Search

Background The Russian invasion of Ukraine caused millions of Ukrainian refugees to flee to other nations. To provide the most appropriate assistance, host nations necessitate up-to-date information regarding Ukrainian refugee's demographic and epidemiological conditions. We aim to investigate the demographic composition, the COVID-19 vaccinations performed, specialist care provided and the prevalence of non-communicable diseases (NCDs) in refugees assisted by an Italian Local Health Authority (LHA). Methods We conducted a retrospective cross-sectional analysis from March to June 2022, analyzing the demographic and epidemiological status of Ukrainians. Statistical analyses were carried out to assess possible associations between NCDs distribution, age and gender. Results LHA Roma 1 assisted 9349 Ukrainian refugees. Of these, 2784 (29.8%) were males and 6565 (70.2%) were females, with a median age of 25 years. Two thousand four hundred and eighty-five Ukrainian refugees were vaccinated against COVID-19. Among them, 401 (16.1%) had at least one NCD. The most frequent groups of diseases were related to the circulatory system (50.6%), the endocrine system (24.9%), and mental and behavioral disorders (6.5%). Conclusion Refugees need healthcare services targeted mainly towards minors and females. It is essential to analyze and monitor the demographic and epidemiological conditions to provide evidence about patient management and the best care integrated into the health service of host countries.

Background: The conflict between Russia and Ukraine has strained the health systems of countries that welcome war refugees on all levels, from national to local. Despite the Public Health guidelines regarding assistance being published on the topic, the scientific literature currently lacks evidence on the experience of applying theory in practice. This study aims to describe evidence-based practices that were implemented and to provide a detailed description of emerging problems and solutions pertaining Ukrainian refugee assistance in the context of one of the biggest Local Health Authorities in Italy (LHA Roma 1). Methods: LHA Roma 1 developed a strategic plan based on local expertise, national and international guidelines to ensure infectious disease prevention and control, as well as continuity of care for non-communicable diseases and mental health. Results: The insertion of Ukrainian refugees in the National Health System through an identification code assignment and other services such as COVID-19 swab and vaccination were provided either in one of the three major assistance hubs or in local district level ambulatories spread throughout the LHA. Many challenges were faced during the implementation phase of the outlined practice guidelines, which required sensible and timely solutions. These challenges include the necessity of rapid resource provision, overcoming linguistic and cultural barriers, guaranteeing a standard of care across multiple sites and coordination of interventions. Public Private Partnerships, the creation of a centralized multicultural and multidisciplinary team and the mutually beneficial collaboration with the local Ukrainian community were essential to guarantee the success of all operations. Conclusions: The experience of LHA Roma 1 helps shed light on the importance of leadership in emergency settings and how a dynamic relationship between policy and practice would allow each intervention to be modulated according to the local environm

BackgroundTelemedical approaches represent a valuable tool for the management of coronavirus disease 2019 patients, allowing daily clinical assessment, monitoring of vital parameters, remote visits, and prescription of treatment or hospitalization in case of clinical worsening. This cross-sectional study aims to evaluate the use, barriers and facilitators of the "Lazio ADVICE" telemedical platform, a regional system for remote assistance for coronavirus disease 2019 patients at home, according to General Practitioners and Family Pediatricians of the Local Health Authority Roma 1, during the coronavirus disease 2019 pandemic. MethodsAn interview-based survey was performed between December 2020 and January 2021. The survey investigated the demographic information of General Practitioner and Family Pediatricians, the knowledge of the platform, frequency of utilization, usefulness, strengths and weaknesses, and hypothesis of future implementation proposed. ResultsWe interviewed 214 physicians and 89 (41.6%) were classified as users and 125 (58.4%) as non-users. Older age and working in District 1, 14 and 15 (vs. District 13) significantly reduced the probability of using the platform physician. Among the 89 users, 19 (21.3%) used the platform every day or even several times a day, 40 (44.9%) several times a week but less than one access per day, 30 (33.7%) used the platform several times a month up to one entry per week. Most of them (92.3%) consider the platform useful. Barriers were poor integration with software and work routine (76.4%), and usability issues (53.9%). Among the 125 non-users, 14 (11.2%) didn't know the existence of the platform, 60 (48.0%) never tried it and 51 (40.8%) tried to use it. Reported reasons for the interruption of use were not very user-friendly (45.1%), perceived useless (37.3%), non-optimal functioning (23.5%), and lack of time (19.6%). ConclusionThe pandemic accelerated the implementation of telemedicine services around Lazio Region, st

No abstract available

The COVID-19 pandemic called for a reorganisation of the methods for providing health services. The aim of this paper is to describe the organisational model implemented by one of Rome's Local Health Units (LHU), ASL Roma 1, for the "at-home COVID-19 vaccination campaign " dedicated to a target population and to outline data related to vaccination coverage stratified by health districts. A cross-sectional study was designed to describe the strategies implemented by LHU to deliver at-home vaccination programmes. People eligible for the at-home vaccination programme included patients living in the area of the LHU, being assisted by the district home care centre or not transportable or individuals with social situations that make traveling difficult. Priority for vaccination was given to (I) age > 80 years, (II) ventilated patients with no age limit, (III) very seriously disabled people with no age limit. Patients' data were acquired from regional and LHU databases. From 5 February until the 16 May, 6127 people got at least one dose of Pfizer-Biontech Comirnaty(R) vaccine, while 5278 (86.14%) completed the necessary two doses. The highest number of vaccines was administered during the first week of April, reaching 1296 doses overall. The number of vaccines administered were similar across the districts. The average number of people vaccinated at home was 6 per 1000 inhabitants in the LHU. This model proved to be extremely complex but effective, reaching satisfying results in terms of vaccination coverage.

