Impact of the 2008 economic crisis on the burden of hepatitis B and C diseases in Southern European countries.

BACKGROUND: The economic crisis that began in 2008 has severely affected Southern (Greece, Italy, Portugal, Spain) Western European (SWE) countries of Western Europe (WE) and may have affected ongoing efforts to eliminate viral hepatitis. This study was conducted to investigate the impact of the economic crisis on the burden of HBV and HCV disease. METHODS: Global Burden of Diseases 2019 data were used to analyse the rates of epidemiological metrics of HBV and HCV acute and chronic infections in SWE and WE. Time series modelling was performed to quantify the impact of healthcare expenditure on the time trend of HBV and HCV disease burden in 2000-2019. RESULTS: Declining trends in incidence and prevalence rates of acute HBV (aHBV) and chronic HBV were observed in SWE and WE, with the pace of decline being slower in the post-austerity period (2010-2019) and mortality due to HBV stabilised in SWE. Acute HCV (aHCV) metrics and chronic HCV incidence and mortality showed a stable trend in SWE and WE, whereas the prevalence of chronic HCV showed an oscillating trend, decreasing in WE in 2010-2019 (p < 0.001). Liver cancer due to both hepatitis infections showed a stagnant burden over time. An inverse association was observed between health expenditure and metrics of both acute and chronic HBV and HCV. CONCLUSIONS: Epidemiological metrics for HBV and HCV showed a slower pace of decline in the post-austerity period with better improvement for HBV, a stabilisation of mortality and a stagnant burden for liver cancer due to both hepatitis infections. The economic crisis of 2008 had a negative impact on the burden of hepatitis B and C. Elimination of HBV and HCV by 2030 will be a major challenge in the SWE countries.

Estimates of antibiotic resistance in Italy and Western Europe in 2019: a MICROBE-based comparative analysis.

BACKGROUND: antimicrobial resistance (AMR) will cause 10 million deaths per year worldwide by 2050, with economic costs of up to 100 trillion dollars. Antibiotic resistance (ABR) constitutes the majority of this health threat. Globally, 1.27 million people died in 2019 as a direct result of ABR. One in 5 deaths occurred in children under five, and 6 bacterial pathogens accounted for more than 70% of ABR-associated deaths. OBJECTIVES: to compare ABR estimates in terms of death and disability-adjusted life-years (DALYs) in 2019 in Italy and in Western Europe (WE) by grading the infectious syndromes and the bacterial pathogens involved, with the aim to identify the most urgent healthcare needs in Italy. DESIGN: the estimates of the burden of ABR in 2019 in WE and Italy, extracted from the Measuring Infectious Causes and Resistance Outcomes for Burden Estimation (MICROBE) tool by the Institute for Health Metrics and Evaluation (IHME; Seattle, USA), reported deaths and DALYs associated with 33 bacterial pathogens across 12 infectious syndromes, as well as deaths and DALYs associated with and attributable to ABR for 23 bacteria and 86 pathogen-drug combinations. The comparison between WE and Italy was performed in steps. First, among the 12 groups of infectious syndromes from the Global Burden of Diseases (GBD) study 2019, the most impacting in terms of deaths and DALYs were ranked based on the magnitude of rates, and the corresponding ABR-associated burden was reported. Then, the burden of the leading pathogens (bacteria, viruses, fungi, and polymicrobial infections) for all infectious syndromes was compared between the two areas. Death and DALY rates associated with ABR were reported for each bacterium, together with the percentage of ABR-attributable burden. Although it is known that Italy is one of the WE countries with the largest share of elderly, crude rates were reported instead of age-standardized rates, in order to quantify the actual burden of ABR in the two areas. SETTING AND PARTICIPANTS: Italy and Western Europe. MAIN OUTCOMES MEASURES: death and DALYs rates per 100,000 inhabitants. RESULTS: the largest difference between ABR-associated death rates in the two areas was found for bloodstream infections (25.2 and 18.8 per 100,000 in Italy and WE, respectively), followed by peritoneal and abdominal infections (15.1 and 12.2 in Italy and WE, respectively). However, the percentages of deaths and DALYs attributable to ABR were always higher in Italy for all the infections considered. Regarding pathogens, Escherichia coli accounted for the greatest burden associated to ABR, in terms of both deaths and DALYs, in both areas. The highest ABR-attributable percentage of deaths was found for Acinetobacter baumannii (28.4% in WE and 31.9% in Italy), accounting also for the highest percentage of ABR-attributable DALYs (28.4% in WE and 31.7% in Italy). The pathogen-drug combination with the highest burden associated with AMR was Escherichia coli-Aminopenicillin, while the greatest AMR-attributable burden was found for Staphylococcus aureus-Methicillin (MRSA). On average, 55.4% of Escherichia coli was resistant to Aminopenicillin in WE, with Italy ranking third (67.6%). Nordic countries showed smaller values, with Sweden in last place (32.8%). The average percentage of MRSA in WE was 16%, with Italy exceeding it by more than 13 pointsConclusions: despite similar sepsis mortality rates in Italy and other WE countries, the proportion of ABR-associated and attributable deaths was higher in Italy. Targeted strategies aimed at reducing the circulation of bacteria and resistant microorganisms together with other interventions could lead to an overall reduction in deaths associated with ABR.

