Category: Nevin Manimala

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2025 Dec 16. doi: 10.3881/j.issn.1000-503X.16975. Online ahead of print.

ABSTRACT

Objective To evaluate the effect of pressure-controlled ventilation-volume guaranteed(PCV-VG)on the perioperative pulmonary oxygenation function of the patients undergoing off-pump coronary artery bypass grafting(OPCABG). Methods Forty patients aged 40-65 years,of both sexes,with the American Society of Anesthesiologists physical status Ⅲ or Ⅳ,preoperative cardiac function(NYHA)class Ⅱ or Ⅲ,scheduled for elective OPCABG were assigned via the random number table method into two groups(n=20):a volume-controlled ventilation(VCV)group(Group V)and a PCV-VG group(Group P). Other respiratory parameters of the anesthesia machine were set consistently in both groups. At the time of sawing the sternum(T₀),when left internal mammary artery harvesting with the operating table tilted 10° to the left(T₁),when left anterior descending coronary artery bypass grafting with the operating table tilted 10° to the right(T₂),when right coronary artery bypass grafting with the operating table in a 30° head-down and tilted 10° to the right(T₃),when circumflex coronary artery bypass grafting with the operating table in a 20° head-down and tilted 15° to the right(T₄),and at the end of the surgery(T₅),the peak airway pressure(Ppeak),mean airway pressure(Pmean),plateau airway pressure(Pplat),and pulmonary dynamic compliance(Cdyn)were recorded. The alveolar-arterial partial pressure difference of oxygen(PA-aDO₂),oxygenation index(OI),and respiratory index(RI)were recorded at the aforementioned time points as well as on postoperative day 1(T₆),day 3(T₇),and day 7(T₈). The dosages of intraoperative drugs(sufentanil,remifentanil,and rocuronium bromide),postoperative endotracheal tube indwelling time,the stay time in the cardiac surgery intensive care unit,and the occurrence of pulmonary complications within 7 days after the surgery were also recorded. Results Compared with Group V,Group P showed significant downward trends in Ppeak,Pmean,and Pplat during T₃-T₅,as well as in PA-aDO₂ and RI during T₃-T₈(all P<0. 05). Meanwhile,Group P exhibited significant upward trends in Cdyn during T₃-T₅ and in OI during T₃-T₈(all P <0. 05). Compared with those in Group V,the postoperative endotracheal tube indwelling time and the stay time in the cardiac surgery intensive care unit were shortened in Group P(all P<0. 05). There was no statistically significant difference in dosages of intraoperative drugs(sufentanil,remifentanil,and rocuronium bromide)or incidence of pulmonary complications within 7 days after the surgery between the two groups of patients(all P>0. 05). Conclusion Compared with VCV,PCV-VG can improve the perioperative pulmonary oxygenation function of the patients undergoing OPCABG.

PMID:41399937 | DOI:10.3881/j.issn.1000-503X.16975

Int J Offender Ther Comp Criminol. 2025 Dec 16:306624X251391790. doi: 10.1177/0306624X251391790. Online ahead of print.

ABSTRACT

This study examines whether clinical need subgroups in forensic care have evolved over 20 years and explores differences in adverse childhood experiences (ACEs) and assaultive behaviors across groups. This retrospective observational study used data from a hospital for men; Sample 1 (S1, N = 97) collected in 1990, and Sample 2 (S2, N = 176) in 2009-2012. A data-driven multiple correspondence analysis and a cluster analysis was conducted on S1 based on clinical needs, then applied to S2. ACEs and assault proportions within each cluster were compared using chi-square tests. Clusters identified: minimal needs (S1 = 23%, S2 = 20%); psychotic disorders (S1 = 19%, S2 = 17%); personality disorders (S1 = 21%, S2 = 22%); complex needs (S1 = 37%, S2 = 41%). Participants reporting ACEs (p = .004) and assault (p < .001) differed between clusters. The third cluster reported the highest ACEs (84.6%) and assault (61.5%).

