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The need for organizations to operate in changing environments is addressed by proposing an approach that integrates organizational development with information system (IS) development taking into account changes in the application context of the solution. This is referred to as Capability Driven Development (CDD). A meta-model representing business and IS designs consisting of goals, key performance indicators, capabilities, context and capability delivery patterns, is being proposed. The use of the meta-model is validated in three industrial case studies as part of an ongoing collaboration project, whereas one case is presented in the paper. Issues related to the use of the CDD approach, namely, CDD methodology and tool support are also discussed.

'Introduction': Social factors might bring about health inequities. Vulnerable population groups, including those suffering from noncommunicable diseases such as type 2 diabetes and depression, might be more prone to suffering the effects of such inequities. This study aimed to identify patients with type 2 diabetes with depression in a primary care setting, with the objective of describing health inequities among urban and suburban dwellers. 'Methods': A quantitative, retrospective and descriptive study was carried out among patients with diabetes attending public primary healthcare centres in different regions of Malta. Participants completed a self-administered questionnaire to identify patient and disease characteristics. Convenience sampling was used. 'Results': The logistic regression model predicting the likelihood of different factors occurring with suburban patients with diabetes as opposed to those residing in urban areas contained five independent variables (severity of depression, monthly income, blood capillary glucose readings, weight and nationality). The full model containing all predictors was statistically significant, c2 (5, 'n'=400), 'p'<0.001, indicating that the model was able to distinguish between urban and suburban areas. The model as a whole explained between 10% (Cox and Snell 'R2') and 20% (Nagelkerke R2) of the variance in urban and suburban areas, and correctly classified 73.8% of cases. All five of the independent variables made a unique, statistically significant contribution to the model. Elevated blood glucose and obesity tended to be more prevalent in suburban respondents than in urban participants. Conversely, participants with diabetes living in urban areas were more likely to be depressed, non-Maltese and have a higher income. Conclusion: Despite the small size of the Maltese islands and the expected social homogeneity, health inequities still exist, highlighting the importance of social factors in the epidemiology of disease. This study provides information for healthcare professionals and policy-makers to mitigate the effects of social inequities on vulnerable population groups.

Background/Objectives: Childhood obesity is a global epidemic. Addressing the modifiable risk factors with effective policies is crucial for both prevention and intervention. This scoping review aims to provide a situational analysis of childhood obesity in Greece by mapping the available evidence on the prevalence of obesity among Greek children and adolescents and exploring the existing policies implemented to address this issue. Methods: A systematic literature search was conducted on 15 September 2023, using the PubMed, Scopus, and IATROTEK-online databases to identify studies related to childhood obesity and policies in Greece. Keyword groups were developed for “childhood obesity,” “Greece,” and either “prevalence” or “policies”. Additional sources, including Google and Google Scholar, were screened to ensure comprehensiveness. Results: A total of 66 studies were included: 61 on obesity prevalence (≤18 years of age) and 5 on existing policies tackling childhood obesity, all in Greece. The collective prevalence was observed to lie within the subsequent range of values: 2.8–21.2%. Regarding both genders, the observed prevalence ranged from 2.8% to 26.7% in males, and between 1.3% and 33.7% in females. The policies adopted in Greece cover various domains (healthy nutrition, public preferences, physical activity, school policies, and programs related to childhood obesity). Conclusions: Childhood obesity in Greece is a major challenge. Greece currently uses some policies and strategies to combat childhood obesity. There is still work to be done: policies play a pivotal role as a key tool to influence lifestyle habits on a broad scale and exert a considerable impact on the reduction in this prevalent health concern.

BackgroundFollowing blunt trauma, diagnosis of shoulder dislocation based on physical examination alone is difficult due to possible concurrent proximal humeral fractures. X-rays are therefore used to confirm diagnosis. Results from recent observational studies comparing diagnostic accuracy of point-of-care ultrasound (PoCUS) with X-rays for shoulder dislocation have been encouraging. The aim of this study was to determine whether PoCUS improves diagnostic accuracy when used with physical examination for the diagnosis of shoulder dislocation, proximal humeral fracture and ascertaining successful reduction in the ED.MethodsA prospective, single-centre, open, parallel randomised control study over a 6-month period was used to answer the research question and test the null hypothesis. Consecutive eligible adult patients attending the ED of Mater Dei Hospital in Malta were randomised to either the control (C) (physical examination only) or experimental group (E) (physical examination and a two-point PoCUS scan). The study objectives were to measure diagnostic accuracy for both examinations for detecting shoulder dislocation, any associated proximal humeral fractures and confirming reduction. X-rays were used as reference standard for both groups.Results1206 patients were enrolled in this study (C n=600, E n=606). 290 dislocations (C n=132 and E n=158), 332 proximal humeral fractures (C n=154 and E n=178) and 278 reductions (C n=130 and E n=148) were analysed. A statistically significant difference (p<0.001) was found between the two groups for diagnostic accuracy in shoulder dislocation (C=65%, likelihood ratio (LR)+=2.03 and LR−=0.35 and E=100%, LR+=∞ and LR−=0), proximal humeral fractures (C=45.7%, LR+=1.23 and LR−=0.52 and E=98.3%, LR+=103.9 and LR−=0.03) and reduction (C=68.7%, E=100%). The null hypothesis for this study was thus rejected.ConclusionsThe addition of PoCUS to a physical examination significantly improves diagnostic accuracy for dislocations, proximal humeral fractures and reduction confirmation.Trial registration numberInternational Standard Randomised Controlled Trials Number Registry (ISRCTN17048126).

