Identifying Predictors of Anal HPV Status in HPV-Vaccinated MSM: A Machine Learning Approach

Anal human papillomavirus (HPV) infection has a high prevalence in men who have sex with men (MSM), resulting in an increased risk for anal cancer. The present work aimed to identify factors associated with HPV in a prospective cohort of HPV-vaccinated MSM using a random forest (RF) approach. This observational study enrolled MSM patients admitted to an Italian (sexually transmitted infection) STI-AIDS Unit. For each patient, rectal swabs for 28 different HPV genotype detection were collected. Two RF algorithms were applied to evaluate predictors that were most associated with HPV. The cohort included 135 MSM, 49% of whom were HIV-positive with a median age of 39 years. In model 1 (baseline information), age, age sexual debut, HIV, number of lifetime sex partners, STIs, were most associated with the HPV. In model 2 (follow-up information), age, age sexual debut, HIV, STI class, and follow-up. The RF algorithm exhibited good performances with 61% and 83% accuracy for models 1 and 2, respectively. Traditional risk factors for anal HPV infection, such as drug use, receptive anal intercourse, and multiple sexual partner, were found to have low importance in predicting HPV status. The present results suggest the need to focus on HPV prevention campaigns.

CMR Predictors of Favorable Outcome in Myocarditis: A Single-Center Experience

Background: Cardiovascular magnetic resonance (CMR) has emerged as the most accurate, non-invasive method to support the diagnosis of clinically suspected myocarditis and as a risk-stratification tool in patients with cardiomyopathies. We aim to assess the diagnostic and prognostic role of CMR at diagnosis in patients with myocarditis. Methods: We enrolled consecutive single-center patients with 2013 ESC consensus-based endomyocardial biopsy (EMB)-proven or clinically suspected myocarditis undergoing CMR at diagnosis. The pre-specified outcome was defined as NYHA class > I and echocardiographic left ventricular ejection fraction (LVEF) < 50% at follow-up. Results: We included 207 patients (74% male, median age 36 years; 25% EMB-proven). CMR showed the highest sensitivity in myocarditis with infarct-like presentation. Patients with EMB-proven myocarditis were more likely to have diffuse LGE and right ventricular LGE (p < 0.001), which was also more common among patients with arrhythmic presentation (p = 0.001). The outcome was met in 17 patients at any follow-up time point, more commonly in those with larger biventricular volumes (p < 0.001), CMR-based diagnosis of dilated cardiomyopathy (p < 0.001), and ischemic LGE (p = 0.005). Higher biventricular systolic function (p < 0.001) and greater LGE extent (p = 0.033) at diagnosis had a protective effect. Conclusions: In our single-center cohort of rigorously defined myocarditis patients, higher biventricular systolic function and greater LGE extent on CMR at diagnosis identified patients with better functional class and higher left ventricular ejection fraction at follow-up. Conversely, larger biventricular volumes, CMR-based DCM features, and the presence of an ischemic LGE pattern at diagnosis were predictors of worse functional class and LV systolic dysfunction at follow-up. Larger prospective studies are warranted to extend our findings to multi-center cohorts.

Management of Pediatric Foreign Body Injuries during the COVID-19 Pandemic: Results of an International Survey

The COVID-19 pandemic has had direct and indirect effects on daily life. In hospitals, the impact of the pandemic was observed in the diagnostic and therapeutic workflow. In this work, we explored potential changes in activities related to the treatment of foreign body injuries (FBIs) in children and the behavioral habits of physicians during the first wave of the pandemic. An online survey was conducted among physicians of the Susy Safe network. The survey comprised items related to respondent information, reference center characteristics, the treatment of FBIs during the COVID-19 pandemic, and a modified COVID-19 Anxiety Scale (CAS). The survey was distributed among the Susy Safe project international network surveillance registry for FBIs. A total of 58 physicians responded to the survey, including 18 (32%) from Europe and 16 (28%) from South America. The respondents indicated that the estimated number of aspirated foreign bodies during the pandemic was lower than or the same as that before the pandemic (43, 74%), and the same was observed for ingested foreign bodies (43, 74%). In univariable logistic regression, no single predictor was associated with a delay in routine care for children or an increasing tendency of medical personnel to avoid procedures. The workflow of physicians involved in the management of FBIs in children has not changed drastically during the COVID-19 pandemic, especially in emergency departments.

Characterization of Non-Food Foreign Bodies Aspirated by Children: A Systematic Review of the Literature

BACKGROUND

Foreign Body Aspiration (FBA) represents a leading cause of death among unintentional injuries in children less than one year of age. This study reviewed case reports and case series reporting non-food FBA in children to characterize aspirated foreign bodies, describing the clinical presentations and the outcomes.

METHODS

A systematic review was conducted according to the PRISMA checklist. Case reports and case series presenting non-food FBA in children (up to 18 years) were eligible to be included. Information regarding study characteristics, child demographics, foreign body characteristics, clinical presentation, and outcome were extracted.

