1,721,109 research outputs found
Space-time models with time dependent covariates for the analysis of the temporal lag between socio-economic factors and lung cancer mortality
No full textThe relationship between socioeconomic factors and mortality for lung cancer is investigated. To identify the proper lag time between socioeconomic factors and lung cancer mortality, a space–time hierarchical Bayesian model with time-dependent covariates is adopted. A real example on lung cancer mortality,
males, in Tuscany (Italy) during the period 1971–1999, is provided. Results confirm the presence of an association between mortality for lung cancer and socioeconomic factors with a temporal lag (latency time) of at least 10 years
Regression to the mean
No full textThe regression to the mean effect has been described in several contexts but still it continues to emerge. It is a kind of selection bias and it is the consequence of measurement error. It was described in clinical studies and epidemiological investigations whenever a selection of high/low responders is part of the study design; second it is present when baseline measurement is considered as confounder of covariate of interests. The general setting of the problem can be formalized via a latent variable and more than one imperfect measurements. Generalized linear mixed models are proposed. We present a comprehensive formulation of the problem and a simple explorative analysis using the correlation coefficients (Pearson’s, Lin’s and Bland-Altman’s mean-difference correlation)
[P-value and the probability of direction of effect]
No full textThe p-value has been widely criticized in the scientific literature for its naive use in classifying results as 'significant' and 'non significant'. Much has been written about it; for example, see the American Statistical Association position statement of march 2016. To date, few alternative measures have been suggested and few changes were observed in the scientific practice regarding the use of p-value despite general agreement on the critics raised on it. In this paper, we use an alternative measure to p-value. It consists in the probability of the direction of the effect, that is the strength of empirical evidence in favour of the alternative directional hypothesis. In the context of scientific research, reporting the probability of the direction of the effect is easier to understand. Moreover, it focuses on the effect in the study rather than on the value under the null hypothesis, which sometimes has little meaning or has been used opportunistically. The proposal is not intended as an alternative to using the confidence interval, but as a probabilistic metric to be used instead of the p-value when we refer to particular hypotheses to be tested
Methodological approaches to evaluate the over-time mortality in SENTIERI epidemiological surveillance system: a focus on cohort analyses
No full text: The SENTIERI Project analyses the health profile of the populations residing in Italian national priority contaminated sites in specific calendar periods using a cross-sectional approach. An aspect that has not been evaluated so far is the analysis over a long period, for understanding the changes in health profiles over time and studying them also in function of the changes occurred in the territories. This article studies temporal trends by birth cohort and calendar period for overall mortality and lung cancer mortality from 1980 to 2018, separately for men and women, for three sites: Priolo (Sicily Region, Southern Italy), Pitelli (Liguria Region, Northern Italy), and Terni-Papigno (Umbria Region, Central Italy). A method for selecting the temporal model that best fits the data is then proposed. General mortality presents complex temporal profiles when considering cumulative risks, and usually the most important temporal axis is the birth cohort for cumulative SMRs (i.e., after adjusting for trends in the reference population). For lung cancer, the most important time axis is the birth cohort and the age-cohort model is the most appropriate, in particular for men of Priolo and Terni
Ovarian cancer deaths attributable to asbestos exposure in Lombardy (Italy) in 2000–2018
Full text linkObjectives We aimed to estimate the fraction of deaths from ovarian cancer attributable to asbestos exposure in Lombardy Region, Italy, using a novel approach that exploits the fact that ovarian cancer asbestos exposure is associated with pleural cancer and other risk factors for breast cancer.Methods This ecological study is based on the Italian National Institute of Statistics mortality data. We formulate a trivariate Bayesian joint disease model to estimate the attributable fraction (AF) and the number of ovarian cancer deaths attributable to asbestos exposure from the geographic distribution of ovarian, pleural and breast cancer mortality at the municipality level from 2000 to 2018. Expected deaths and standardised mortality ratios were calculated using regional rates.Results