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Aims: To evaluate to which extent pregnancies of very short duration (<32 weeks' gestation) are concentrated in level III centers. Methods: Area-based study in the 57 maternity units of the Lazio Region (Italy), years 2003-2004, including: 1012 live births (gestational age 22-31 weeks), 261 fetal losses (22-31 weeks) and 209 induced abortions (22-25 weeks). Variables associated with access to a level III unit were evaluated through multivariable logistic regression models. Results: 83.7% of all pregnancies <32 weeks (88.8% of live births, 71.6% of fetal losses and 75.1% of induced abortions) were admitted to a level III perinatal center; 23.4% of live newborns, delivered in a level III hospital, were subsequently transferred to a same level facility. The probability that a fetal loss was not treated in a level III perinatal unit was higher for women without pregnancy complication, with lower education level, and living outside the metropolitan area. Conclusions: Regionalization of perinatal care in Lazio is not satisfactory. Concentration of high-risk deliveries in level III centers is good, but in utero transfer is insufficient. This study can help to define the effectiveness of different organizational systems on access to locally available perinatal facilities and to optimize general organizational patterns of perinatal care. [ABSTRACT FROM AUTHOR]

Aim: We conducted a randomized controlled trial to assess the effectiveness of a support intervention delivered by health professionals to increase the rate and duration of breastfeeding. Methods: A randomized controlled intervention study was conducted in the period 2000-2001 among 605 mothers who had given birth in a public maternity ward located in the city of Rome, Italy. The intervention consisted of a home visit by a midwife from the maternity ward of the hospital. The outcome of the study was the infant's feeding habits, assessed by a 24-h recall. The effect of the intervention on the duration of breastfeeding was estimated by the Kaplan-Meier method and by the Cox multivariate regression model. Results: According to intention-to-treat analysis, there was no significant difference between the intervention and the control group, after controlling for confounding factors (hazard ratio (HR) 1.04; 95% confidence interval (95% CI): 0.85-1.26). The duration of breastfeeding was shorter (HR 1.61; 95% CI: 1.13-2.31) for women in the intervention group who refused the obstetric visit. Conclusion: Our study shows that an early home support programme delivered by health professionals was not effective in increasing breastfeeding initiation and duration. [ABSTRACT FROM AUTHOR]

Objective: To determine which factors contribute to the decision to admit individuals to psychiatric wards in general hospitals.Method: Data on 1,379 individuals undergoing psychiatric evaluation in eight emergency rooms in a region of central Italy were collected. A logistic regression analysis was used to evaluate the likelihood of psychiatric admission considering the independent effects of demographic, social, and clinical factors and of the history of psychiatric treatment.Results: The adjusted odds ratio for psychiatric admission significantly increased with the following variables: severity of symptoms; presence of paranoid states and schizophrenic psychoses, affective psychoses and acute psychotic conditions (with neurotic disorders used as reference); a history of outpatient treatment; the presence of a staff member of a community mental health facility upon presentation at the emergency room; and the availability of beds in the psychiatric ward.Conclusion: The independent effect played by the presence of a staff member of a community mental health facility is of particular interest, suggesting the existence of a collaborative relationship between inpatient and outpatient services. [ABSTRACT FROM AUTHOR]

The aim of the article is to compare utilization of prenatal care, modality of obstetric care, and pregnancy outcomes in foreign born (FB) and Italian born (IB) mothers. The study was carried out in the Lazio region of Central Italy, which has 5 000 000 million inhabitants. Information was obtained from neonatal administrative hospital discharge records, containing data on maternal and neonatal characteristics. During the years 2001 -2002 there were 82 619 live births among lB mothers and 13015 among FB mothers. Results suggest that the utilisation of prenatal care was lower in immigrant mothers.

This study investigated the effects of antenatal steroid (AS) administration on the clinical conditions of preterm infants shortly after birth, and estimated the residual contribution of AS, after adjusting for the clinical risk index for babies (CRIB), on in hospital mortality. The study population consisted of all infants under 32 weeks gestation or with a birth weight less than or equal to 1500 g admitted within the first week after birth to 11 neonatal intensive care units in the Lazio region of central Italy during the years 1999-2001. A positive effect of Full AS treatment on mortality was mainly among those babies with an intermediate CRIB score while for the sickest babies the benefit of AS treatment disappears.

