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21 pages, 2548 KiB

Open AccessArticle

The Influence of Food Regimes on Oxidative Stress: A Permutation-Based Approach Using the NPC Test

by Agata Zirilli, Rosaria Maddalena Ruggeri, Maria Cristina Barbalace, Silvana Hrelia, Luca Giovanella, Alfredo Campennì, Salvatore Cannavò and Angela Alibrandi

Healthcare 2023, 11(16), 2263; https://doi.org/10.3390/healthcare11162263 - 11 Aug 2023

Viewed by 1095

Abstract

(1) Background: This paper aims to assess the existence of significant differences between two dietary regimes (omnivorous vs. semi-vegetarian) with reference to some oxidative stress markers (SOD, GPx, TRxR, GR, AGEs, and AOPPs) using non-parametric combination methodology based on a permutation test. (2) [...] Read more.

(1) Background: This paper aims to assess the existence of significant differences between two dietary regimes (omnivorous vs. semi-vegetarian) with reference to some oxidative stress markers (SOD, GPx, TRxR, GR, AGEs, and AOPPs) using non-parametric combination methodology based on a permutation test. (2) Methods: At the endocrinology unit of Messina University Hospital, two hundred subjects were asked to fill out a questionnaire about their dietary habits. None were under any pharmacological treatment. Using the NPC test, all comparisons were performed stratifying patients according to gender, age (≤40 or >40 years), BMI (normal weight vs. overweight), physical activity (sedentary vs. active lifestyle), TSH, FT4 levels in quartiles, and diagnosis of Hashimoto’s thyroiditis. We evaluated differences in oxidative stress parameters in relation to two examined dietary regimes (omnivorous vs. semi-vegetarian). (3) Results: The antioxidant parameters GPx and TRxR were significantly lower in subjects with an omnivorous diet than in semi-vegetarians, particularly in females, both age groups, subjects with normal weight, those not affected by Hashimoto’s thyroiditis, and both the sedentary and active lifestyle groups. Finally, the AGE and AOPP markers were significantly lower in semi-vegetarians. (4) Conclusion: Thanks to the NPC methodology, we can state that dietary patterns exert a significant influence on some oxidative stress parameters. Full article

(This article belongs to the Special Issue Clinical Epidemiology and Biostatistics for Health Sciences)

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8 pages, 435 KiB

Open AccessCommunication

Optimizing Clinical Decision Making with Decision Curve Analysis: Insights for Clinical Investigators

by Daniele Piovani, Rozeta Sokou, Andreas G. Tsantes, Alfonso Stefano Vitello and Stefanos Bonovas

Healthcare 2023, 11(16), 2244; https://doi.org/10.3390/healthcare11162244 - 10 Aug 2023

Cited by 6 | Viewed by 1876

Abstract

A large number of prediction models are published with the objective of allowing personalized decision making for diagnostic or prognostic purposes. Conventional statistical measures of discrimination, calibration, or other measures of model performance are not well-suited for directly and clearly assessing the clinical [...] Read more.

A large number of prediction models are published with the objective of allowing personalized decision making for diagnostic or prognostic purposes. Conventional statistical measures of discrimination, calibration, or other measures of model performance are not well-suited for directly and clearly assessing the clinical value of scores or biomarkers. Decision curve analysis is an increasingly popular technique used to assess the clinical utility of a prognostic or diagnostic score/rule, or even of a biomarker. Clinical utility is expressed as the net benefit, which represents the net balance of patients’ benefits and harms and considers, implicitly, the consequences of clinical actions taken in response to a certain prediction score, rule, or biomarker. The net benefit is plotted against a range of possible exchange rates, representing the spectrum of possible patients’ and clinicians’ preferences. Decision curve analysis is a powerful tool for judging whether newly published or existing scores may truly benefit patients, and represents a significant advancement in improving transparent clinical decision making. This paper is meant to be an introduction to decision curve analysis and its interpretation for clinical investigators. Given the extensive advantages, we advocate applying decision curve analysis to all models intended for use in clinical practice. Full article

(This article belongs to the Special Issue Clinical Epidemiology and Biostatistics for Health Sciences)