Injury Patterns and Gender in Italy.

Introduction: Globally, injuries pose significant public health challenges, with road traffic accidents in particular being responsible for considerable morbidity, mortality, and economic distress. Italy has been significantly impacted due to its high population density and frequency of road traffic and domestic incidents. Method: This study set out to investigate the incidence of self-reported road traffic and home and leisure accidents in the Italian general population. A particular emphasis was placed on exploring possible gender differences across varying age groups. The data was obtained from the European Health Interview Survey and a representative sample of the Italian population was analyzed. Results: The analysis revealed that regardless of age, women experienced a reduced risk of road traffic accidents compared to men. However, gender disparities in home-leisure accidents were observed to be age-dependent. Women under the age of 25 exhibited a lower likelihood of home-leisure accidents and serious accidents necessitating hospital admission in comparison to their male counterparts. In contrast, women aged 65 and above had an increased likelihood of home-leisure accidents as opposed to men in the same age category. Conclusions: The findings of this study highlight the importance of considering age and gender as significant factors in the occurrence of different types of accidents, offering insight into how injury rates vary between these demographic groups within Italy.

Trust in science, medicine and medical providers and its relations to vaccine beliefs: A latent class analysis.

AIM: People may differ in their vaccine-related beliefs (i.e. efficacy, safety, purpose), with a host of factors influencing these differences. This can produce homogeneous groups of individuals who share certain beliefs, attitudes and opinions not only towards vaccines but science and medicine in general. This study aims to characterise distinct subgroups and identify ideal targets for tailored public health interventions to reinforce favourable vaccine beliefs. METHODS: Latent class analysis was used to derive unique profiles using the 2019 Gallup survey of 140 countries. We modelled a composite of vaccine beliefs and regressed this on class membership and relevant covariates. RESULTS: Patterns of item endorsement indicated a well-fitting five-class model, with classes distinguished based on whether individuals sought personal knowledge about science, medicine and health; trusted science and scientists; and reported confidence in the health care system. The lowest levels of vaccine beliefs were reported by a class lacking trust and confidence and the highest levels were reported by a class endorsing trust, confidence and desiring medical and scientific knowledge. Country-level income was moderately related to class membership, and vaccine beliefs were higher in lower-income countries. CONCLUSIONS: Findings suggest that public health campaigns can focus on improving trust in science and medical providers. Efforts to improve vaccination rates can only be achieved when individuals trust science, view the work of scientists as beneficial and hold favourable views towards health care providers. Individuals will then accrue the necessary wisdom to make good health care decisions that affect not only themselves but also their fellow citizens.

Identifying patient subgroups with different trends of patient-reported outcomes (PROMs) after elective knee arthroplasty.

BACKGROUND: Patient-reported outcome measures (PROMs) are increasingly being used to assess the effectiveness of elective total knee arthroplasty (TKA). However, little is known about how PROMs scores change over time in these patients. The aim of this study was to identify the trajectories of quality of life and joint functioning, and their associated demographic and clinical features in patients undergoing elective TKA. METHODS: A prospective, cohort study was conducted, in which PROMs questionnaires (Euro Quality 5 Dimensions 3L, EQ-5D-3L, and Knee injury and Osteoarthritis Outcome Score Patient Satisfaction, KOOS-PS) were administered to patients at a single center undergoing elective TKA before surgery, and at 6 and 12 months after surgery. Latent class growth mixture models were used to analyze the patterns of change in PROMs scores over time. Multinomial logistic regression was used to investigate the association between patient characteristics and PROMs trajectories. RESULTS: A total of 564 patients were included in the study. The analysis highlighted differential patterns of improvement after TKA. Three distinct PROMs trajectories were identified for each PROMs questionnaire, with one trajectory indicating the most favorable outcome. Female gender appears to be associated with a presentation to surgery with worse perceived quality of life and joint function than males, but also more rapid improvement after surgery. Having an ASA score greater than 3 is instead associated with a worse functional recovery after TKA. CONCLUSION: The results suggest three main PROMs trajectories in patients undergoing elective TKA. Most patients reported improved quality of life and joint functioning at 6 months, which then stabilized. However, other subgroups showed more varied trajectories. Further research is needed to confirm these findings and to explore the potential clinical implications of these results.