PMID:41399934 | DOI:10.1177/0306624X251391790

Expert Rev Pharmacoecon Outcomes Res. 2025 Dec 16. doi: 10.1080/14737167.2025.2603944. Online ahead of print.

ABSTRACT

BACKGROUND: The long-term impact of preventive policies in the Netherlands on the mental health of young adults remains unclear. Therefore, this paper describes the development of a conceptual model of youth mental health that serves as the foundation of a future decision-analytic model.

RESEARCH DESIGN AND METHODS: Stakeholders were engaged through three rounds of focus group discussions to indicate the factors of youth mental health that affect the likelihood of developing mental disorders later in life, and the relationships among them. Findings were discussed with stakeholders and in a study team that included members with diverse backgrounds. Literature was used as an additional information source for the relationships among the selected factors.

RESULTS: In total, 43 stakeholders participated in the focus group discussions. Eleven factors of youth mental health were regarded as most influential, with 13 relationships among them. The final conceptual model was approved by the stakeholders and the study team.

CONCLUSIONS: Through integrating stakeholder perspectives and published literature, a conceptual model was created that captures essential factors and relationships affecting (long-term) mental health. Although stakeholder engagement requires extensive planning, it enhanced the model’s credibility and validity, and could therefore serve as a complement to other conceptual modeling approaches.

PMID:41399892 | DOI:10.1080/14737167.2025.2603944

Epidemiol Prev. 2025 Jul-Aug;49(4):321-330. doi: 10.19191/EP25.4.A849.075.

ABSTRACT

BACKGROUND: maintenance immunosuppressive therapy, indicated for patients after solid organ transplantation – kidney (R), liver (F), heart (C), lung (P) – and aimed at preventing rejection, involves the intake of at least one Calcineurin (CNI) inhibitor (Cyclosporin – CsA – or Tacrolimus – TAC) in combination with an Antimetabolite (Antim) (Mycophenolate Mofetil or Mycophenolic Acid – MMF – or Azathioprine – AZA) or a proliferation signal inhibitor (mTOR) (Sirolimus – SIR – or Everolimus – EVE) with the possible addition of corticosteroids (in particular Prednisone – PRED). The possibility of comparing prescribing patterns identified through different data sources represents an important methodological challenge and could shed light on the accuracy, advantages, and limitations of different information sources, aspects that must be considered when planning future observational studies.

OBJECTIVES: to assess, within a cohort of solid organ transplant patients, the levels of concordance in the definition of post-transplant immunosuppressive therapy between health administrative flows and what is reported by the medical specialist during the patient’s periodic follow-up visit.

DESIGN: analysis of the level of concordance of information on post-transplant maintenance immunosuppressive therapy collected from two different data sources: the regional health administrative databases (SIS) and the national transplant information system (SIT). This analysis was performed as part of a retrospective cohort study – the CESIT study – including all patients undergoing single solid organ transplantation (heart, liver, lung, kidney) between 2009 and 2019 in four Italian regions (Lombardy, Lazio, Veneto, Sardinia). The therapeutic combinations of immunosuppressants were identified by means of specific algorithms applied to the SIS data and subsequently compared with the therapeutic patterns recorded by specialist physicians during follow-up visits (FU) and entered electronically in the SIT flow sheets. The analysis focuses mainly on the therapy delivered in the 30 days following hospital discharge (index therapy); it is then extended to comparisons made over longer time windows (at 1, 2, and 3 years from the date of hospital discharge).

MAIN OUTCOME MEASURES: the level of agreement between the two data sources in defining the index therapy was assessed using three methods: 1. Cohen’s k statistic: this method allowed quantification of the level of agreement at the level of individual active substance; 2. proportion of active ingredients in common: an ordinal categorical variable was calculated for each patient indicating the level of concordance between the sources: null (no active ingredient in common), low (<40 % of ATCs in common), medium (40-59 %), high (>60 %), perfect (identical combinations); 3. Levenshtein distance (LS): considering polypharmacies from a formal point of view as strings, the computational effort that would be required to make them equal was estimated.