Background Size at birth is an important predictor of neonatal outcomes, but there are inconsistencies on the definitions and optimal cut-offs. Aims The aim of this study is to compute birth size percentiles for Italian very preterm singleton infants and assess relationship with hospital mortality. Study design Prospective area-based cohort study. Subjects All singleton Italian infants with gestational age 22–31 weeks admitted to neonatal care in 6 Italian regions (Friuli Venezia-Giulia, Lombardia, Marche, Tuscany, Lazio and Calabria) (n. 1605). Outcome measure Hospital mortality. Methods Anthropometric reference charts were derived, separately for males and females, using the lambda (λ) mu (μ) and sigma (σ) method (LMS). Logistic regression analysis was used to estimate mortality rates by gestational age and birth weight centile class, adjusting for sex, congenital anomalies and region. Results At any gestational age, mortality decreased as birth weight centile increased, with lowest values observed between the 50th and the 89th centiles interval. Using the 75th–89th centile class as reference, adjusted mortality odds ratios were 7.94 (95% CI 4.18–15.08) below 10th centile; 3.04 (95% CI 1.63–5.65) between the 10th and 24th; 1.96 (95% CI 1.07–3.62) between the 25th and the 49th; 1.25 (95% CI 0.68–2.30) between the 50 h and the 74th; and 2.07 (95% CI 1.01–4.25) at the 90th and above. Conclusions Compared to the reference, we found significantly increasing adjusted risk of death up to the 49th centile, challenging the usual 10th centile criterion as risk indicator. Continuous measures such as the birthweight z-score may be more appropriate to explore the relationship between growth retardation and adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To compare Emergency Room (ER) utilisation by subjects diagnosed as suffering from a mental disorder, who were born in Strong Migratory Pressure Countries (SMPC) or in Italy. To evaluate the predictors of admission to psychiatric and to non-psychiatric wards. Method: Data collected from Information System of Emergency Rooms were analysed. ER contacts in the years 2000–2004 pertaining to subjects who received a psychiatric diagnosis (ICD9-CM codes), and who were born in SMPC or in Italy were examined. “Contacts” included a total of 68,867 assessments made in the ER of all general hospitals in Rome having an acute psychiatric ward. Gender, age and clinical information on SMPC-born and Italian-born patients were compared. A multinomial logistic regression analysis was performed in order to determine risk factors for admission to a psychiatric or to a non-psychiatric ward. Results: At the end of follow-up, 11.7% of ER contacts concerned patients born in SMPC. Compared to the Italian-born group, these patients were younger and received more frequently a diagnosis of “Alcohol and substance abuse and dependencies”, while admissions to a psychiatric ward were significantly less common. Conclusion: Monitoring health service utilisation may provide relevant information for the delivery of culturally sensitive mental health services. [Copyright &y& Elsevier]

Objective To study the impact of terminations of pregnancy (TOP) on very preterm mortality in Europe. Design European prospective population-based cohort study. Setting Ten regions from nine European countries participating in the MOSAIC (Models of OrganiSing Access to Intensive Care for very preterm babies) study. These regions had different policies on screening for congenital anomalies (CAs) and on pregnancy termination. Population or sample Births 22–31 weeks gestational age. Methods The analysis compares the proportion of TOP among very preterm births and assesses differences in mortality between the regions. Main outcome measures Pregnancy outcomes (termination, antepartum death, intrapartum death and live birth) and reasons for termination, presence of CAs and causes of death for stillbirths and live births in 2003. Results Pregnancy terminations constituted between 1 and 21.5% of all very preterm births and between 4 and 53% of stillbirths. Most terminations were for CAs, although some were for obstetric indications (severe pre-eclampsia, growth restriction, premature rupture of membranes). TOP contributed substantially to overall fetal mortality rates in the two regions with late second-trimester screening. There was no clear association between policies governing screening and pregnancy termination and the proportion of CAs among stillbirths and live births, except in Poland, where neonatal deaths associated with CAs were more frequent, reflecting restrictive pregnancy termination policies. Conclusion Proportions of TOP among very preterm births varied widely between European regions. Information on terminations should be reported when very preterm live births and stillbirths are compared internationally since national policies related to screening for CAs and the legality and timing of medical terminations differ. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to assess pressure ulcer prevalence in a group of long-term units and to describe the main factors associated both with risk for and presence of a pressure ulcer. BACKGROUND: Despite being potentially preventable, pressure ulcers are highly frequent among institutionalized patients and are associated with increased morbidity and mortality. METHOD: A cross-sectional study was carried out, involving 571 patients from 10 long-term units in Rome, Italy. Healthcare staff in each unit evaluated pressure ulcer risk and collected clinical data while a single Registered Nurse assessed all patients to identify pressure ulcers. Univariate and multivariate analyses were performed for the two outcomes: condition at risk for pressure ulcers (Braden score < or = 16) and pressure ulcer presence. The data were collected in February-March 2005. FINDINGS: The overall prevalence of pressure ulcers was 27%. Multivariate analysis showed a statistically significant positive association between high-risk condition of pressure ulcer and previous stroke (OR = 1.96; 95% CI 1.30-2.96), previous trauma (OR = 1.83; 95% CI 1.12-2.99) and cognitive decline (OR associated with a 1 point Short Portable Mental State Questionnaire increase = 1.26; 95% CI 1.05-1.50). The model for pressure ulcer presence confirmed a statistically significant excess in patients with cardiovascular diseases (OR = 1.79; 95% CI 1.13-2.85), with high Activity of Daily Living scores (OR associated with a 1 point increase 1.38; 95% CI 1.03-1.84) and low Braden Scale scores (OR associated with a 1 point increase = 0.80; 95% CI 0.70-0.87). The risk of pressure ulcers according to number of full-time nurses and auxiliary staff per 10 beds lower than five was marginally statistically significant (OR = 1.60; 95% CI 0.98-2.61). CONCLUSION: Further research is needed to validate our findings and further prospective research is needed to identify ways of preventing pressure ulcers. Our data on staffing suggest that organizational factors should be taken into account when exploring determinants of pressure ulcers. [ABSTRACT FROM AUTHOR]