Effects of Meditation for Surgeons: A Systematic Review of the Scientific Literature.

OBJECTIVE: The aim of this study was to systematically review the available evidence about meditation's effects on surgeons. SUMMARY BACKGROUND DATA: Meditation and Mindfulness are positively associated with better mental health and performance in different types of workers and professionals needing high levels of concentration. Surgery is one of the activities with the greatest need for high concentration. Even though these findings are supported by a number of studies, evidence is lacking on the effect of meditation on surgeons. METHODS: We searched PubMed for meditation-related studies that focused on surgeons. A total of 243 articles were retrieved and after screening 8 were selected for data extraction. Four of these studies were pilot studies; 3 of them were randomized controlled trials. RESULTS: Meditation was found to be beneficial for surgeons. Benefits span from motor skills to mental and physiological improvements. CONCLUSION: More awareness and attention on this subject could improve surgeons' well-being as well as patients' outcomes.

Patterns of Emergency Department visits for acute and chronic diseases during the two pandemic waves in Italy.

BACKGROUND: Evidence is lacking about the impact of subsequent COVID-19 pandemic waves on Emergency Departments (ED). We analyzed the differences in patterns of ED visits in Italy during the two pandemic waves, focusing on changes in accesses for acute and chronic diseases. METHODS: We conducted a retrospective study using data from a metropolitan area in northern Italy that includes twelve ED. We analyzed weekly trends in non-COVID-19 ED visits during the first (FW) and second wave (SW) of the pandemic. Incidence rate ratios (IRRs) of triage codes, patient destination, and cause-specific ED visits in the FW and SW of the year 2020 vs. 2019 were estimated using Poisson regression models. MAIN FINDINGS: We found a significant decrease of ED visits by triage code, which was more marked for low priority codes and during the FW. We found an increased share of hospitalizations compared to home discharges both in the FW and in the SW. ED visits for acute and chronic conditions decreased during the FW, ranging, from -70% for injuries (IRR = 0.2862, p < 0.001) to -50% and - 60% for ischemic heart disease and heart failure. CONCLUSIONS: The two pandemic waves led to a selection of patients with higher and more urgent needs of acute hospital care. These findings should lead to investigate how to improve systems' capacity to manage changes in population needs.

Frauds in scientific research and how to possibly overcome them.

Frauds and misconduct have been common in the history of science. Recent events connected to the COVID-19 pandemic have highlighted how the risks and consequences of this are no longer acceptable. Two papers, addressing the treatment of COVID-19, have been published in two of the most prestigious medical journals; the authors declared to have analysed electronic health records from a private corporation, which apparently collected data of tens of thousands of patients, coming from hundreds of hospitals. Both papers have been retracted a few weeks later. When such events happen, the confidence of the population in scientific research is likely to be weakened. This paper highlights how the current system endangers the reliability of scientific research, and the very foundations of the trust system on which modern healthcare is based. Having shed light on the dangers of a system without appropriate monitoring, the proposed analysis suggests to strengthen the existing journal policies and improve the research process using new technologies supporting control activities by public authorities. Among these solutions, we mention the promising aspects of the blockchain technology which seems a promising solution to avoid the repetition of the mistakes linked to the recent and past history of research.

Adoption of Digital Technologies in Health Care During the COVID-19 Pandemic: Systematic Review of Early Scientific Literature.