RESULTS: there were 2,692 solid organ transplant patients for whom index therapy information was available from both SIS and SIT (C: 6.8%; F: 44.9%; P: 5.2%; R: 43.1%). In comparison to CNI immunosuppressants, Cohen’s k coefficient showed high levels of concordance for all transplant types (CsA heart: 0.78; CsA liver: 0.96 – TAC heart: 0.74; TAC kidney: 0.92); while for MMF, differential performance by organ type was evident (MMF heart: 0.51; MMF kidney: 0.78). For the Preds, there was greater discordance in particular in R and F. When comparing immunosuppressive therapy as a whole, the ‘high/perfect’ concordance levels concerned on average 80.1% of the patients (F: 70.1%; R: 91.3%). The results were comparable by applying LS. Finally, the concordance at 1, 2, and 3 years after discharge reported a less good performance than with index therapy, which was, however, stable over the time intervals considered.

CONCLUSIONS: the level of concordance between therapeutic combinations for the same patient detected between different sources was generally high: despite this, the level of agreement varied according to the individual active substance, the type of transplant and the time window examined. The results of this work show that SIS are a valuable tool for defining immunosuppressive maintenance therapies and offer useful elements to consider when planning observational studies based on the two data flows.

PMID:41399891 | DOI:10.19191/EP25.4.A849.075

Epidemiol Prev. 2025 Jul-Aug;49(4):308-320. doi: 10.19191/EP25.4.A863.067.

ABSTRACT

BACKGROUND: when facing growing environmental and social challenges, it is essential to involve citizens and social actors to increase the probability of success of the interventions, after establishing a cohesive and harmonised working group.

OBJECTIVES: to illustrate the tools for risk communication activity developed as part of the ‘One Health Citizen Science’ Project (OHCS), the actions undertaken and the preliminary results that offer an overview of the context and perspectives; to analyse the results of the internal survey of the group of experts working in OHCS on the issues of risk perception and communication in the specific context of citizen science (CS).

DESIGN: description of the actions undertaken in the OHCS communication sector and a transversal study on risk perception and CS.

SETTING AND PARTICIPANTS: within the OHCS project, the following tools were produced during various meetings: information sheets, to be compiled for each of the 7 polluted sites and the 2 regional waste plans, containing useful information for setting up a risk communication programme; a methodological document for risk communication, to be used as a guide for the construction of specific communication plans in each area; an internal questionnaire, consisting of 29 questions to deepen the knowledge of the project partners, administered through the Google Forms platform.

MAIN OUTCOME MEASURES: description of the actions undertaken in the OHCS communication sector and a transversal study on risk perception and CS of the experts, part of the project team; quantitative and qualitative analysis of the information sheets; evaluation of the impact of the methodological document for risk communication; analysis of the data obtained from the internal questionnaire, through descriptive statistical methods and multivariate analysis, implemented with R Software.

RESULTS: the information sheets contain useful information for risk communication, but need to be updated. The methodological document is still only partially used. The internal questionnaire administered to the experts of the project team saw the participation of 46 adults (between 30 and 59 years old: N. 35; 76,09%), mainly female (N. 31; 67,39%), with a high level of education. The results confirm the awareness, expected in sector operators, that dangers involve risks and reinforce the indication to work directly to mitigate them. Over two thirds of respondents have not participated in CS projects, and the majority declared themselves convinced that there are protection and prevention measures that can be implemented immediately, involving the responsible authorities and providing widespread information dedicated to different stakeholders.

CONCLUSIONS: the OHCS project, launched in 2023, has developed useful tools for collecting information and preparing environmental monitoring and biomonitoring activities. The results obtained so far show an improvement in the quality and quantity of the information collected, which is useful for involving social actors. The approaches used promote systematic methodologies that can facilitate the participation of all stakeholders. Internal communication actions within the project have contributed to the consolidation of the project team and the mapping of citizens’ social actors, and have developed awareness of the importance of CS for the planned activities and replicability in other contexts.