RESULTS

The review included 248 articles published between 1965 and 2023, corresponding to 294 cases. The male gender was the most prevalent (194 cases, 66%), and the median age was 3.5 years (Interquartile Range: 1-8 years). Button batteries were the objects most frequently reported (21 cases, 7.1%). Objects were located most often in the bronchus (102 cases, 35%). The most common symptom was cough (181 cases, 62%), followed by respiratory distress (160 cases, 54%) and wheezing/stridor (127 cases, 43%).

CONCLUSIONS

The present systematic review may have relevant public health implications, since characterizing objects that cause foreign body injuries is essential to reduce the burden of this phenomenon.

Association of Vegetarian and Vegan Diets with Cardiovascular Health: An Umbrella Review of Meta-Analysis of Observational Studies and Randomized Trials

BACKGROUND

Cardiovascular diseases (CVDs) are leading global causes of mortality. Unhealthy diets have been linked to an increased risk of CVD, while plant-based diets have shown potential protective effects. This umbrella review summarizes the evidence on the association between vegetarian diets and cardiovascular and cerebrovascular diseases.

METHODS

PubMed, Scopus, Embase, CINAHL, Cochrane, and Web of Science were consulted. Meta-analyses grouped by author and outcome were performed. The heterogeneity was evaluated using I2 statistics.

RESULTS

There was a 41.2% risk reduction for cerebrovascular disease. CVD incidence had a 29% reduced risk. CVD mortality had a 13.8% risk reduction, while IHD incidence had a 24.1% reduction, but with high heterogeneity. IHD mortality showed a significant 32.1% risk reduction. Ischemic stroke had a significant 32.9% risk reduction across six studies. Stroke incidence showed a significant 39.1% risk reduction in a single study. There was a non-significant 11.6% risk reduction for stroke mortality with moderate heterogeneity.

CONCLUSION

Healthier diets are associated with reduced risks of cerebrovascular disease, CVD incidence, IHD mortality, and ischemic stroke. However, evidence quality and consistency vary, emphasizing the need for more research. Policymakers and healthcare professionals should prioritize promoting healthy diets for CVD prevention.

Physical activity assessment with wearable devices in rheumatic diseases: a systematic review and meta-analysis

OBJECTIVES

In the management of rheumatic musculoskeletal disorders (RMDs), regular physical activity (PA) is an important recognized non-pharmacological intervention. This systematic review and meta-analysis aims to evaluate how the use of wearable devices (WDs) impacts physical activity in patients with noninflammatory and inflammatory rheumatic diseases.

METHODS

A comprehensive search of articles was performed in PubMed, Embase, CINAHL and Scopus. A random-effect meta-analysis was carried out on the number of steps and moderate-vigorous physical activity (MVPA). Univariable meta-regression models were computed to assess the possibility that the study characteristics may act as modifiers on the final meta-analysis estimate.

RESULTS

In the analysis, 51 articles were included, with a total of 7488 participants. Twenty-two studies considered MVPA outcome alone, 16 studies considered the number of steps alone, and 13 studies reported information on both outcomes. The recommended PA threshold was reached for MVPA (36.35, 95% CI 29.39, 43.31) but not for daily steps (-1092.60, -1640.42 to -544.77). Studies on patients with fibromyalgia report a higher number (6290, 5198.65-7381.62) of daily steps compared with other RMDs. Patients affected by chronic inflammatory arthropathies seemed to fare better in terms of daily steps than the other categories. Patients of younger age reported a higher overall level of PA than elderly individuals for both the number of steps and MVPA.

CONCLUSION

Physical activity can be lower than the recommended threshold in patients with RMDs when objectively measured using WD. WDs could be a useful and affordable instrument for daily monitoring physical activity in RMDs and may support an increase in activity levels.

PROSPERO TRIAL REGISTRATION

CRD42021227681, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227681.

Parents’ knowledge about their children’s congenital heart disease: an observational study

Introduction

Congenital heart diseases (CHD) represent abnormalities of cardiovascular structure or function present at birth. The degree of knowledge of parents of children with CHD determines the quality of care and the quality of life of their children. Several studies have shown that parents’ knowledge is still lacking.

Objectives

This study aims to translate and validate in Italian the Leuven Knowledge Questionnaire for Congenital Heart Disease (LKQCHD) and to assess the knowledge of parents of children with CHD about heart defect, treatments, preventive measures, opportunities for physical activity and reproductive problems of their children.

Methods

Translation and validation of the questionnaire were performed using a multistep method: forward translation, backward translation, and pilot testing. Five experts in CHD were included for the validation of the questionnaire. The sample consisted of fifty-four pairs of parents of children with CHD. Parents were contacted by telephone; knowledge was assessed using an electronic questionnaire.

Results

Five items were found to have an Item Content Validity Index (I-CVI) of 0.6, 2 of 0.5, and 2 of 0.2. The Scale ContentValidity Index (S-CVI) was found to be 0.80. Regarding parental knowledge, the results show that almost all parents are able to correctly state the name of the diagnosis and the description and location of the heart defect. However, parental knowledge has important gaps; in particular, parents are less informed about the most characteristic sign of endocarditis, the possibility of contracting endocarditis more than once in a lifetime, and risk factors. Parental knowledge also seems to be lacking regarding symptoms suggesting worsening health status in their children.