BACKGROUND: The COVID-19 pandemic is favoring digital transitions in many industries and in society as a whole. Health care organizations have responded to the first phase of the pandemic by rapidly adopting digital solutions and advanced technology tools. OBJECTIVE: The aim of this review is to describe the digital solutions that have been reported in the early scientific literature to mitigate the impact of COVID-19 on individuals and health systems. METHODS: We conducted a systematic review of early COVID-19-related literature (from January 1 to April 30, 2020) by searching MEDLINE and medRxiv with appropriate terms to find relevant literature on the use of digital technologies in response to the pandemic. We extracted study characteristics such as the paper title, journal, and publication date, and we categorized the retrieved papers by the type of technology and patient needs addressed. We built a scoring rubric by cross-classifying the patient needs with the type of technology. We also extracted information and classified each technology reported by the selected articles according to health care system target, grade of innovation, and scalability to other geographical areas. RESULTS: The search identified 269 articles, of which 124 full-text articles were assessed and included in the review after screening. Most of the selected articles addressed the use of digital technologies for diagnosis, surveillance, and prevention. We report that most of these digital solutions and innovative technologies have been proposed for the diagnosis of COVID-19. In particular, within the reviewed articles, we identified numerous suggestions on the use of artificial intelligence (AI)-powered tools for the diagnosis and screening of COVID-19. Digital technologies are also useful for prevention and surveillance measures, such as contact-tracing apps and monitoring of internet searches and social media usage. Fewer scientific contributions address the use of digital technologies for lifestyle empowerment or patient engagement. CONCLUSIONS: In the field of diagnosis, digital solutions that integrate with traditional methods, such as AI-based diagnostic algorithms based both on imaging and clinical data, appear to be promising. For surveillance, digital apps have already proven their effectiveness; however, problems related to privacy and usability remain. For other patient needs, several solutions have been proposed, such as telemedicine or telehealth tools. These tools have long been available, but this historical moment may actually be favoring their definitive large-scale adoption. It is worth taking advantage of the impetus provided by the crisis; it is also important to keep track of the digital solutions currently being proposed to implement best practices and models of care in future and to adopt at least some of the solutions proposed in the scientific literature, especially in national health systems, which have proved to be particularly resistant to the digital transition in recent years.

Patient-reported outcome measures (PROMs) after elective hip, knee and shoulder arthroplasty: protocol for a prospective cohort study.

BACKGROUND: The number of hip, knee and shoulder arthroplasties continues to rise worldwide. The Organization for Economic Cooperation and Development has launched an initiative (called PaRIS Initiative) for the systematic collection of Patient Reported Outcome Measures (PROMs) in patients undergoing elective hip and knee arthroplasty. The Rizzoli Orthopedic Institute (IOR) was selected as a pilot center for the launch of the Initiative in Italy given that IOR hosts the Registry of Orthopedic Prosthetic Implants (RIPO), a region-wide registry which collects joint implant data from all the hospitals in the Emilia-Romagna Region. In this specific geographic area information related to PROMs after joint replacement is unknown. This paper describes the protocol of a study (PaRIS-IOR) that aims to implement the collection of a set of PROMs within an existing implant registry in Italy. The study will also investigate the temporal trend of PROMs in relation to the type of prosthesis and the type of surgical intervention. METHODS: The PaRIS-IOR study is a prospective, single site, cohort study that consists of the administration of PROMs questionnaires to patients on the list for elective arthroplasty. The questionnaires will be administered to the study population within 30 days before surgery, and then at 6 and 12 months following surgery. The study population will consist of consecutive adult patients undergoing either hip, knee or shoulder arthroplasty. The collected data will be linked with those routinely collected by the RIPO in order to assess the temporal trend of PROMs in relation to the type of prosthesis and the type of surgical intervention. DISCUSSION: The PaRIS-IOR study could have important implications in targeting the factors influencing functional outcomes and quality of life reported by patients after hip, knee and shoulder arthroplasty, and will also represent the first systematic collection of PROMs related to arthroplasty in Italy. TRIAL REGISTRATION: Protocol version (1.0) and trial registration data are available on the platform www.clinicaltrial.gov with the identifier NCT03790267 , first posted on December 31, 2018.

Preoperative valgus deformity has twice the risk of failure as compared to varus deformity after total knee arthroplasty.