PMID:41399890 | DOI:10.19191/EP25.4.A863.067

Epidemiol Prev. 2025 Jul-Aug;49(4):299-307. doi: 10.19191/EP25.4.A886.077.

ABSTRACT

BACKGROUND: survival rates for childhood cancers have significantly improved over recent decades, with 5-year survival now approaching 90% for many types. However, documented variations in survival across European countries and Italian regions highlight the need to address inequalities. One of the most critical prognostic factors is the extent of tumour spread at diagnosis (tumour stage).

OBJECTIVES: the BENCHISTA-ITA aims to enhance understanding of regional differences in childhood cancer survival and to promote the widespread adoption of the Toronto Guidelines (TG) by Italian cancer registries for the most common solid paediatric tumours.

DESIGN: the study will examine stage distribution and survival for nine solid paediatric cancers: medulloblastoma, neuroblastoma, Wilms tumour, retinoblastoma, and ependymoma (age: 0-14 years), as well as astrocytoma, osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma (age: 0-19 years).

SETTING AND PARTICIPANTS: the study will include all children under 15 or 20 years (depending on the tumour type) diagnosed between 01.01.2013 and 31.12.2017, with relevant histological codes. Participating Italian cancer registries will assign tumour stage at diagnosis using the Toronto Guidelines.

STATISTICAL ANALYSIS: the statistical power to detect differences in stage distribution and survival rates among regions is limited by the number of incident cases per tumour type and region. Therefore, analyses will be descriptive, with 95% confidence intervals. Overall survival for each tumour type will be estimated using the Kaplan-Meier method.

CONCLUSIONS: BENCHISTA-ITA represents an important step toward a more complete and standardized registration of childhood cancers in Italy. The results may support targeted interventions to reduce inequalities and improve outcomes for paediatric patients.

PMID:41399889 | DOI:10.19191/EP25.4.A886.077

Epidemiol Prev. 2025 Jul-Aug;49(4):291-298. doi: 10.19191/EP25.4.A848.068.

ABSTRACT

OBJECTIVES: to review pneumococcal vaccination recommendations in at-risk adults and people aged 65 years or over across the Italian Regions.

DESIGN: mapping review of available online resources, both at regional and local health unit level, on pneumococcal vaccination programmes by age and risk group.

SETTING AND PARTICIPANTS: the review included institutional websites of regional and local health authorities, freely accessible to the public via generic search engines, containing information on pneumococcal vaccination in frail people.

MAIN OUTCOME MEASURES: the following information was collected and classified: • populations targeted by the immunization programme; • type of recommended vaccine (conjugate and/or polysaccharide); • adopted vaccination schedule; • mode of patient contact; • involved health professional; • availability of vaccination registry; • availability of vaccination coverage data; • presence of online awareness campaigns.

RESULTS: a total of 24 institutional websites, representative of all Italian Regions, were included in the review. More than 90% of the recommendations collected were published between 2023 and 2024. In 75% of the analyzed documents, the Regions offer pneumococcal vaccination to the cohort aged 65 years; in 46% of the documents, the offer is extended to all persons aged 65 years and over. In 96% of the resources, the vaccination programme includes at-risk adults, and 75% of these give details of the diseases for which vaccination is recommended. In seven resources, it is reported that Regions recommend a single dose of the 20-valent pneumococcal conjugate vaccine, in the others the use of the pneumococcal conjugate vaccine (PCV) followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is indicated, with different schedules. In at-risk adults, 83% of the documents recommend the sequential schedule with PCV followed by PPSV23, with time schedules defined in 63% of cases. The mode of patient contact is reported in 7 web resources, 4 of which include sending an invitation letter at 65 years of age. Vaccination center health professionals (16/24) and general practitioners (15/24) are the healthcare providers most involved in promoting and administering vaccination. In 71% of the resources, the regional health authorities were reported to have promoted targeted communication campaigns. Data on PCV coverage by age were available for 6 Regions, but not by risk group.