Conclusions

The Italian version of the LKQCHD has proved to be a valid tool to measure the level of knowledge of parents of children with CHD, allowing to identify in which areas it is necessary to improve the education addressed to parents.

Key messages

• Assessing the knowledge of parents of children with CHD allows to improve their education.

• The Italian version of the LKQCHD is a valid tool to measure the level of knowledge of parents of children with CHD.

POS0163 USEFULNESS OF WEARABLE DEVICES TO ASSESS PHYSICAL ACTIVITY IN NON-INFLAMMATORY AND INFLAMMATORY RHEUMATIC DISEASES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

In the last years, the rise of personalized medicine has grown up. So, patient-oriented wearable technologies have been developed. Wearable devices (WD) are useful to collect objective data related to physical activity. In the management of rheumatic musculoskeletal disorders (RMDs) a regular physical activity is an important recognized non-pharmacological intervention [1].

Objectives

This systematic review aims at evaluating how the use of WDs impacts physical activity in patients with non-inflammatory and inflammatory rheumatic diseases.

Methods

A systematic review and meta-analysis were performed. A comprehensive search of articles was performed in the following databases: MEDLINE via PubMed, EMBASE, CINAHL, and Scopus. A random-effect meta-analysis has been carried out on the number of steps and moderate to vigorous physical activity (MVPA). Univariable meta-regression models have been computed to assess the possibility that the study characteristics may act as effect modifiers on the final meta-analysis estimate. The primary outcome is the level of physical activity evaluated with a wearable device as a number of daily steps and MVPA. The secondary outcome is the comparison of both a number of steps and MVPA to reference value for healthy people. The number of steps per day and the time spent in MVPA considered as a mean or median were collected. Missing information was calculated from available data when possible.

The reference value for steps was 7000 steps per day, this value was derived by a literature review commissioned by the Public Health Agency of Canada on the number of steps/day suitable for adults [2]. MVPA reference value was of 150 min/week and was derived by WHO guidelines [3].

Results

An overall of 1788 studies was considered in the title/abstract screening. In the analysis, 51 articles were included, with an overall of 7488 participants. Twenty-two studies considered MVPA outcome alone, 16 studies number of steps alone and 13 studies reported information on both outcomes.

The results of this meta-analysis show that there is a high level of I2 heterogeneity, 99%, according to diagnosis.

Recommended threshold for daily steps was reached for MVPA (36.35, 95% CI 29.39 - 43.31) but not for daily steps (-1092.60, 95% CI -1640.42 - -544.77), with fibromyalgia reporting a higher number (6290, 95% CI 5198.65 – 7381.62) of daily steps compared to other RMDs. Patients affected by chronic inflammatory arthropathies seem to fare better in terms of daily steps than the other categories. Patients with rheumatoid or other chronic arthritis reported a higher number of steps, respectively 6361 (95% CI 5382.51; 7340.35) and 6290.14 (95% CI 5198.65; 7381.62).

Non-elderly people show a higher overall level of physical activity compared to the elderly, 6796.11 (95% CI 5974.10; 7618.13) versus 5431.85 (95% CI 4633.76; 6229.95).

Non-elderly group show higher level MVPA compared to the reference value 38.96 (95% CI 18.35; 59.68) vs 11.77 (95% CI 3.32; 20.21).

Conclusion

RMDs suffer of low level of physical activity and WDs are useful and affordable instruments to support the increase of it. WDs can be used in daily monitoring of physical activity in RMDs.

References

[1]Osthoff A-KR, Niedermann K, Braun J, Adams J, Brodin N, Dagfinrud H, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018;77(9):1251–60.

[2]Tudor-Locke C, Craig CL, Brown WJ, Clemes SA, De Cocker K, Giles-Corti B, et al. How many steps/day are enough? for adults. Int J Behav Nutr Phys Act. 2011;8(1):79.

[3]Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–62.

Disclosure of Interests

None declared

Epidemiology and Trends over Time of Foreign Body Injuries in the Pediatric Emergency Department

This paper presents the epidemiology of foreign body injuries in the Pediatric Emergency Department (PED) of Padova (Italy) along with its trends over an eleven-year period based on administrative data. Annual incidence rates (IRs) of PED presentations for foreign body (FB) injuries per 1000 person-years were calculated. Univariable and multivariable generalized linear (GLM) Poisson models were estimated to evaluate the relationship between FB injury incidence and year, triage priority, nationality, injury site, and FB type. During the study period, there were 217,900 presentations of pediatric residents in the province of Padova; of these, 3084 (1.5%) reported FB injuries involving the ears, nose, throat, gastrointestinal tract or eyes. The annual IR of FB injury episodes increased from 10.45 for 1000 residents in 2007 (95% CI, 9.24, 11.77) to 12.66 for 1000 residents in 2018 (95% CI, 11.35, 14.08). Nonfood items were the FBs that were most frequently reported. The intermediate urgent triage code was the most represented for FB injuries, with IRs ranging from 5.44 (95% CI: 4.59, 6.40) in 2008 to 8.56 in 2018 (95% CI: 7.50, 9.74). A total of 170 patients who presented for FB injuries were hospitalized (5.5%). The annual FB-related injury IR has increased over time, although most episodes are not life threatening. Educational and prevention programs on FB-related injuries should be promoted and dedicated to childcare providers.