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11 pages, 287 KiB

Open AccessArticle

Asthma, COPD, Respiratory, and Allergic Health Effects in an Adult Population Living near an Italian Refinery: A Cross-Sectional Study

by Mariangela Valentina Puci, Ottavia Eleonora Ferraro, Maria Cristina Monti, Marco Gnesi, Paola Borrelli, Ennio Cadum, Pietro Perotti, Simona Migliazza, Simona Dalle Carbonare, Cristina Montomoli and Simona Villani

Healthcare 2023, 11(7), 1037; https://doi.org/10.3390/healthcare11071037 - 4 Apr 2023

Cited by 3 | Viewed by 2343

Abstract

Background and aim. Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of morbidity and mortality worldwide. Globally, 545 million people suffer from chronic respiratory diseases with a wide geographical variability. Risk factors for asthma are both genetic and related to several [...] Read more.

Background and aim. Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of morbidity and mortality worldwide. Globally, 545 million people suffer from chronic respiratory diseases with a wide geographical variability. Risk factors for asthma are both genetic and related to several environmental factors (internal and external pollutants); these also have an important role in the occurrence of COPD. The aim of this study was to describe the prevalence of asthma, COPD, and asthma/COPD overlap (ACO) in an adult population living in two municipalities located in the Po Valley. Methods. A standardized questionnaire on respiratory symptoms and sociodemographic characteristics was self-administered to a random sample of the adult population aged 20–64 years, living near a refinery in Northern Italy during the period between 2016 and 2019. Logistic and multinomial regression were implemented to explore factors associated with asthma, COPD, and ACO. Results. In total, 1108 subjects filled out the questionnaire, the mean age was 48.02 ± 12.34 years (range 21–68), and 53% of the respondents/participants were female. Half of the responders were non-smokers, but the frequency of current and former smokers was significantly greater in men than in women (p < 0.001). The likelihood of being a probable case of asthma decreased with increasing age and increased for smokers. Tobacco smoke was associated with the presence of COPD and ACO. Conclusion. Respiratory diseases such as asthma and COPD are common in the general population, with differences among countries worldwide. Our findings show, on the basis of the main confirmed risk factor, namely smoking, that it is useful to plan target programs and actions in order to reduce smoking, thus improving the quality of life in public health. Full article

(This article belongs to the Special Issue Clinical Epidemiology and Biostatistics for Health Sciences)

10 pages, 275 KiB

Open AccessArticle

Vaccination Coverage and Associated Factors of COVID-19 Uptake in Adult Primary Health Care Users in Greece

by Izolde Bouloukaki, Anna Christoforaki, Antonios Christodoulakis, Thodoris Krasanakis, Eirini Lambraki, Rodanthi Pateli, Manolis Markakis and Ioanna Tsiligianni

Healthcare 2023, 11(3), 341; https://doi.org/10.3390/healthcare11030341 - 24 Jan 2023

Cited by 4 | Viewed by 1850

Abstract

In our study, attitudes and perceptions of adult primary health care users regarding COVID-19 vaccination were evaluated. A single-center, cross-sectional study was conducted during a 1-year period (March 2021–March 2022) in a rural area in Crete, Greece. A sample of 626 self-reported questionnaires [...] Read more.

In our study, attitudes and perceptions of adult primary health care users regarding COVID-19 vaccination were evaluated. A single-center, cross-sectional study was conducted during a 1-year period (March 2021–March 2022) in a rural area in Crete, Greece. A sample of 626 self-reported questionnaires was collected at the end of the study period. Overall, 78% of respondents stated that they had received the COVID-19 vaccine. The reasons behind vaccine uptake were mainly personal beliefs and the desire to avoid professional constraints. The presence of diabetes type 2, fear of infection, and high perceived efficacy of vaccine previous flu vaccination, living with vulnerable persons, and the influence of scientific information were all significant predictors of COVID-19 vaccine uptake. On the contrary, unwillingness and/or uncertainty to be vaccinated was associated with fear of vaccine side effects, information insufficiency, media/internet information, older age, the presence of inflammatory arthritis, previous COVID-19 infection, the belief that infection confers much greater immunity than the vaccine, and attitudes against vaccinations in general were predictors against COVID-19 vaccination. In conclusion, taking into account all of the above predictors and particularly those regarding safety and vaccine effectiveness may guide future strategies appropriately tailored to specific characteristics and needs of different geographic populations. Full article