CONCLUSIONS: the findings of this study highlight significant heterogeneity in the offer of pneumococcal vaccination to at-risk adults and people aged 65 years and older among Italian Regions. Greater efforts are needed to standardize and harmonize vaccination policies and to coordinate vaccination communication. The integration of immunization registries with high-risk patient clinical data will allow the systematic identification of vaccine candidates and facilitate the monitoring of vaccination coverage.

PMID:41399888 | DOI:10.19191/EP25.4.A848.068

Epidemiol Prev. 2025 Jul-Aug;49(4):279-290. doi: 10.19191/EP25.4.A873.073.

ABSTRACT

BACKGROUND: gambling is a widespread phenomenon among adolescents, with increasing prevalence among preadolescents.

OBJECTIVES: to describe the prevalence of gambling and problematic gambling in a sample of secondary school students of Piedmont Region (Northern Italy) and Lazio Region (Central Italy) which participated in the “GAPUnplugged” experimental study.

METHODS: data were collected through an anonymous questionnaire created ad hoc and administered between November 2022 and January 2023. Prevalence of gambling in the past 12 months and 30 days and of problematic and at-risk behaviour measured through the SOGS-RA scale were estimated.

RESULTS: 1,874 students aged 12 to 14 participated in the study. Prevalence of gambling was 55.7% in the last 12 months and 36.4% in the last 30 days. Sixteen percent of students engaged in regular gambling (3 or more times in the last 30 days), 7.2% had at risk gambling behaviour, and 3.4% had problematic gambling behaviour. Prevalence was higher among males and among students of schools of the city of Rome.

CONCLUSIONS: gambling among preadolescents is a widespread phenomenon, with a proportion of students at risk or exhibiting problematic behaviours similar to other addictive risk behaviours. It is needed to create and implement specific preventive interventions to limit early exposure to gambling in adolescence and preadolescence.

PMID:41399887 | DOI:10.19191/EP25.4.A873.073

Epidemiol Prev. 2025 Jul-Aug;49(4):267-271. doi: 10.19191/EP25.4.078.

ABSTRACT

Problematic smartphone and social media use among adolescents has rapidly become a social emergency with significant mental health implications. Recent studies show an increase in psychiatric symptoms and suicidal behaviors related to patterns of addictive use rather than total exposure time. This phenomenon, amplified by neurocognitive reward mechanisms and the possibility of continuous access, compromises attention, sleep, and interpersonal skills. Prevention strategies are structured on three levels: technical and legal control (use restrictions and school bans), educational and family empowerment (digital education and family use plans), and health prevention through screening and counseling. The article concludes with the hope for a change in strategy: not only limiting use, but also fostering a conscious and critical relationship with technology through coordinated, evidence-based policies.

PMID:41399885 | DOI:10.19191/EP25.4.078

Epidemiol Prev. 2025 Jul-Aug;49(4):258-266. doi: 10.19191/EP25.4.081.

ABSTRACT

Juvenile prisons represent a jumble of dilemmas and choices for those concerned about the health and future of young detained people. While often presented as an opportunity for “rescue” and even social redemption, juvenile justice facilities offer a variety of approaches, ranging from the more advanced ones that allow effective interactions with the “outside” (family, school, and the world of work) to the more closed ones where the lack of support and activities exposes the most serious aspects of any incarceration: violence, isolation, and various forms of addiction. Italy’s main and largest juvenile prison, named after Cesare Beccaria (an Italian philosopher universally renowned for laying the conceptual foundations against the death penalty and torture), has been experiencing a period of great difficulty for years, characterized by widespread violence, inadequate care for the needs of young people in prison, staff frustration, and social criminalization of inmates, accompanied by the stigmatization of those who work there. The author analyses the risks for young people detained in such places and invites to reflect about what general conclusions can be drawn about juvenile prisons in today’s Italian society.

PMID:41399884 | DOI:10.19191/EP25.4.081