Feasibility and Role of Right Ventricular Stress Echocardiography in Adult Patients

Background:

The great technological advancements in the field of echocardiography have led to applications of stress echocardiography (SE) in almost all diagnostic fields of cardiology, from ischemic heart disease to valvular heart disease and diastolic function. However, the assessment of the right ventricle (RV) in general, and in particular in regard to the contractile reserve of the RV, is an area that has not been previously explored. We, therefore, propose a study to investigate the potential use of SE for the assessment of RV function in adult patients.

Aims and objectives:

The primary aim is to evaluate the feasibility of right ventricular SE. The secondary aim is to assess right ventricular contractile reserve.

Matherials and Methods:

Eighty-one patients undergoing a physical or dobutamine stress echocardiogram for cardiovascular risk stratification or chest pain were the subject of the study. An exercise leg cycle using a standard WHO protocol was used to simultaneously assess the right and left ventricular global and regional function as well as acquiring Doppler data. Whereas the patient had limitations in mobility, a dobutamine SE was be performed. We evaluated the average values of tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), S-wave, systolic pulmonary artery pressure (sPAP), and right ventricle global longitudinal (free wall) strain (RVGLS) during baseline and at the peak of the effort. RV contractile reserve was defined as the change in RVGLS from rest to peak exercise. We also assessed the reproducibility of these measurements between two different expert operators (blind analysis).

Results:

At least 3 over 5 RV function parameters were measurable both during baseline and at the peak of the effort in 95% of patients, while all 5 parameters in 65% of our population, demonstrating an excellent feasibility. All RV-studied variables showed a statistically significant increase (P < 0.001) at peak compared to the baseline. The average percentage increases at peak were 31.1% for TAPSE, 24.8% for FAC, 50.6% for S-wave, 55.2% for PAPS, and 39.8% for RV strain. The reproducibility between operators at baseline and peak was excellent. Our study demonstrates that TAPSE, FAC, and S-wave are highly feasible at rest and at peak, while TAPSE, S-wave, and sPAP are the most reliable measurements during RV stress echo.

Conclusion:

RVGLS is useful in the assessment of RV contractile reserve in patients with good acoustic window. Further studies are needed to evaluate the impact of contrast echocardiography in improving RV contractile reserve assessment during SE.

Monitoring Patients Reported Outcomes after Valve Replacement Using Wearable Devices: Insights on Feasibility and Capability Study: Feasibility Results

Wearable devices (WDs) can objectively assess patient-reported outcomes (PROMs) in clinical trials. In this study, the feasibility and acceptability of using commercial WDs in elderly patients undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) will be explored. This is a prospective observational study. Participants were trained to use a WD and a smartphone to collect data on their physical activity, rest heart rate and number of hours of sleep. Validated questionnaires were also used to evaluate these outcomes. A technology acceptance questionnaire was used at the end of the follow up. In our participants an overall good compliance in wearing the device (75.1% vs. 79.8%, SAVR vs. TAVR) was assessed. Half of the patients were willing to continue using the device. Perceived ease of use is one of the domains that scored higher in the technology acceptance questionnaire. In this study we observed that the use of a WD is accepted in our frail population for an extended period. Even though commercial WDs are not tailored for clinical research, they can produce useful information on patient behavior, especially when coordinated with intervention tailored to the single patient.

The Surplus Transplant Lung Allocation System in Italy: An Evaluation of the Allocation Process via Stochastic Modeling

Background: Lung transplantation is a specialized procedure used to treat chronic end-stage respiratory diseases. Due to the scarcity of lung donors, constructing fair and equitable lung transplant allocation methods is an issue that has been addressed with different strategies worldwide. This work aims to describe how Italy’s “national protocol for the management of surplus organs in all transplant programs” functions through an online app to allocate lung transplants. We have developed two probability models to describe the allocation process among the various transplant centers. An online app was then created. The first model considers conditional probabilities based on a protocol flowchart to compute the probability for each area and transplant center to receive each n-th organ in the period considered. The second probability model is based on the generalization of the binomial distribution to correlated binary variables, which is based on Bahadur’s representation, to compute the cumulative probability for each transplant center to receive at least nth organs. Our results show that the impact of the allocation of a surplus organ depends mostly on the region where the organ was donated. The discrepancies shown by our model may be explained by a discrepancy between the northern and southern regions in relation to the number of organs donated.