In a trial of adjuvant treatment for patients with resected ALK -positive non–small-cell lung cancer, disease-free survival at 2 years was 93.6% with the ALK inhibitor alectinib and 63.7% with standard chemotherapy.

Parkinson’s disease (PD) is a neurodegenerative disorder that causes a progressive impairment in motor and cognitive functions. Although semantic fluency deficits have been described in PD, more specific semantic memory (SM) and lexical availability (LA) domains have not been previously addressed. Here, we aimed to characterize the cognitive performance of PD patients in a set of SM and LA measures and determine the smallest set of neuropsychological (lexical, semantic, or executive) variables that most accurately classify groups. Thirty early-stage non-demented PD patients (age 35–75, 10 females) and thirty healthy controls (age 36–76, 12 females) were assessed via general cognitive, SM [three subtests of the CaGi battery including living (i.e., elephant) and non-living things (i.e., fork)], and LA (eliciting words from 10 semantic categories related to everyday life) measures. Results showed that PD patients performed lower than controls in two SM global scores (picture naming and naming in response to an oral description). This impairment was particularly pronounced in the non-living things subscale. Also, the number of words in the LA measure was inferior in PD patients than controls, in both larger and smaller semantic fields, showing a more inadequate recall strategy. Notably, the classification algorithms indicated that the SM task had high classification accuracy. In particular, the denomination of non-living things had a classification accuracy of ∼80%. These results suggest that frontostriatal deterioration in PD leads to search strategy deficits in SF and the potential disruption in semantic categorization. These findings are consistent with the embodied view of cognition.

Objective. To evaluate whether serum titers of second-generation anticyclic citrullinated peptide antibodies (anti-CCP2) are associated with the severity and extent of interstitial lung disease in rheumatoid arthritis (RA-ILD). Methods. In across-sectional study, 39 RA-ILD patients confirmed by high-resolution computed tomography (HRCT) were compared with 42 RA without lung involvement (RA only). Characteristics related to RA-ILD were assessed in all of the patients and serum anti-CCP2 titers quantified. Results. Higher anti-CCP2 titers were found in RA-ILD compared with RA only (medians 77.9 versus 30.2 U/mL, P<0.001). In the logistic regression analysis after adjustment for age, disease duration (DD), smoke exposure, disease activity, functioning, erythrocyte sedimentation rate, and methotrexate (MTX) treatment duration, the characteristics associated with RA-ILD were higher anti-CCP2 titers (P=0.003) and + RF (P=0.002). In multivariate linear regression, the variables associated with severity of ground-glass score were anti-CCP2 titers (P=0.02) and with fibrosis score DD (P=0.01), anti-CCP2 titers (P<0.001), and MTX treatment duration (P<0.001). Conclusions. Anti-CCP2 antibodies are markers of severity and extent of RA-ILD in HRCT. Further longitudinal studies are required to identify if higher anti-CCP2 titers are associated with worst prognosis in RA-ILD.

Aflatoxins, a group of extremely toxic mycotoxins produced by Aspergillus flavus, A. parasiticus and A. nomius, can occur as natural contaminants of certain agricultural commodities, particularly maize. These toxins have been shown to be hepatotoxic, carcinogenic, mutagenic and cause severe human and animal diseases. The effectiveness of neutral electrolyzed oxidizing water (NEW) on aflatoxin detoxification was investigated in HepG2 cells using several validation methodologies such as the 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide assay, the induction of lipid peroxidation, the oxidative damage by means of glutathione modulation, the Ames test and the alkaline Comet assay. Our results showed that, after the aflatoxin-contaminated maize containing 360 ng/g was soaked in NEW (60 mg/L available chlorine, pH 7.01) during 15 min at room temperature, the aflatoxin content did not decrease as confirmed by the immunoaffinity column and ultra performance liquid chromatography methods. Aflatoxin fluorescence strength of detoxified samples was similar to untreated samples. However, aflatoxin-associated cytotoxicity and OPEN ACCESS Toxins 2015, 7 4295 genotoxicity effects were markedly reduced upon treatment. According to these results, NEW can be effectively used to detoxify aflatoxin-contaminated maize.

Abstract Stomach cancer (SC) incidence and mortality are relevant public health issues worldwide. In Colombia, screening for preneoplastic lesions (PNL) and the presence of H. pylori is not routinely performed. Therefore, the aim of this study was to evaluate OLGA-OLGIM staging and the interobserver agreement in gastritis and preneoplastic lesions in patients with gastroduodenal symptoms from Colombia. A cross-sectional study was conducted in 272 patients with gastroduodenal symptoms. Gastric biopsies were taken following the Updated Sydney System with the OLGA-OLGIM classification, and the results were evaluated by two pathologists. Chronic gastritis and PNL were reported in 76% and 24% of the patients, respectively. Furthermore, 25% of the patients with PNL displayed gastric atrophy (GA) and 75% intestinal metaplasia (IM). Agreement in the histopathological reading for IM was good, whereas for OLGA was variable, and for the H. pylori quantity was poor. OLGA-OLGIM stages 0-II were the most frequent (96%), while stage III (4%) and SC (4%) were the least frequent. Age and coffee consumption were associated with a higher prevalence of PNL. This work determined that 4% of the population is at high risk of developing SC and would benefit from follow-up studies. Reinforcement of training programs to improve the agreement in histopathology readings is required.