We found shared dependencies between ovarian and pleural cancer, which capture risk factors common to the two diseases (asbestos exposure), and a spatially structured clustering component shared between ovarian and breast cancer, capturing other risk factors. Based on 10 462 ovarian cancer deaths, we estimated that 574 (95% credibility interval 388-819) were attributable to asbestos (AF 5.5%; 95% credibility interval 3.7-7.8). AF reaches 34%-47% in some municipalities with known heavy asbestos pollution.Conclusions The impact of asbestos on ovarian cancer occurrence can be relevant, particularly in areas with high asbestos exposure. Estimating attributable cases was possible only by using advanced Bayesian modelling to consider other risk factors for ovarian cancer. These findings are instrumental in tailoring public health surveillance programmes and implementing compensation and prevention policies
Spatial analysis of incidence of cutaneous melanoma in the friuli venezia giulia region in the period 1995-2005
Full text linkIncidence distribution of cutaneous melanoma depends on phenotypic characteristics of population and geographic location. In Italy, in the period 1999-2003 Friuli Venezia Giulia (FVG) region had the second highest incidence rates for males and the third for females. We analysed melanoma and lip cancer incidence data of the FVG cancer registry for the period 1995-2005. We used Bayesian hierarchical spatial models to describe the spatial pattern by gender. We decomposed the geographical distribution of the risk in two parts: a component linked to chronic exposure and a component related to intermittent exposure. In order to model the chronic component we considered the geographical distribution of incidence cases of lip cancer, for which chronic occupational solar radiation exposure is a documented risk factor. We also analysed the distribution by site and we calculated standardised rates for body surface area. This study documents a significant gradient in the incidence of cutaneous melanoma in FVG. High standardised incidence rates are present in the area of Trieste and in the coastal area. The descriptive analysis by age group and by site, showed risks associated with intermittent exposures in both genders. For the coastal area the risk is especially high for sites traditionally linked to high cumulative exposures (face and neck), especially among men. The results suggest diagnostic preventive interventions in the populations living in the area of Trieste, given the high rates observed in the young age groups
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Rehabilitative management of individuals with spinal cord injury in Italy (2018–2021): a study of dispersion
No full textopenBackground
La Scheda di Dimissione Ospedaliera (SDO) è un documento sanitario e amministrativo obbligatorio, utilizzato in Italia per registrare in modo standardizzato tutte le informazioni relative a un ricovero ospedaliero. Il flusso SDO prevede l’invio delle informazioni dalle strutture di ricovero afferenti al SSN alle Regioni per poi confluire al Ministero della Salute; l’archivio può essere consultato ai fini della ricerca in quanto è possibile l’analisi dei dati aggregati.
Obiettivo
Il presente studio si focalizza negli anni 2018-2021 e mira ad indagare, nel territorio nazionale, quante persone con patologia principale corrispondente ad una lesione midollare di natura traumatica non sono state prese in carico da un’Unità Spinale (codice di ricovero 28), ma abbiano invece avuto accesso a ricoveri riabilitativi di altra tipologia. Di questa popolazione, ne è stata indagata l’età, il genere, la durata del ricovero, il reparto di ammissione e dimissione, oltre che la modalità di dimissione.
Studio
Lo studio ha previsto l’analisi delle Schede di Dimissione Ospedaliera: tramite identificazione per codice di patologia principale, sono stati individuati e analizzati 4.358 primi ricoveri negli anni indicati. E’ emerso che i pazienti si distribuiscono come 2.451 maschi con età media di 57,14 anni (DS=21,75) e 1.907 femmine con età media di 60,59 anni (DS=22,03), dati che si allineano a quelli presenti in letteratura. I relativi giorni di degenza seguono una media di 46,51 giorni (DS=56,51) per i maschi e 43,49 (DS=41,02) per le femmine, riportando una durata del ricovero inferiore rispetto ai ricoveri nelle Unità Spinali negli stessi anni (Artuso P., 2023). E’ stato rilevato che 3.441 pazienti (78,96%) sono stati ammessi e successivamente dimessi da reparti di riabilitazione intensiva (codice 56), mentre 778 pazienti (17,85%) sono stati accolti da reparti di riabilitazione ad alta specializzazione (codice 75), e 115 pazienti (2,64%) da reparti di riabilitazione estensiva/lungodegenze (codice 60). Infine, è stato osservato che, alla dimissione, il 14,1% dei pazienti dello studio sono stati trasferiti presso un altro reparto di riabilitazione, senza quindi completare il percorso riabilitativo impostato e intrapreso durante il primo ricovero.