A Machine Learning Approach for Investigating Delirium as a Multifactorial Syndrome

Delirium is a psycho-organic syndrome common in hospitalized patients, especially the elderly, and is associated with poor clinical outcomes. This study aims to identify the predictors that are mostly associated with the risk of delirium episodes using a machine learning technique (MLT). A random forest (RF) algorithm was used to evaluate the association between the subject’s characteristics and the 4AT (the 4 A’s test) score screening tool for delirium. RF algorithm was implemented using information based on demographic characteristics, comorbidities, drugs and procedures. Of the 78 patients enrolled in the study, 49 (63%) were at risk for delirium, 32 (41%) had at least one episode of delirium during the hospitalization (38% in orthopedics and 31% both in internal medicine and in the geriatric ward). The model explained 75.8% of the variability of the 4AT score with a root mean squared error of 3.29. Higher age, the presence of dementia, physical restraint, diabetes and a lower degree are the variables associated with an increase of the 4AT score. Random forest is a valid method for investigating the patients’ characteristics associated with delirium onset also in small case-series. The use of this model may allow for early detection of delirium onset to plan the proper adjustment in healthcare assistance.

[The Healthcare-associated infections (HAIs) and infection Control link nurse as a strategy to face them: review of literature]

INTRODUCTION

Healthcare-associated infections (HAIs) are the most common adverse event in hospitals and a major public health problem with a negative impact on morbidity, mortality and quality of life. Governmental and non-governmental organizations are developing and strengthening plans to improve Infection and Prevention Control (IPC) programmes. Adopting reliable, effective and integrated IPC programmes can prevent 50% of HAIs. Implementation of a Infection Control Link Nurse (ICLN) system at the health care facility level is one of these.

AIM

To obtain from a literature review evidence-based recommendations and practical instruments for developing and implementing a training course for ICLN.

METHODS

A literature review was conducted by searching the Cochrane Library, PubMed, Cinahl without time limits, until July 2019. PICO methodology was adopted to build the research question and the Prisma Flow Diagram chosen for the selection of studies. Results The final review included 4 studies which dealt with the following main topics: selection of the personnel, profile, educational pathway, activities and factors that affects ICLN.

DISCUSSION

Even though there is no accordance on duration and contents of LN training courses, its usefulness is well accepted. Using expert clinical nurses on prevention, control and management of HAIs for LN programmes is useful when they are capable of being opinion leaders and trainers among their teams, as well as a formal connection to management areas and administrators.

Prevalence of Thromboembolic Complications in COVID-19 Infection: A Systematic Review and Meta-Analysis

Introduction: The coronavirus disease (COVID-19) infection is proved to be involved in the onset of thromboembolism episodes. This study aims to evaluate the prevalence of thromboembolic complications in patients with COVID-19 from March until May 2020. Methods: A literature review was conducted in MEDLINE (via PubMed), Scopus, Embase, Cochrane, and CINHAL without any language and date of publication restriction (Prospero registration number CRD42020186925). The inclusion criteria were as following: 1) patients with diagnosis of COVID-19; 2) occurrence of thromboembolic event, and 3) patients older than 18 years of age. A multi-variable random effects model was computed accounting for correlations among outcomes by considering a heterogeneous compound symmetry covariance matrix. Results: Observational studies included 2,442 participants from 268 to 7,999 participants per study, 1,014 (41.52%) were male and 825 (33.78%) were female. The multi-variable pooled event rate of acute myocardial infarction was rare, estimated to be 0.03 (95% confidence interval [CI]: 0.00–0.07; p=0.23); this is also true for the meta-analytical estimate of disseminated intravascular disease which was 0.04 (95% CI: 0.00–0.08; p=0.03). Conversely, other events were found to be more frequent. Indeed, the pooled proportion of pulmonary embolism was 0.14 (95% CI: 0.08–0.20; p<0.001), while the venous thromboembolic event rate is 0.15 (95% CI: 0.09-0.30; p=0.04). The pooled intrahospital mortality rate was equal to 0.12 (95% CI: 0.08–0.16; p<0.001). Conclusions: Thromboembolic events, particularly venous thromboembolic event rate and pulmonary embolism, are a frequent complication in patients hospitalised with COVID-19. These findings suggest that the threshold for clinical suspicion should be low to trigger prompt diagnostic testing and that evaluation of therapeutic treatment should be considered in patients in intensive care units with COVID-19.

A Validation Study of NOVA Classification for Ultra-Processed Food on the USDA Food and Nutrient Database

Objectives

In the last years, a group of Brazilian researchers has proposed a new food classification system, named NOVA, based on the extent of food processing. However, the feasibility of such classification has been debated, together with its cross-cultural validity. The present work assessed the NOVA classification feasibility, conducting a validation study on the USDA Food Composition Database.

Methods

Two independent reviewers rated each food reported in the 2015–2016 USDA Food and Nutrient Database to be or not ultra-processed food (UPF) according to the criteria presented in the manuscripts published by Monteiro CA et al. in 2016 and 2019 presenting the NOVA classification. A third independent reviewer solved disagreements. The Cohen's Kappa was calculated to evaluate the agreement between the two independent reviewers.

