context of radiation oncology education. This scoping review aims to map the existing literature on XR technologies in radiation oncology training and education, identify barriers to their adoption and highlight opportunities for broader integration into curricula.

Methods
This scoping review will follow the Arksey and O’Malley framework with enhancements by Levac et al and will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search will be conducted across databases, including MEDLINE, Scopus and Web of Science, to identify relevant studies on the use of XR technologies in radiation oncology education. Studies will be selected based on predetermined inclusion criteria using the population, concept, context framework. Data extraction will focus on the types of XR technologies used, educational settings, learning outcomes, barriers to adoption and methodologies for evaluating XR effectiveness. The results will be synthesised through descriptive statistics and qualitative thematic analysis. A consultation phase will engage experts to refine findings and ensure the practical relevance of the review.

Ethics and dissemination
This protocol does not require ethics approval at the current stage as it involves a scoping review of publicly available literature. Ethics approval will be obtained prior to initiating the consultation phase involving experts. Written informed consent will be obtained from all individual participants included in the study. The study will be conducted in accordance with relevant guidelines and regulations and was approved by the Chang Gung Medical Foundation Institutional Review Board on 13 May 2025 (ref.: 202500731B0). The findings of this review will be disseminated through peer-reviewed publications, conference presentations and tailored executive summaries aimed at educators, policymakers and stakeholders in radiation oncology education.

Introduction
The nursing profession has undergone significant evolution over the past century, shifting from a role traditionally viewed as an auxiliary to physicians to one of autonomous healthcare professionals equipped with specialised skills and expertise. This shift is driven by the increasing recognition of the importance of evidence-based practice in enhancing patient outcomes and advancing the field of nursing. Consequently, nursing research has emerged as a critical priority in the profession. This study seeks to explore the nursing research landscape in Malaysia, where data remain limited, by examining trends before, during and after the COVID-19 pandemic.

Methods and analysis
This scoping review will be conducted following the Arksey and O’Malley framework, using four electronic databases: PubMed, Scopus and CINAHL for journal articles published between 2015 and 2024, and Web of Science for conference proceedings from the same period.

Ethics and dissemination
The findings from this scoping review will provide an overview of the nursing research landscape in the Malaysian context, offering insights that could guide the future advancement of nursing research in the country. The results will be disseminated through submission to a peer-reviewed scientific journal for publication. Ethical approval is not required for this scoping review, as it involves the synthesis of data from available published literature.