PURPOSE: The aim of this study was to assess whether preoperative valgus or varus deformity affected survivorship after total knee arthroplasty (TKA) and to quantify the risk factors for implant failure in a registry-based population. METHODS: The Emilia-Romagna Registry of Prosthetic Orthopedic Implants was examined regarding TKAs performed on patients with a preoperative diagnosis of valgus or varus deformity. Demographics, implant characteristic and survivorships were investigated and compared. A total of 2327 TKA procedures performed from 2000 to 2016 were included in the study. Six hundred and forty primary TKAs with a diagnosis of valgus deformity were evaluated with a median follow-up of 3.3 years; 1687 primary TKAs with a diagnosis of varus deformity were evaluated with a median follow-up of 2.5 years. RESULTS: Bi-compartmental, cemented posterior stabilised fixed-bearing implants were preferred. For both diagnoses, the implant survivorship rate was greater than 98% in the first year. However, the survival curve of the TKAs implanted for valgus deformity showed a greater slope in the first 3 years as compared to the survival curve of those implanted for varus deformity. Valgus deformity had a 2.1-fold higher risk for revision as compared with varus deformity. Infection was a major cause of implant failure in TKAs for varus deformity, 9/24 (37.5%), while its incidence was lower for valgus deformity, 1/21 (4.8%). CONCLUSIONS: Preoperative valgus alignment showed a twofold risk of failure as compared to varus alignment after TKA. This should be considered in daily practice, and surgeons are called on to pay more attention when performing TKAs on such patients. Prospective randomised controlled trials are, therefore, necessary to better understand the role of preoperative coronal knee deformity in implant failure. LEVEL OF EVIDENCE: Prognostic study, level III.

Real and predicted mortality under health spending constraints in Italy: a time trend analysis through artificial neural networks.

BACKGROUND: After 2008 global economic crisis, Italian governments progressively reduced public healthcare financing. Describing the time trend of health outcomes and health expenditure may be helpful for policy makers during the resources' allocation decision making process. The aim of this paper is to analyze the trend of mortality and health spending in Italy and to investigate their correlation in consideration of the funding constraints experienced by the Italian national health system (SSN). METHODS: We conducted a 20-year time-series study. Secondary data has been extracted from a national, institution based and publicly accessible retrospective database periodically released by the Italian Institute of Statistics. Age standardized all-cause mortality rate (MR) and health spending (Directly Provided Services - DPS, Agreed-Upon Services - TAUS, and private expenditure) were reviewed. Time trend analysis (1995-2014) through OLS and Multilayer Feed-forward Neural Networks (MFNN) models to forecast mortality and spending trend was performed. The association between healthcare expenditure and MR was analyzed through a fixed effect regression model. We then repeated MFNN time trend forecasting analyses on mortality by adding the spending item resulted significantly related with MR in the fixed effect analyses. RESULTS: DPS and TAUS decreased since 2011. There was a mismatch in mortality rates between real and predicted values. DPS resulted significantly associated to mortality (p < 0.05). In repeated mortality forecasting analysis, predicted MR was found to be lower when considering the pre-constraints health spending trend. CONCLUSIONS: Between 2011 and 2014, Italian public health spending items showed a reduction when compared to prior years. Spending on services directly provided free of charge appears to be the financial driving force of the Italian public health system. The overall mortality was found to be higher than the predicted trend and this scenario may be partially attributable to the healthcare funding constraints experienced by the SSN.

Transferring Health Big Data within the European Legal Framework: What Role for National Healthcare Services?

The main objective of this article is to describe the legal principles governing the selection by European public authorities, such as National Health Services (NHS) of third parties, when entering into agreements for the transfer of health data. According to Directive 2003/98/EC, and in light of the provisions of the Treaties of the European Union, the choice as to how a public authority makes its data available to third parties needs to be transparent, non-discriminatory and may not in any case benefit a specific company at the expense of others. For this reason, we maintain that a hypothetical agreement by which a public authority grants exclusive access to a large amount of health data to a private company selected with non-transparent criteria appears highly questionable. We advocate that the NHS should adopt more appropriate data policies aimed at promoting the sustainability of the NHS, following the legal framework analysed in this article.

Analyzing the 20-year declining trend of hospital length-of-stay in European countries with different healthcare systems and reimbursement models.