Results

The agreement between the reviewers was only moderate, with a Cohen's Kappa of 0.58. The disagreement pertained mainly the mixed dishes since it was difficult for the two independent reviewers to rate (UPF or not) the single food components of the mixed dishes.

Conclusions

Such work provides insights on the difficulties encountered in applying the NOVA classification to a real-word food database outside the cultural context in which the NOVA classification was developed.

Funding Sources

N/A.

Using Social Networks to Estimate the Number of COVID-19 Cases: The Incident (Hidden COVID-19 Cases Network Estimation) Study Protocol

Recent literature has reported a high percentage of asymptomatic or paucisymptomatic cases in subjects with COVID-19 infection. This proportion can be difficult to quantify; therefore, it constitutes a hidden population. This study aims to develop a proof-of-concept method for estimating the number of undocumented infections of COVID-19. This is the protocol for the INCIDENT (Hidden COVID-19 Cases Network Estimation) study, an online, cross-sectional survey with snowball sampling based on the network scale-up method (NSUM). The original personal network size estimation method was based on a fixed-effects maximum likelihood estimator. We propose an extension of previous Bayesian estimation methods to estimate the unknown network size using the Markov chain Monte Carlo algorithm. On 6 May 2020, 1963 questionnaires were collected, 1703 were completed except for the random questions, and 1652 were completed in all three sections. The algorithm was initialized at the first iteration and applied to the whole dataset. Knowing the number of asymptomatic COVID-19 cases is extremely important for reducing the spread of the virus. Our approach reduces the number of questions posed. This allows us to speed up the completion of the questionnaire with a subsequent reduction in the nonresponse rate.

The SYSTEMIC Project: A Pilot Study to Develop a Registry of Patients With an Ostomy for Predictive Modeling of Outcomes

BACKGROUND: Stomal and peristomal skin complications represent a significant burden on the physical and psychological well-being of patients. PURPOSE: To develop a predictive tool for identifying the risk of complications in patients following ostomy surgery. METHODS: The oStomY regiSTry prEdictive ModelIng outCome (SYSTEMIC) project was developed to improve patient-oriented outcomes. Demographic, medical history, and stoma-related variables were obtained from patients at the wound ostomy clinic of the University Hospital of Padova, Italy. A follow-up assessment was completed 30 days after stoma surgery. Two (2) Bayesian machine learning approaches (naïve Bayes) were carried out to define an automatic peristomal complication predictive tool. A sensitivity analysis was performed to evaluate the possible effects of the prior choices on naïve Bayes performance. RESULTS: The algorithms were based on preliminary data from 52 patients (28 [53.3%] had a colostomy and 24 [46.7%] had an ileostomy). In terms of postoperative complications, no significant differences were observed between patients with different body mass indices (P = .16), those who underwent elective surgery compared with those who underwent emergency surgery (P = .66), and those who had or had not been preoperatively sited (P = .44). The algorithms showed an overall moderate ability to correctly classify patients according to the presence of peristomal complications (accuracy of nearly 70% in both models). In the the data-driven prior model, the probability of developing complications was greater for participants with malignancies or other diseases (0.3314 for both levels) than for patients with diverticula and bowel perforation (0.1453) or inflammatory bowel disease (0.1918). CONCLUSION: The development of an easy-to-use algorithm may help nonspecialized nurses evaluate the likelihood of future peristomal complications in patients with an ostomy and implement preemptive measures.

The SYSTEMIC Project: A Pilot Study to Develop a Registry of Patients With an Ostomy for Predictive Modeling of Outcomes

BACKGROUND

Stomal and peristomal skin complications represent a significant burden on the physical and psychological well-being of patients.

PURPOSE

To develop a predictive tool for identifying the risk of complications in patients following ostomy surgery.

METHODS

The oStomY regiSTry prEdictive ModelIng outCome (SYSTEMIC) project was developed to improve patient-oriented outcomes. Demographic, medical history, and stoma-related variables were obtained from patients at the wound ostomy clinic of the University Hospital of Padova, Italy. A follow-up assessment was completed 30 days after stoma surgery. Two (2) Bayesian machine learning approaches (naïve Bayes) were carried out to define an automatic peristomal complication predictive tool. A sensitivity analysis was performed to evaluate the possible effects of the prior choices on naïve Bayes performance.

RESULTS

The algorithms were based on preliminary data from 52 patients (28 [53.3%] had a colostomy and 24 [46.7%] had an ileostomy). In terms of postoperative complications, no significant differences were observed between patients with different body mass indices (P = .16), those who underwent elective surgery compared with those who underwent emergency surgery (P = .66), and those who had or had not been preoperatively sited (P = .44). The algorithms showed an overall moderate ability to correctly classify patients according to the presence of peristomal complications (accuracy of nearly 70% in both models). In the the data-driven prior model, the probability of developing complications was greater for  participants with malignancies or other diseases (0.3314 for both levels) than for patients with diverticula and bowel perforation (0.1453) or inflammatory bowel disease (0.1918).

