"Post-ACL Rupture Integrated Rehabilitative Pathway: Factors Influencing Economic Resources Absorption"

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Influence of Magnesium as a Major Contributor of Water Hardness on Some Cardiac Disease Risk Factors

Various ecological studies report a reduction in cardiovascular disease mortality risk with increasing magnesium levels in drinking water. Most of the studies done in this field were epidemiologic studies.The aim of the present study was to examine whether magnesium addition to drinking water can affect risks of cardiac disease. The study included five groups of male albino rats. The rats received either tap water or water containing 5, 10, 20 g of magnesium sulfate per liter. During the whole experiment, all the groups received hypercholesterolemic diet except for the normal control which received normal basal diet. At the end of the experiment, blood was drawn for the determination of plasma magnesium, lipid profile and liver function. In addition, the extent of obesity was determined using the body mass index (BMI). In all groups magnesium addition was associated with higher levels of plasma magnesium. The blood analysis showed a significant decrease in serum total cholesterol, triglycerides, LDL- cholesterol and VLDL- cholesterol, while there was a significant increase in HDL- cholesterol in groups received magnesium sulfate in drinking water, compared with the hypercholesterolemic group received tap water. GOT, GPT and ALP followed the same trend. The addition of MgSO4 to the drinking water results in significant decrease in BMI of the magnesium treated groups relative to the hypercholesterolemic control. These results showed that high magnesium concentration in drinking water is capable of decreasing some cardiac disease risk factors in male albino rats. Keywords: Cardiac disease, hypercholesterolemia, Magnesium, Risk factors, Water

An empirical analysis of conviction patterns, change over the life-course and external influences in relation to sexual offending behaviour

This PhD uses statistical analysis and qualitative interviews to analyse behaviour patterns in the context of causal theories of sexual offending and desistance from it, with a particular emphasis on socio-cultural reasons why people offend, stop offending, or offend at different points in life. This research makes an original contribute to the literature in a number of ways. There are six main findings from this research that contribute to the literature in this area. One of the key findings is that there is substantial heterogeneity of offending behaviour amongst sexual offenders, suggesting that there is no one-size-fits-all approach for prevention, intervention or management. There was support in the research for a link between sexual offending and prolific non-sexual offending, but this only appeared to be one of several different sexual offending pathways. Other groups of offenders displayed considerable specialism in their offending (in terms of type of sexual offence and the fact that they had often only been convicted of sexual offences). This was magnified by the finding that offending rates were generally lower for sexual convictions than for other convictions: in fact, the vast majority of people in the dataset only had convictions for one sexual offence. There was evidence from the qualitative interviews that adverse life events were a contributory factor to sexual offending, and the thesis has found that there is support for both psychological and socio-cultural causes (including gender-based elements), as well as an interaction between the two. It also suggested that there is evidence that sexual offending is not stable over the life-course, and that situational factors appear to be important in terms of determining behavioural change. Implications for prevention, intervention and management of sexual offenders are discussed

A comparative analysis of a disposable and a reusable pedicle screw instrument kit for lumbar arthrodesis: integrating HTA and MCDA

Objective: Lumbar arthrodesis is a common surgical technique that consists of the fixation of one or more motion segments with pedicle screws and rods. However, spinal surgery using these techniques is expensive and has a significant impact on the budgets of hospitals and Healthcare Systems. While reusable and disposable instruments for laparoscopic interventions have been studied in literature, no specific information exists regarding instrument kits for lumbar arthrodesis. The aim of the present study was to perform a complete health technology assessment comparing a disposable instrument kit for lumbar arthrodesis (innovative device) with the standard reusable instrument. Methods: A prospective and observational study was implemented, by means of investigation of administrative records of patients undergoing a lumbar arthrodesis surgical procedure. The evaluation was conducted in 2013, over a 12- month time horizon, considering all the procedures carried out using the two technologies. A complete health technology assessment and a multi-criteria decision analysis approach were implemented in order to compare the two alternative technologies. Economic impact (with the implementation of an activity based costing approach), social, ethical, organisational, and technology-related aspects were taken into account. Results: Although the cost analysis produced similar results in the comparison of the two technologies (total cost equal to € 4,279.1 and € 4,242.6 for reusable instrument kit and the disposable one respectively), a significant difference between the two instrument kits was noted, in particular concerning the organisational impact and the patient safety. Conclusions: The replacement of a reusable instrument kit for lumbar arthrodesis, with a disposable one, could improve the management of this kind of devices in hospital settings

Integrating Health Technology Assessment and Multi-Criteria Decision Analysis in Optimizing Diabetic Macular Edema Management: Results from an Italian Multi-Regional Study

Health Technology Assessment (HTA) is a widely implemented technical tool used to inform the decision-making process..

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer

Purpose: To investigate the implications of the introduction of two hormonal therapies, abiraterone acetate + prednisone (AA+P) and enzalutamide (ENZA), for the treatment of naïve patients with metastatic castration-resistant prostate cancer (mCRPC) in the Italian setting. Methods: In 2017–2018, a Health Technology Assessment was conducted in Italy, considering the National Healthcare Service (NHS) perspective. Data were retrieved from literature evidence, economic evaluations, and qualitative questionnaires, considering the 9 EUnetHTA dimensions, and a final multi-criteria approach. Results: On the basis of mCRPC prevalence and incidence rates in Italy, the analysis considered 11,212 males eligible to either AA+P or ENZA treatments. Both drugs led to an improvement of the patients’ overall survival, with respect to the standard of care, composed of docetaxel chemotherapy. However, AA+P showed a higher rate of drug-related moderate adverse events and a monitoring activities incidence superior to ENZA (+70%, p-value=0.00), which led to a major resources absorption (€ 1,056.02 vs € 316.25, p-value=0.00), whereas ENZA showed a better cost-effectiveness average value (CEV: 54,586.12 vs 57,624.15). Economic savings ranging from 1.46% to 1.61% emerged for the NHS, as well as organizational advantages, with fewer minutes required for the mCRPC management (AA+P: 815 mins vs ENZA: 500 mins). According to experts’ perceptions, based on a 7-item Likert scale (ranging from −3 to +3), similar results emerged on ethical and social impact (ENZA: 1.35 vs AA+P: 1.48, p-value>0.05), and on legal dimension (ENZA: 0.67 vs AA+P: 0.67, p-value>0.05), since both drugs improved the patients’ quality of life and received approval for use. High-level perceptions related to ENZA adoption emerged with regard to equity (ENZA: 0.69 vs AA+P: 0.25, p-value<0.05), since it is cortisone-free. Multi-criteria approach analysis highlighted a higher score of ENZA than comparator (0.79 vs 0.60, p-value=0.00). Conclusion: The evidence-based information underlined the advantages of ENZA and AA+P treatments as therapeutic options for mCRPC patients. In the appraisal phase, the higher score than the comparator suggested ENZA as the preferred treatment for mCRPC