The study aims to investigate the last 20-year (2000-2019) of hospital length of stay (LOS) trends and their association with different healthcare systems (HS) among 25 European countries. A panel dataset was created using secondary data from Eurostat and Global Burden of Disease study databases, with dependent and control variables aggregated at the national level over a period of 20 years. A time trend analysis was conducted using a weighted least squares model for panel data to investigate the association between LOS, HS models [National Health Service (NHS), National Health Insurance, Social Health Insurance (SHI), and Etatist Social Health Insurance], healthcare reimbursement schemes [Prospective Global Budget (PGB), Diagnosis Related Groups (DRG), and Procedure Service Payment (PSP)], and control variables. The study showed a reduction of average LOS from 9.20 days in 2000 to 7.24 in 2019. SHI was associated with a lower LOS compared to NHS (b = - 0.6327, p < 0.05). Both DRG (b = 1.2399, p < 0.05) and PSP (b = 1.1677, p < 0.05) reimbursement models were positively associated with LOS compared to PGB. Our results confirmed the downward trend of LOS in the last 20 years, its multifactorial nature, and the influence of the SHI model of HS. This could be due to the financial incentives present in fee-for-service payment models and the role of competition in creating a market for healthcare services. These results offer insight into the factors influencing healthcare utilization and can inform the design of more effective, efficient, and sustainable HS.

What's the Impact of Safety Footwear on Workers Concerning Foot-Related Problems? A Systematic Review.

BACKGROUND: This study aims to assess the impact of safety footwear (SF) on workers concerning foot-related problems, especially regarding discomfort, foot pain, and skin lesions. METHODS: A literature search of PubMed, Embase, Scopus, and Cochrane databases was performed according to PRISMA guidelines. Studies reporting foot-related problems in workers wearing SF were included. Exclusion criteria included non-English papers, reviews, laboratory and animal studies, expert opinions, letters to the editor, and grey literature. The quality assessment was performed using the Newcastle-Ottawa Scale. Descriptive statistic was used to present data. RESULT: The initial search results yielded 483 articles; 7 articles were included in the review process. Despite the extensive variety of SF, all studies consistently reported symptomatic discomfort and pain. The discomfort factors included heat, sweating, heaviness, and footwear flexibility, with primary issues in the toes, toecaps, or metatarsal-toe crease region. The pain prevalence ranged from 42.3% to 60.8% in various anatomical regions. Irritant Contact Dermatitis was the most common (97.9%) foot dermatosis, but other foot lesions were reported: dry skin (30.2%), calluses (30%), hard nails (28%), corns (27%), and blisters. CONCLUSIONS: Current SFs are designed to comply with safety regulations but are influenced by the frequent occurrence of discomfort and foot problems. The literature review identified weaknesses in certain design features. Recommendations have been proposed to improve SF development. These include addressing issues such as the selection of specific types and designs of SF based on task performance and the working environment, footwear weight, and breathable materials for moisture permeation. Considerations should also encompass distinct sizing for an optimal fit, insole application, especially for prolonged standing users, and education programs to prevent foot-related issues.

Corrigendum: Time-Trends in Air Pollution Impact on Health in Italy, 1990-2019: An Analysis from the Global Burden of Disease Study 2019.

[This corrects the article DOI: 10.3389/ijph.2023.1605959.].

Predict, diagnose, and treat chronic kidney disease with machine learning: a systematic literature review.

OBJECTIVES: In this systematic review we aimed at assessing how artificial intelligence (AI), including machine learning (ML) techniques have been deployed to predict, diagnose, and treat chronic kidney disease (CKD). We systematically reviewed the available evidence on these innovative techniques to improve CKD diagnosis and patient management. METHODS: We included English language studies retrieved from PubMed. The review is therefore to be classified as a "rapid review", since it includes one database only, and has language restrictions; the novelty and importance of the issue make missing relevant papers unlikely. We extracted 16 variables, including: main aim, studied population, data source, sample size, problem type (regression, classification), predictors used, and performance metrics. We followed the Preferred Reporting Items for Systematic Reviews (PRISMA) approach; all main steps were done in duplicate. RESULTS: From a total of 648 studies initially retrieved, 68 articles met the inclusion criteria. Models, as reported by authors, performed well, but the reported metrics were not homogeneous across articles and therefore direct comparison was not feasible. The most common aim was prediction of prognosis, followed by diagnosis of CKD. Algorithm generalizability, and testing on diverse populations was rarely taken into account. Furthermore, the clinical evaluation and validation of the models/algorithms was perused; only a fraction of the included studies, 6 out of 68, were performed in a clinical context. CONCLUSIONS: Machine learning is a promising tool for the prediction of risk, diagnosis, and therapy management for CKD patients. Nonetheless, future work is needed to address the interpretability, generalizability, and fairness of the models to ensure the safe application of such technologies in routine clinical practice.