CONCLUSION

The development of an easy-to-use algorithm may help nonspecialized nurses evaluate the likelihood of future peristomal complications in patients with an ostomy and implement preemptive measures.

Resting Energy Expenditure in the Elderly: Systematic Review and Comparison of Equations in an Experimental Population

Elderly patients are at risk of malnutrition and need an appropriate assessment of energy requirements. Predictive equations are widely used to estimate resting energy expenditure (REE). In the study, we conducted a systematic review of REE predictive equations in the elderly population and compared them in an experimental population. Studies involving subjects older than 65 years of age that evaluated the performance of a predictive equation vs. a gold standard were included. The retrieved equations were then tested on a sample of 88 elderly subjects enrolled in an Italian nursing home to evaluate the agreement among the estimated REEs. The agreement was assessed using the intraclass correlation coefficient (ICC). A web application, equationer, was developed to calculate all the estimated REEs according to the available variables. The review identified 68 studies (210 different equations). The agreement among the equations in our sample was higher for equations with fewer parameters, especially those that included body weight, ICC = 0.75 (95% CI = 0.69-0.81). There is great heterogeneity among REE estimates. Such differences should be considered and evaluated when estimates are applied to particularly fragile populations since the results have the potential to impact the patient's overall clinical outcome.

Profiling Patients by Intensity of Nursing Care: An Operative Approach Using Machine Learning

Physical function is a patient-oriented indicator and can be considered a proxy for the assignment of healthcare personnel. The study aims to create an algorithm that classifies patients into homogeneous groups according to physical function. A two-step machine-learning algorithm was applied to administrative data recorded between 2015 and 2018 at the University Hospital of Padova. A clustering-large-applications (CLARA) algorithm was used to partition patients into homogeneous groups. Then, machine learning technique (MLT) classifiers were used to categorize the doubtful records. Based on the results of the CLARA algorithm, records were divided into three groups according to the Barthel index: <45, >65, ≥45 and ≤65. The support vector machine was the MLT showing the best performance among doubtful records, reaching an accuracy of 66%. The two-step algorithm, since it splits patients into low and high resource consumption, could be a useful tool for organizing healthcare personnel allocation according to the patients' assistance needs.

The Barthel index as an indicator of hospital outcomes: A retrospective cross-sectional study with healthcare data from older people

AIMS

The assessment of functional status is a more appropriate measure in the older people than traditional healthcare outcomes. The present study aimed to analyse the association between functional status assessed using the Barthel Index and length of stay, in-hospital mortality, discharge destination, and Diagnosis-Related Groups-based cost.

DESIGN

This study was a retrospective study that used administrative data from patients older than 65 discharged from the University Hospital of Padua (Italy) in 2016.

METHODS

A logistic regression model for categorical variables (length of stay, in-hospital mortality, and discharge destination) and a generalized linear model with gamma distributions and log links for continuous variables (cost of hospitalization) were used to evaluate associations with the Barthel Index.

RESULTS

A total of 13,484 admissions were included in the analysis. In-hospital mortality, safe discharge, and length of stay were higher in patients with severe dependence than in patients with mild/no dependence with a 12-fold increased risk of death (OR = 12.81; 95% CI 9.22-18.14), a 4 times greater likelihood of safe discharge (OR = 4.64; 95% CI 3.96-5.45), and a 2-fold increase in length of stay (OR = 2.56; 95% CI 2.34-2.81). On the other hand, no significant association was found between the cost of hospitalization and the Barthel Index.

CONCLUSIONS

Barthel Index was strongly associated with in-hospital mortality, discharge destination, and length of stay. The costs of hospitalization, however, were not related to patients' functional impairment.

IMPACT

The study considers functional status as an indicator of hospital outcomes. Better comprehension of the relationship between functional status and healthcare outcomes may help with early and adequate healthcare planning and resource management.

Using Wearable Devices to Monitor Physical Activity in Patients Undergoing Aortic Valve Replacement: Protocol for a Prospective Observational Study

Background

In last few decades, several tools have been developed to measure physical function objectively; however, their use has not been well established in clinical practice.

Objective

This study aims to describe the preoperative physical function and to assess and compare 6-month postoperative changes in the physical function of patients undergoing treatment for aortic stenosis with either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). The study also aims to evaluate the feasibility of wearable devices in assessing physical function in such patients.

Methods

This is a prospective observational study. The enrollment will be conducted 1 month before patients’ SAVR/TAVR. Patients will be provided with the wearable device at baseline (activity tracker device, Garmin vívoactive 3). They will be trained in the use of the device, and they will be requested to wear it on the wrist of their preferred hand until 12 months after SAVR/TAVR. After baseline assessment, they will undergo 4 follow-up assessments at 1, 3, 6, and 12 months after SAVR/TAVR. At baseline and each follow-up, they will undergo a set of standard and validated tests to assess physical function, health-related quality of life, and sleep quality.

Results

The ethics committee of Vicenza in Veneto Region in Italy approved the study (Protocol No. 943; January 4, 2019). As of October 2020, the enrollment of participants is ongoing.