Conclusioni
I dati estratti e le successive analisi statistiche hanno permesso di fornire un quadro accurato di alcune caratteristiche riguardo le persone che hanno svolto un percorso riabilitativo non corrispondente al gold standard previsto per la lesione midollare. Lo studio propone elementi di riflessione sul percorso offerto a questi pazienti e ai benefici che i futuri studi trarrebbero dall’adozione della nuova SDO-R e del registro nazionale delle lesioni midollari, peraltro già previsto dalla normativa italiana.Background
The Hospital Discharge Form (Scheda di Dimissione Ospedaliera, SDO) is a mandatory medical and administrative document used in Italy to systematically record all information related to a hospital admission. The SDO data flow involves the transmission of information from healthcare facilities affiliated with the National Health Service (SSN) to the regional authorities, ultimately converging at the Ministry of Health. The resulting database is accessible for research purposes, as it allows for the analysis of aggregated data.
Objective
This study focuses on the period 2018–2021 and aims to investigate, at the national level, the number of individuals with a primary diagnosis of traumatic spinal cord injury who were not admitted to a Spinal Unit (hospitalization code 28), but instead received other types of rehabilitative care. For this population, the following variables were analyzed: age, sex, length of hospital stay, admitting and discharging departments, and discharge modality.
Methods
The study involved the analysis of Hospital Discharge Forms (SDO). Through identification by primary diagnosis code, a total of 4,358 first hospitalizations were identified and analyzed during the specified years. The patient population consisted of 2,451 males with a mean age of 57.14 years (SD = 21.75) and 1,907 females with a mean age of 60.59 years (SD = 22.03), consistent with findings reported in the literature. The corresponding length of stay showed a mean of 46.51 days (SD = 56.51) for males and 43.49 days (SD = 41.02) for females, which is shorter than the length of stay observed in Spinal Units during the same period (Artuso P., 2023). It was found that 3,441 patients (78.96%) were admitted to and discharged from intensive rehabilitation units (code 56), 778 patients (17.85%) from highly specialized rehabilitation units (code 75), and 115 patients (2.64%) from extensive rehabilitation/long-term care units (code 60).
Finally, it was observed that, at discharge, 14.1% of patients were transferred to another rehabilitation ward, indicating that the rehabilitative process initiated during the first hospitalization was not completed.
Conclusions
The extracted data and statistical analyses provide a detailed picture of patients with traumatic spinal cord injury who underwent rehabilitation outside of the recommended gold-standard care pathway. The study raises critical reflections on the quality and structure of care provided and highlights the potential benefits of implementing the updated HDR-R system and establishing a national registry for spinal cord injuries, which is already mandated by Italian legislation
Effects of Integrating a Customised Home Exercise Programme Combined with Botulinum Toxin in the Treatment of Idiopathic Cervical Dystonia: Cross-over Study
No full textreservedIntroduzione- La distonia cervicale (DC) è un disturbo neurologico del movimento caratterizzato da contrazioni muscolari che causano movimenti ripetitivi e posture anomale. Le iniezioni di tossina botulinica rappresentano il trattamento gold standard, ma l’integrazione con un programma di esercizi domiciliari potrebbe migliorare ulteriormente i sintomi e il benessere psico-sociale dei pazienti, prolungando gli effetti terapeutici.
