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In this paper we consider the problem of estimating causal effects in a framework with many treatments through a simulation study. We engage in Monte Carlo simulations to evaluate the performance of inverse probability of treatment weighting (IPTW) with 10 treatments, estimating the propensity scores using Generalized Boosted Models. We assess the performance of IPTW under three different scenarios representing treatment allocations, and compare it with a simple parametric approach, i.e. logistic regression. IPTW's estimates are less biased, even though they exhibit a higher variance than those based on logistic regression. Moreover, we apply IPTW to the estimation of the neighbourhood effect on the probability of older people experiencing at least one fracture requiring hospitalization during the year 2002 by comparing 10 neighbourhoods in the city of Turin (Italy). Our paper demonstrates that IPTW can be successfully applied to the estimation of neighbourhood effects, and, more generally, to the estimation of causal effects in the presence of many treatments. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the extent to which neonatal analgesia for invasive procedures has changed in the last 5 years since the publication of Italian guidelines. Methods: We compared survey data for the years 2004 and 2010 on analgesia policy and practices for common invasive procedures at Italian Neonatal Intensive Care Units (NICUs); 75 NICUs answered questionnaires for both years and formed the object of this analysis. Results: By 2010 analgesia practices for procedural pain had improved significantly for almost all invasive procedures ( p < 0.05), both non-pharmacological and pharmacological methods being adopted by the majority of NICUs (unlike the situation in 2004). The routine use of medication for major invasive procedures was still limited, however (35% of lumbar punctures, 40% of tracheal intubations, 46% during mechanical ventilation). Postoperative pain treatment was still inadequate, and 41% of facilities caring for patients after surgery did not treat pain routinely. Pain monitoring had definitely improved since 2004 ( p < 0.05), but not enough: only 21% and 17% of NICUs routinely assess pain during mechanical ventilation and after surgery, respectively. Conclusion: There have been improvements in neonatal analgesia practices in Italy since national guidelines were published, but pain is still undertreated and underscored, especially during major invasive procedures. It is mandatory to address the gap between the recommendations in the guidelines and clinical practice must be addressed through with effective quality improvement initiatives. [ABSTRACT FROM AUTHOR]