Conclusions

The use of the wearable devices for real-time monitoring of physical activity of patients undergoing aortic valve replacement is a promising opportunity for improving the clinical management and consequently, the health outcomes of such patients.

Trial Registration

Clinicaltrials.gov NCT03843320; https://tinyurl.com/yyareu5y

International Registered Report Identifier (IRRID)

DERR1-10.2196/20072

Association between air pollution and Pediatric Intensive Care Units hospitalization rates

Background

In the last years air pollution has been linked to an increased risk of several children respiratory pathologies, especially low respiratory tract infections. In more severe cases, the child could be hospitalized in Pediatric Intensive Care Unit (PICU). The present study aims to evaluate the association between the exposure to air pollution and (i) PICU admissions and (ii) hospitalization rates among children with a previous PICU admission.

Methods

PICU admissions due to respiratory diseases were collected from 2010 to 2019 in Padua hospital (Italy) based on a large clinical Italian register. Furthermore, for subjects admitted in 2013, all subsequent hospitalizations have been tracked until 2019 from hospital discharge records. Environmental data were obtained from monitoring stations located within 20 km from the children residence. A conditional logistic regression based on a time-stratified case-crossover design will be performed to evaluate the association between hospital admissions and NO2, PM2.5 and PM10 in aerodynamic diameter.

Results

The registry contains data about more than 30000 PICU admissions, of which around 30 % are of children under one year of age. An increased prevalence for respiratory diseases' admissions, from 18% in 2010 to 24% in 2019 can be observed. More than 400 children were admitted to Padua's PICU in 2013. In the following years, all these subjects experienced at least one hospitalization (median 2, [IQR 1-5]) for more than 2000 hospital admissions from 2014 up to 2019.

Conclusions

Exposure of infants to air pollution could lead to more severe outcome as hospitalization as a result of a vulnerable lung condition that eases virus infections. This condition identifies a particularly frail population. With this approach, an association between air pollution and PICU admissions could be investigated in order to adopt public health policies aimed at safeguarding this frail population.

Key messages

The study would detect an association between air pollution and hospital admissions as severe outcomes in infants and children. Furthermore, this is the first study that would assess if there is an association between these two factors in more frail subjects already hospitalized in a Pediatric Intensive Care Unit.

Energy Requirement Equations in Elderly Patients: A Systematic Review (P01-002-19)

Objectives

Elderly patients are at risk of malnutrition and need an appropriate assessment of energy requirements. In the clinical setting, predictive equations are widely used to estimate the Resting Energy Expenditure (REE). Although easy to use, these equations are not always validated for the elderly and, even if validated, they often provide different outputs of energy requirements for the same subject. This study aimed at doing a systematic review of the equations for the estimation of REE in the elderly with the final aim of developing a web-based application helping clinicians in finding out the most appropriate equation for estimating the REE for each subject.

Methods

The systematic review was carried out using PubMed and Scopus following PRISMA guidelines. Studies in subjects older than 65 years of age, testing the performance of a predictive equation for the estimation of REE vs. a gold standard (indirect calorimetry or doubly labeled water) were included in the review. Studies performed in critically ill elderly patients were excluded.

Results

The initial search identified 2035 studies. The final review included 50 studies. Included studies were mainly observational, conducted in healthy elderly subjects enrolled in the outpatient setting, and using indirect calorimetry as gold standard. The 50 studies included in the review corresponded to 189 different equations. Several parameters were included in the equations and they can be divided as following: anthropometric characteristics, body composition parameters, environmental measures, laboratory tests, presence of comorbidities, and physical activity frequency.

Conclusions

The assessment of the energy requirements in the elderly is crucial for the management of nutritional problems in this population group since nutritional problems are related to worse health outcomes. The present study showed a wide use of different type of equations for the estimation of REE in the elderly highlighting the need of choosing the most appropriate predictive equation according to the subject characteristics and health status. The web application that is currently under development will help clinicians in doing that.

Funding Sources

Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy.

Communicating Risk Regarding Food Consumption: The Case of Processed Meat

The present research combines real data and parameters found in recent literature that were used to design realistic scenarios demonstrating the potential effects (benefits and costs) of the World Health Organization (WHO)’s risk communication regarding the consumption of processed meat, which was proven to be associated with an increased risk of colorectal cancer (CRC) in an International Agency for Research on Cancer (IARC)/WHO report. The impact of the risk communication of processed meat consumption was simulated using Monte Carlo microsimulation models. The results showed that a 1% reduction in the number of high-level processed meat consumers may lead to a yearly decrease in CRC cases of 406.43 (IC 95%: −243.94, 1056.81), while the more extreme scenario of a 15% reduction may lead to 2086.62 fewer cases (IC 95%: 1426.66, 2746.57). On the other hand, if demand contraction in the processed meat sector resulted in a 0.1% loss in employment, one could expect 27.23 all-cause mortalities attributable to job loss (IC 95%: 16.55, 37.80). This simulation study demonstrates that caution should be taken when implementing public awareness campaigns, particularly when the prevention message is not straightforward.