Background Road Traffic Injuries (RTI) and Home Injuries (HI) represent a relevant public health problem. In the Lazio region of Italy a surveillance system was activated. Objective To describe the surveillance system and report the health information in terms of temporal trends for the 5-year period 2001–2005. Methods We identified all Emergency Department (ED) visits and then linked them with hospital discharges and mortality registry. From the integrated database, we calculated the rates of ED visits, of hospital admissions, and of mortality, reporting the temporal trends. Results The 5-year surveillance showed a rate of 3151/100 000 for RTI ED visit and of 2976/100 000 for HI ED visit. The 15–29 year old was the group with the highest incidence of RTI ED visit and hospitalisation rate, 6845 and 493 per 100 000 inhabitants respectively; while the highest HI ED visit rate was in 0–4 years old (5958/100 000) and in older persons (3131/100 000) subjects. During the study period RTI and HI ED visit and hospitalisation rate showed a decreasing trend. The RTI surveillance revealed a decreasing trend for hospital admissions, and a decline of fatal cases from 2003, when the drivers license point system began. It identified higher number of fatal cases (22% more) than the official statistics. The HI surveillance revealed a significant increasing trend in more severe cases, and a stable trend for mortalities. Conclusion This study underlines the usefulness of the surveillance in order to monitor temporal trends and effectiveness of preventive measures. [ABSTRACT FROM PUBLISHER]

Objective To explore the relationship between morbidity, hospitalisation, mortality from Road Traffic Injuries (RTI) and Home Injuries (HI) and socioeconomic status (SES) of the area of residence. Source: RTI and HI surveillance based on the integration between the Emergency Department (ED) Hospital and Mortality data of Lazio region. The SES index (five levels: 1 most privileged areas; 5 most deprived areas) was derived using census data. For each injured subject the SES index of its census tract of residence was obtained. Population Residents in Rome, 2005 Italy. Analyses For each level of SES, we computed rates for ED visits, hospitalisation and mortality, adjusted by sex and age. IRR and 95% CI have been estimated using Poisson Regression. Results Out of 127 129 ED visits, 9576 (7.5%) were followed by a hospitalisation and 594 (0.5%) died within 30 days. SES was estimated for 109 993 cases, 87% of the total. The rates of RTI and HI ED visits were higher among the most deprived level of SES (IRR 1.27 95% CI 1.24 to 1.30; IRR 1.33 95% CI 1.29 to 1.37, respectively) compared to the most privileged ones. A strong relation was found between RTI mortalities and poor level of SES. These findings were more marked for 0–4 year old HI and RTI injured and for males. Conclusion RTI and HI incidence were associated to sociodemographic factors. This finding has implications for targeting injury prevention interventions and resources. [ABSTRACT FROM PUBLISHER]

BACKGROUND: The Mini-Mental State Examination (MMSE) has contributed to detecting cognitive impairment, yet few studies have evaluated its accuracy when used by general practitioners (GP) in an actual public-health setting. OBJECTIVES: We evaluated the accuracy of MMSE scores obtained by GPs by comparing them to scores obtained by Alzheimer's Evaluation Units (UVA). METHODS: The study was observational in design and involved 59 voluntary GPs who, after having undergone training, administered the MMSE to patients with symptoms of cognitive disturbances. Individuals who scored < or = 24 (adjusted by age and educational level) were referred to Alzheimer's Evaluation Units (UVA) for diagnosis (including the MMSE). UVAs were unblinded to the MMSE score of the GP. To measure interrater agreement, the weighted Kappa statistic was calculated. To evaluate factors associated with the magnitude of the difference between paired scores, a linear regression model was applied. To quantify the accuracy in discriminating no cognitive impairment from any cognitive impairment and from Alzheimer's disease (AD), the ROC curves (AUC) were calculated. RESULTS: For the 317 patients, the mean score obtained by GPs was significantly lower (15.8 vs. 17.4 for the UVAs; p < 0.01). However, overall concordance was good (Kappa = 0.86). Only the diagnosis made by the UVA was associated with the difference between paired scores: the adjusted mean difference was 3.1 for no cognitive impairment and 3.8 for mild cognitive impairment. The AUC of the scores for GPs was 0.80 (95%CI: 0.75-0.86) for discriminating between no impairment and any impairment and 0.89 (95%CI: 0.84-0.94) for distinguishing patients with AD, though the UVA scores discriminated better. CONCLUSION: In a public-health setting involving patients with symptoms of cognitive disturbances, the MMSE used by the GPs was sufficiently accurate to detect patients with cognitive impairment, particularly those with dementia. [ABSTRACT FROM AUTHOR]