Impact of different scoring algorithms applied to multiple-mark survey items on outcome assessment: an in-field study on health-related knowledge.

INTRODUCTION: Health-related knowledge is often assessed through multiple-choice tests. Among the different types of formats, researchers may opt to use multiple-mark items, i.e. with more than one correct answer. Although multiple-mark items have long been used in the academic setting - sometimes with scant or inconclusive results - little is known about the implementation of this format in research on in-field health education and promotion. METHODS: A study population of secondary school students completed a survey on nutrition-related knowledge, followed by a single- lecture intervention. Answers were scored by means of eight different scoring algorithms and analyzed from the perspective of classical test theory. The same survey was re-administered to a sample of the students in order to evaluate the short-term change in their knowledge. RESULTS: In all, 286 questionnaires were analyzed. Partial scoring algorithms displayed better psychometric characteristics than the dichotomous rule. In particular, the algorithm proposed by Ripkey and the balanced rule showed greater internal consistency and relative efficiency in scoring multiple-mark items. A penalizing algorithm in which the proportion of marked distracters was subtracted from that of marked correct answers was the only one that highlighted a significant difference in performance between natives and immigrants, probably owing to its slightly better discriminatory ability. This algorithm was also associated with the largest effect size in the pre-/post-intervention score change. DISCUSSION: The choice of an appropriate rule for scoring multiple- mark items in research on health education and promotion should consider not only the psychometric properties of single algorithms but also the study aims and outcomes, since scoring rules differ in terms of biasness, reliability, difficulty, sensitivity to guessing and discrimination.

Tobacco smoking among students in an urban area in Northern Italy.

INTRODUCTION: Tobacco smoking, which usually begins in teenage, is one of the most important lifestyle risk factors for chronic diseases and a major public health problem worldwide. The aims of the study were to determine the prevalence of tobacco smoking and the mean age of initiation among adolescents in Genoa (Italy) and to identify some socio-demographic predictors that could be associated with the onset of smoking. MATERIALS AND METHODS: 2,301 randomly selected students (14-19 years old) in Genoa completed an ad hoc questionnaire. The Kaplan-Meier method was used to evaluate the instantaneous risk of experimenting with smoking. A multivariate logistic regression model was used to determine whether current or previous smoking status was associated with socio-demographic characteristics. RESULTS: 59.5% of respondents had tried smoking, while 35.6% defined themselves as current smokers. No difference in current smoking prevalence emerged between males and females (35.2% and 35.9%, respectively, p = 0.83). The mean age on initiation was 13.5 years for males and 13.9 years for females. The instantaneous probability of trying smoking changed with age, reaching a maximum at 14 years. Subjects who tried smoking before this age were more inclined to continue smoking. The probability of being a current smoker was significantly higher among students from unmarried-parent families and those attending vocational and technical secondary schools. CONCLUSIONS: There is a great need for the activation of new health promotion interventions and enforcement of those already existing, in order to raise awareness of the damage caused by smoking among adolescents, especially those belonging to high-risk groups.

New versus old meningococcal group B vaccines: how the new ones may benefit infants & toddlers.

Invasive disease caused by Neisseria meningitidis is associated with high mortality and high disability rates and mainly affects children under one year of age. Vaccination is the best way to prevent meningococcal disease, especially in infants and toddlers. The introduction of massive meningococcal serogroup C vaccination has drastically reduced the incidence of disease caused by this serogroup, and serogroup B has now become the main causative agent in several industrialized countries. The first serogroup B vaccines, which were used for more than two decades, were based on outer membrane vesicles and proved to be protective only against specific epidemic strains in Cuba, Norway, Brazil and New Zealand. Moreover, these often elicited a scant immune response in young children. Innovative genomics-based reverse vaccinology subsequently enabled researchers to identify genes encoding for surface proteins that are able to elicit a strong immune response against several B strains. This important discovery led to the development and recent approval in Europe of the four-component meningococcal serogroup B (4CMenB) vaccine. Large clinical trials have shown high immunogenicity and tolerability and acceptable safety levels of 4CMenB in infants and toddlers. This vaccine is expected to cover a large number of circulating invasive strains and may also be efficacious against other serogroups. Young children are particularly vulnerable to the devastating consequences of meningococcal disease. Given the high performance of 4CMenB and its non-interference with routine vaccinations, this age-group will be the first to benefit from the introduction of this vaccine.

[Pancreaticoduodenal resection in the treatment of malignant periampullar tumors].

The experience of performance of pancreaticoduodenal resection (PDR) in 412 patients in 1998-2009 yrs for malignant periampullar tumors was analyzed. In 296 patients a standard PDR was done and in 116, with tumoral affection of distal part of common biliary duct and duodenal large papilla - pylorus-preserving PDR Individualized approach was used, exploiting modern technologies of pylorus-preserving PDR: saving gastroduodenal artery, selective ligation of right branch of dorsal pancreatic and lower pancreatoduodenal artery, dorsal and translateral surgical approaches usage. In 26 patients PDR was accomplished with resection of vessels. In 12 patients a no-touch procedure of PDR was applied. There were analyzed the results of application of modified extended lymphadenectomy while PDR performance. Complications had occurred in 29.5% patients, lethality was 2.7%. The survival indices had constituted at average 24 mo--in pancreatic tumors, 48 mo--in tumors of a distal part of common biliary duct and 72 mo--for localized in duodenal large papilla. Introduction of a new methods of PDR would permit to improve an early and late results of treatment.