(This article belongs to the Special Issue Clinical Epidemiology and Biostatistics for Health Sciences)

15 pages, 870 KiB

Open AccessArticle

Non-Motherhood between Obligation and Choice: Statistical Analysis Based on Permutation Tests of Spontaneous and Induced Abortion Rates in the Italian Context

by Angela Alibrandi, Lavinia Merlino, Claudio Guarneri, Ylenia Ingrasciotta and Agata Zirilli

Healthcare 2022, 10(8), 1514; https://doi.org/10.3390/healthcare10081514 - 11 Aug 2022

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Abstract

(1) Background: This paper aims to examine two relevant phenomena in the context of public health: spontaneous abortion (SA) and induced abortion (IA). SA is one of the most common complications of pregnancies; IA is a conscious choice that is made by the [...] Read more.

(1) Background: This paper aims to examine two relevant phenomena in the context of public health: spontaneous abortion (SA) and induced abortion (IA). SA is one of the most common complications of pregnancies; IA is a conscious choice that is made by the mother/couple. (2) Methods: Permutation tests were applied to SA and IA standardized rates detected by ISTAT (2016–2020). The NPC test, chosen for its optimal properties, was applied to compare different Italian territorial divisions (stratifying for year and age classes of women) and analyze the trend of years by stochastic ordering. (3) Results: Only for SA, there are significant differences among the three territorial divisions: the South records higher SA standardized rates than the North and the Center; the rates of IA are similar. Relating to distinct women age classes, the SA standardized rates do not show significant differences among the three analyzed geographical areas; different results are highlighted for IA. Stochastic ordering shows that only the IA standardized rates are characterized by a significant monotonous decreasing trend over the years. (4) Conclusion: The SA phenomenon has shown a decreasing trend that could be justified by the progress of science. For IA, we can certainly say that the general decrease in the phenomenon is due to the greater use of contraceptive methods that help to prevent unwanted pregnancies. Full article

(This article belongs to the Special Issue Clinical Epidemiology and Biostatistics for Health Sciences)

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11 pages, 726 KiB

Open AccessArticle

Development and Validation of a Novel Pre-Pregnancy Score Predictive of Preterm Birth in Nulliparous Women Using Data from Italian Healthcare Utilization Databases

by Ivan Merlo, Anna Cantarutti, Alessandra Allotta, Elisa Eleonora Tavormina, Marica Iommi, Marco Pompili, Federico Rea, Antonella Agodi, Anna Locatelli, Rinaldo Zanini, Flavia Carle, Sebastiano Pollina Addario, Salvatore Scondotto and Giovanni Corrao

Healthcare 2022, 10(8), 1443; https://doi.org/10.3390/healthcare10081443 - 1 Aug 2022

Cited by 2 | Viewed by 1896

Abstract

Background: Preterm birth is a major worldwide public health concern, being the leading cause of infant mortality. Understanding of risk factors remains limited, and early identification of women at high risk of preterm birth is an open challenge. Objective: The aim of the [...] Read more.

Background: Preterm birth is a major worldwide public health concern, being the leading cause of infant mortality. Understanding of risk factors remains limited, and early identification of women at high risk of preterm birth is an open challenge. Objective: The aim of the study was to develop and validate a novel pre-pregnancy score for preterm delivery in nulliparous women using information from Italian healthcare utilization databases. Study Design: Twenty-six variables independently able to predict preterm delivery were selected, using a LASSO logistic regression, from a large number of features collected in the 4 years prior to conception, related to clinical history and socio-demographic characteristics of 126,839 nulliparous women from Lombardy region who gave birth between 2012 and 2017. A weight proportional to the coefficient estimated by the model was assigned to each of the selected variables, which contributed to the Preterm Birth Score. Discrimination and calibration of the Preterm Birth Score were assessed using an internal validation set (i.e., other 54,359 deliveries from Lombardy) and two external validation sets (i.e., 14,703 and 62,131 deliveries from Marche and Sicily, respectively). Results: The occurrence of preterm delivery increased with increasing the Preterm Birth Score value in all regions in the study. Almost ideal calibration plots were obtained for the internal validation set and Marche, while expected and observed probabilities differed slightly in Sicily for high Preterm Birth Score values. The area under the receiver operating characteristic curve was 60%, 61% and 56% for the internal validation set, Marche and Sicily, respectively. Conclusions: Despite the limited discriminatory power, the Preterm Birth Score is able to stratify women according to their risk of preterm birth, allowing the early identification of mothers who are more likely to have a preterm delivery. Full article