Obiettivo- Questo studio cross-over mira a valutare l’efficacia della combinazione di tossina botulinica e riabilitazione fisioterapica domiciliare autonoma rispetto al solo trattamento con tossina botulinica. La finalità è migliorare l’articolarità e il controllo motorio del tratto cervicale, con un impatto positivo sulla qualità della vita dei pazienti con DC.
Materiali e metodi - Questo studio pilota crossover randomizzato a singolo cieco, parte del progetto “RaDiCe” della SOC di Neurologia e Clinica Neurologica ASUFC, ha coinvolto due gruppi di partecipanti. Il gruppo A, composto da 13 soggetti, ha ricevuto iniezioni di tossina botulinica e un programma di esercizi domiciliari personalizzati. Otto di questi soggetti sono stati inclusi anche nel gruppo B, che ha ricevuto solo il trattamento con tossina botulinica. Al tempo T0, sono state effettuate valutazioni cinematiche dei movimenti di capo e collo e somministrate scale di valutazione sulla gravità della patologia (TWSTRS), ansia (SAS), depressione (DBI-II) e qualità della vita (CDIP-58). Le valutazioni sono state ripetute dopo 6 settimane di esercizi (T1). I soggetti sono stati assegnati casualmente ai gruppi A o B, con un periodo di wash out di 3 settimane tra i trattamenti.
Risultati- L’analisi dei dati cinematici e delle scale di valutazione ha mostrato un miglioramento nei parametri esaminati, tra cui articolarità, velocità angolare, ripetibilità, simmetria e compensi, nonostante una certa variabilità individuale. Inoltre, si è osservato un miglioramento generale nella gravità della patologia, nell’ansia, nella depressione e nella qualità della vita dei partecipanti.
Conclusioni- Il trattamento combinato di tossina botulinica e fisioterapia domiciliare ha dimostrato di migliorare significativamente la mobilità cervicale, il controllo motorio e la qualità della vita nei pazienti con distonia cervicale idiopatica. Questi risultati suggeriscono che l’integrazione di esercizi domiciliari può potenziare gli effetti del trattamento standard con tossina botulinica.Introduction- Cervical dystonia (DC) is a neurological movement disorder characterised by muscle contractions that cause repetitive movements and abnormal postures. Botulinum toxin injections represent the gold standard treatment, but integration with a home exercise programme could further improve patients' symptoms and psychosocial well-being, prolonging the therapeutic effects.
Objective- This cross-over study aims to evaluate the efficacy of the combination of botulinum toxin with a customised home exercise programme. The aim is to improve articularity and motor control of the cervical spine, with a positive impact on the quality of life of patients with DC.
Materials and methods - This single-blind randomised crossover pilot study, part of the ‘RaDiCe’ project of the SOC of Neurology and Neurological Clinic ASUFC, involved two groups of participants. Group A, consisting of 13 subjects, received botulinum toxin injections and a customised home exercise programme. Eight of these subjects were also included in group B, which only received botulinum toxin treatment. At time T0, kinematic evaluations of head and neck movements were performed and rating scales on pathology severity (TWSTRS), anxiety (SAS), depression (DBI-II) and quality of life (CDIP-58) were administered. The assessments were repeated after 6 weeks of exercise (T1). Subjects were randomly assigned to groups A or B, with a wash-out period of 3 weeks between treatments.
Results- Analysis of the kinematic data and rating scales showed improvement in the parameters examined, including articularity, angular velocity, repeatability, symmetry and compensations, despite some individual variability. In addition, a general improvement was observed in the severity of pathology, anxiety, depression and quality of life of the participants.
Conclusions- The combined treatment of botulinum toxin and home physiotherapy has been shown to significantly improve cervical mobility, motor control and quality of life in patients with idiopathic cervical dystonia. These results suggest that home exercise supplementation may enhance the effects of standard botulinum toxin treatment
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