The province of Brescia faces a relevant epidemiological situation, with the prevalence of HCV and HBV infection reaching up to 3.0% in some areas. After the COVID-19 pandemic, the increase in HCV-related hepatocellular carcinomas has been overall in migrants. [In Brescia and its province], there is a high number of migrants originating from countries with a high prevalence of viral hepatitis. The epidemiological context has led the MISI Foundation and the non-profit organization "Il Filo della Salute" to undertake a project aimed at identifying infections of HBV and HCV in a settled migrant population from Eastern Europe employed as caregivers. Through the analysis of the most suitable methodologies to engage the target population, which is generally reluctant to undergo medical analyses and tests in the host country, communication strategies have been identified using social web channels and disseminated by influencers to promote the project. The project attracted 350 participants (300 women and 50 men), mainly originating from Moldova. Following pre-test counseling, a self-test for HCVAb was administered, resulting in a positive outcome for 18 (5,1%). Among these, 4.2% tested positive for HCV RNA. In 300 subjects, the HBsAg test was offered, yielding a positive result in 8,3% of cases. All infected individuals were offered linkage to the nearest hepatological or infectious disease care facility based on their residence. The project has allowed the identification of a high number of migrants residing in the province of Brescia infected with HCV or HBV, with percentages consistent with the epidemiology of their country of origin. Within public health projects, it would be crucial to invest in dedicated screening campaigns for the settled migrant population, also considering the role as a caregiver, which is important for both minimizing the risk of transmission and reducing the progression of the infection.
Introduction: Degenerative Lumbar spinal stenosis (DLSS) is the most common cause of spine surgery for patients above 55 years. Surgery options include decompression alone or with spinal fusion. The DRG system uses classification algorithms that categorize patients into groups with similar clinical and resource consumption characteristics, using ICD-10 nomenclature for diagnoses and ICD-9-CM for procedures. Objective: Identify clinical and epidemiological variables of DLSS surgery patients based on Chile’s DRG system data and define factors associated with arthrodesis as a complement to decompression. Study Design: Retrospective observational study. Methods: This study used the national DRG database to analyze factors predicting the need for fusion in patients with DLSS. Data from 31 public hospitals in Chile were analyzed for patients discharged between 2020 and 2022. Variables considered included age, gender, presence of other spinal pathologies, and attending physician specialty. For the descriptive analysis of qualitative variables, frequencies and percentages were used.The study used univariate and multivariate logistic regression analysis. A statistical significance level of less than 0.05 was considered. Results: We analyzed 1024 patients with lumbar spinal stenosis and found that 54.6% were female and 45.4% were male (p= 0.0034). The majority of the patients (57.4%) were aged between 60 and 79 years. 75% of orthopedic surgeons opted for decompression plus arthrodesis, while neurosurgeons preferred decompression alone in 73% of cases. The most significant predictors for decompression with fusion were the physician’s specialty in orthopedic surgery, female sex, and the presence of other spinal pathologies such as scoliosis, herniated disc, and spondylolisthesis. Patients treated by an Orthopedic Surgeon had an 8.2 times greater probability of undergoing decompression plus arthrodesis as compared to those treated by a Neurosurgeon. Additionally, the presence of spondylolisthesis increased the probability of decompression with fusion by 6.2 times, and the presence of scoliosis increased it by 6.6 times. Neurosurgeons opted for decompression alone in 89.7% of the cases with DLSS stenosis and herniated disc, while only 48.9% of orthopedic surgeons opted for the same option (p=0.0000). Conclusion: Our study based on DRG records from public hospitals in Chile has identified certain factors linked to a higher frequency of spinal arthrodesis. These factors include the surgery being performed by orthopedic surgeons, patients aged between 40 and 60 years old, the presence of degenerative spondylolisthesis and degenerative scoliosis, and the absence of a
Introduction: Surprisingly, multivariate multilevel analyses, which is often used to analyse longitudinal data, is seldom used to analyse multiple, correlated outcomes, such as questionnaire subscales or biological risk factors. Therefore, the aim of the study was to compare multivariate multilevel analysis with separate, per outcome, analyses in data with correlated outcomes retrieved from the same individual, in both cross sectional and longitudinal studies. Method: To compare the results of multivariate multilevel analysis with the separate analyses of each outcome, both real life example datasets and simulated data in which various characteristics are systematically varied, were used. Results: Multivariate multilevel analyses produced substantially more accurate estimates and standard errors than separate analyses for each outcome in incomplete datasets and when analysing longitudinal relations with time-dependent covariates. In complete datasets, for time-independent covariates (e.g., baseline characteristics) and when the development over time is analysed, results of the two analytical approaches were highly similar. It was also found that similarity of standard deviations between the outcomes is needed for a proper estimation of the standard error of the regression coefficient in a multivariate multilevel analysis. Similarity of standard deviations can be obtained by using z-scores. Furthermore, before using longitudinal multivariate multilevel analyses it has to be evaluated which type of clustering provides the best model fit. Conclusion: Multivariate multilevel analysis is an elegant way to analyse multiple correlated outcomes, which is superior to separate analyses for each outcome in case of missing data and/or when timedependent covariates are analysed. Keywords: Multivariate Multilevel Modelling; Cross-sectional data; Longitudinal data; Correlated outcomes; Real life data; Simulated data. List of abbreviations
The COVID-19 pandemic was a public health emergency between 2020 and 2022 with a direct impact on the lives of health professionals. The objective of the study was to identify the prevalence of contamination of the disease in primary care professionals in Salvador-Ba, Brazil, work activities changed by the pandemic, and the impacts on the mental health of these professionals. A cross-sectional study was carried out, and the reference population was the universe of professionals with higher and secondary education (N=1675) who worked in the network. An electronic form was applied from December 2021 to April 2022, including socioeconomic and demographic issues, health history and comorbidities, routine and working hours, contamination by COVID-19, and evaluation of the emotional aspects of these professionals through the application of the Anxiety Scale (GAD-7) and Burnout Syndrome (Maslach Burnout Inventory) questionnaire. A descriptive analysis of the variables of interest was performed using central tendency and dispersion measures and absolute and relative frequencies. 321 workers participated in the study, 97.20% with a workload of 40 hours per week. The female gender was the majority - 83.18%, married marital status with 57.94% and having a postgraduate degree was the most present level of education (48.50%). Among the comorbidities, hypertension had the highest occurrence (10.59%). 80.7% of health professionals revealed that they participated in the screening team (reception) of patients with or suspected of COVID-19 and in the organization of vaccination. Contamination by COVID-19 was 64.79%, and 41.83% attributed it to work activity. Of the total, 67.28% of workers had some type of anxiety intensity. Regarding the Burnout indices, it was observed that 47.06% had a high level of emotional exhaustion, 68.84% had a high level of depersonalization, and 99.06% considered their professional fulfillment to be low.
Managing coronavirus disease-2019 (COVID-19) pandemic, as an unprecedented public health emergency is considered to be one of the most burdensome cases of Public Health Management (PHM) in the 21st century.