(This article belongs to the Special Issue Clinical Epidemiology and Biostatistics for Health Sciences)

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20 pages, 422 KiB

Open AccessArticle

An Accelerated Failure Time Cure Model with Shifted Gamma Frailty and Its Application to Epidemiological Research

by Haro Aida, Kenichi Hayashi, Ayano Takeuchi, Daisuke Sugiyama and Tomonori Okamura

Healthcare 2022, 10(8), 1383; https://doi.org/10.3390/healthcare10081383 - 25 Jul 2022

Cited by 2 | Viewed by 1951

Abstract

Survival analysis is a set of methods for statistical inference concerning the time until the occurrence of an event. One of the main objectives of survival analysis is to evaluate the effects of different covariates on event time. Although the proportional hazards model [...] Read more.

Survival analysis is a set of methods for statistical inference concerning the time until the occurrence of an event. One of the main objectives of survival analysis is to evaluate the effects of different covariates on event time. Although the proportional hazards model is widely used in survival analysis, it assumes that the ratio of the hazard functions is constant over time. This assumption is likely to be violated in practice, leading to erroneous inferences and inappropriate conclusions. The accelerated failure time model is an alternative to the proportional hazards model that does not require such a strong assumption. Moreover, it is sometimes plausible to consider the existence of cured patients or long-term survivors. The survival regression models in such contexts are referred to as cure models. In this study, we consider the accelerated failure time cure model with frailty for uncured patients. Frailty is a latent random variable representing patients’ characteristics that cannot be described by observed covariates. This enables us to flexibly account for individual heterogeneities. Our proposed model assumes a shifted gamma distribution for frailty to represent uncured patients’ heterogeneities. We construct an estimation algorithm for the proposed model, and evaluate its performance via numerical simulations. Furthermore, as an application of the proposed model, we use a real dataset, Specific Health Checkups, concerning the onset of hypertension. Results from a model comparison suggest that the proposed model is superior to existing alternatives. Full article

(This article belongs to the Special Issue Clinical Epidemiology and Biostatistics for Health Sciences)

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Review

Jump to: Research

16 pages, 312 KiB

Open AccessReview

A Review of Anthropometric Measurements for Saudi Adults and Elderly, Directions for Future Work and Recommendations to Establish Saudi Guidelines in Line with the Saudi 2030 Vision

by Essra A. Noorwali and Abeer M. Aljaadi

Healthcare 2023, 11(14), 1982; https://doi.org/10.3390/healthcare11141982 - 8 Jul 2023

Cited by 2 | Viewed by 2480

Abstract

Body weight is a significant risk factor for the disease burden of noncommunicable diseases (NCDs). Anthropometric measurements are the first step in determining NCDs risk, and clinicians must have access to valid cutoffs. This study aims to review the literature of Saudi national [...] Read more.

Body weight is a significant risk factor for the disease burden of noncommunicable diseases (NCDs). Anthropometric measurements are the first step in determining NCDs risk, and clinicians must have access to valid cutoffs. This study aims to review the literature of Saudi national guidelines and studies previously conducted in Saudi Arabia (SA) and to provide insights and recommendations to establish national guidelines in anthropometric measurements for Saudi adults/elderly in line with the Saudi 2030 Vision. In total, 163 studies were included, and 12 of them contributed to the development of specific anthropometric cutoffs. Cutoffs for metabolic syndrome, waist circumference, and body mass index were established in Saudi adults. However, limited studies were conducted in the elderly. This review warrants establishing standard cutoffs of Saudi adult anthropometrics to avoid over/underreporting of malnutrition and adiposity. This review will help policymakers and the Ministry of Health to establish national guidelines and standard cutoffs to be used in SA for anthropometric measurements that may assist in detecting malnutrition and NCDs. Full article

(This article belongs to the Special Issue Clinical Epidemiology and Biostatistics for Health Sciences)

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