A step-by-step researcher's guide to the use of an AI-based transformer in epidemiology: an exploratory analysis of ChatGPT using the STROBE checklist for observational studies.

Objective: This study aims at investigating how AI-based transformers can support researchers in designing and conducting an epidemiological study. To accomplish this, we used ChatGPT to reformulate the STROBE recommendations into a list of questions to be answered by the transformer itself. We then qualitatively evaluated the coherence and relevance of the transformer's outputs. Study design: Descriptive study. Methods: We first chose a study to be used as a basis for the simulation. We then used ChatGPT to transform each STROBE checklist's item into specific prompts. Each answer to the respective prompt was evaluated by independent researchers in terms of coherence and relevance. Results: The mean scores assigned to each prompt were heterogeneous. On average, for the coherence domain, the overall mean score was 3.6 out of 5.0, and for relevance it was 3.3 out of 5.0. The lowest scores were assigned to items belonging to the Methods section of the checklist. Conclusions: ChatGPT can be considered as a valuable support for researchers in conducting an epidemiological study, following internationally recognized guidelines and standards. It is crucial for the users to have knowledge on the subject and a critical mindset when evaluating the outputs. The potential benefits of AI in scientific research and publishing are undeniable, but it is crucial to address the risks, and the ethical and legal consequences associated with its use.

Changes in private health service utilisation and access to the Italian National Health Service between 2006 and 2019: a cross-sectional comparative study.

OBJECTIVES: Previous research highlighted that in the early 2000s a significant share of the Italian population used and paid out of pocket for private healthcare services even when they could potentially have received the same treatments from the National Health Service (NHS). The decrease in public investments in healthcare and the increase in health needs due to the population ageing may have modified the use of private health services and equity of access to the Italian NHS. This study aims to investigate the change in the prevalence of individuals who have fully paid out of pocket for accessing healthcare services in Italy between 2006 and 2019 and the main reasons behind this choice. DESIGN: Cross-sectional comparative study. PARTICIPANTS AND COMPARISON: Two representative samples of the Italian population were collected in 2006 and 2019. OUTCOME MEASURES: Prevalence of access to fully paid out-of-pocket private health services; type of service of the last fully paid out-of-pocket access; main reasons for the last fully paid out-of-pocket access. RESULTS: We found an increase in the prevalence of people who declared having fully paid out of pocket at least one access to health services during their lifetime from 79.0% in 2006 to 91.9% in 2019 (adjusted OR 2.66; 95% CI 1.98 to 3.58). 'To avoid waiting times' was the main reason and it was significantly more frequent in 2019 compared with 2006 (adjusted OR 1.75; 95% CI 1.45 to 2.11). CONCLUSIONS: This comparative study, conducted the year before the outbreak of the COVID-19 pandemic, highlighted an increase in the prevalence of Italian residents who have fully paid out of pocket for access to health services to overcome long waiting times. Our findings may indicate a reduced access and possible worsening of the equity of access to the public and universalistic Italian NHS between 2006 and 2019.

Regional and sex inequalities of avoidable mortality in Italy: A time trend analysis.

Objectives: This study provides a comprehensive analysis of avoidable mortality (AM), treatable mortality (TM), and preventable mortality (PM) across Italy, focusing on region- and gender-specific inequalities over a 14-year period. Study design: Time-trend analysis (2006-2019). Methods: The study was conducted using mortality data from the Italian Institute of Statistics to evaluate the extent and patterns of AM, TM, and PM in Italy. Biennial age-standardized mortality rates were calculated by gender and region using the joint OECD/Eurostat list. Results: The overall AM rates showed a large reduction from 2006/7 (221.0 per 100,000) to 2018/9 (166.4 per 100,000). Notably, females consistently displayed lower AM rates than males. Furthermore, both gender differences and the North-South gap of AM decreased during the period studied. The regions with the highest AM rates fluctuated throughout the study period. The highest percentage decrease in AM from 2006/7 to 2018/9, for both males (-41.3 %) and females (-34.2 %), was registered in the autonomous province of Trento, while the lowest reduction was observed in Molise for males (-17.4 %) and in Marche for females (-10.0 %). Conclusions: Remarkable gender and regional differences in AM between 2006 and 2019 have been recorded in Italy, although they have decreased over years. Continuous monitoring of AM and the implementation of region- and gender-specific interventions is essential to provide valuable insights for both policy and public health practice. This study contributes to the efforts to improve health equity between Italian regions.