INTRODUZIONEVaccinarsi in Lazio è uno dei portali web regionali che ruotano intorno al sito VaccinarSì. Nato dalla collaborazione tra enti, regioni, università, aziende sanitarie locali e società scientifiche, questo sito unisce gli esperti attivi a livello regionale sul tema della protezione vaccinale. Obiettivo di questa iniziativa è fornire ai cittadini e agli operatori sanitari, in particolare della Regione Lazio, un’informazione completa, comprensibile e verificabile, tale da facilitare le decisioni e il confronto su questo tema oltre i luoghi comuni, i miti e la falsa scienza. MATERIALI E METODIIl sito Vaccinarsi in Lazio contiene cinque sezioni principali (Le Vaccinazioni nel Lazio, Scienza e Conoscenza, Info utili, In Evidenza, Contattaci). Il portale si avvale del lavoro di uno staff tecnico (composto prevalentemente da medici in formazione specialistica in Igiene e Medicina Preventiva) e un comitato tecnico-scientifico, oltre alla collaborazione di un panel di esperti di alto valore scientifico. Inoltre, sono state predisposte le pagine facebookTM e twitterTM che rilanciano sui social media i contenuti presenti sul sito.RISULTATISebbene sia in rete solo dall’aprile del 2018, il portale ha pubblicato oltre 100 pagine web su vari aspetti legati alle vaccinazioni. Sono presenti sul sito: una scheda informativa per ogni malattia prevenibile da vaccino e per ogni rispettivo vaccino, una sottosezione vantaggi e rischi reali delle vaccinazioni, una contro la disinformazione e una sui viaggi internazionali. Inoltre nella sezione “Info utili” si trova la pagina sugli ambulatori vaccinali presenti sul territorio, che è stata la pagina web più visitata dopo l’homepage. Infine, il sito aggiorna gli utenti su eventi e notizie di rilevanza nazionale e regionale sul tema vaccinale. CONCLUSIONIVaccinarsi in Lazio s’inserisce nel mondo della corretta informazione sul tema delle vaccinazioni che ha visto impegnati enti, istituzioni ed esperti in un’azione di presidio

BACKGROUND: Since overweight and obesity has become epidemic in children and adolescents, the aim of this study was to determine the role of highly-integrated programs in preventing and reducing prevalence of children and adolescent obesity and overweight, even evaluating if this approach has properly been effective in communities with different determinants as in the Pacific Area. METHODS: According to PRISMA guidelines, a systematic review of literature was conducted and a meta-analysis was performed to compare obese/overweight prevalence between the intervention and the control group. RESULTS: We identified 23 studies describing 14 programs. For 11 out of 14 programs, obese/overweight prevalence changing from baseline were definable and meta-analysis of them showed a significant change of obese/overweight prevalence (-0.03; 95% CI = -0.04 to -0.01; P < 0.0001). Secondary outcomes as dietary (such as vegetable intake, carbonated beverages, fruit juice, drinks, healthful food consumption), physical activity and TV-time-spent was analyzed in many of the studies to define community readiness and behavioral changes. Macro-interventions, based on what was observed in our systematic review have a high potential to reach the entire population. CONCLUSION: Adoption of coordinated cross-sectoral, multi-component and multi-stakeholder initiatives to oppose obesity remains a challenge, but it is also desirable as one of the possible solutions to this major public health issue.

Background: Public reporting (PR) of healthcare (HC) provider’s quality was proposed as a public health instrument for providing transparency and accountability in HC. Our aim was to assess the impact of PR on five main domains: quality improvement; patient choice, service utilization and market share; provider‘s perspective; patient experience; and unintended consequences. Methods: PubMed, Scopus, ISI WOS, and EconLit databases were searched to identify studies investigating relationships between PR and five main domains, published up to April 1, 2016. Results: Sixty-two papers published between 1988 and 2015 were included. Nineteen studies investigated quality improvement, 19 studies explored the unintended consequences of PR, 10 explored the effects on market share, 10 on patients’ choice, 7 evaluated the provider‘s perspective, 4 economic outcome, 4 service utilization, 2 purchasers’ use of PR and 2 studies explored patient experiences. The effect of PR was diverse throughout the studies—mostly positive on: patient experience (100%), quality improvement (63%), patient choice, service utilization and market share (46%); mixed on provider‘s perspective and economic outcome (27%) and mainly negative on unintended consequences (68%). Conclusions: Our research covering different outcomes and settings reported that PR is associated with changes in HC provider‘s behavior and can influence market share. Unintended consequences are a concern of PR and should be taken into account when allocating HC resources. The experiences collected in this paper could give a snapshot about the impact of PR on a HC user‘s perception of the providers’ quality of care, helping them to make empowered choices.

BACKGROUND: High-grade dural arteriovenous fistulas (dAVFs) can present shunts with very different angio-architectural characteristics. Specific hemodynamic factors may affect clinical history and determine very different clinical courses. OBJECTIVES: To evaluate the relationship between some venous angio-architectural features in high-grade dAVFs and clinical presentation. Specific indicators of moderate or severe venous hypertension were analyzed, such as altered configurations of the dural sinuses (by a single or a dual thrombosis), or overload of cortical vessels (restrictions of outflow, pseudophlebitic cortical vessels, and venous aneurysms). METHODS: The institutional series was retrospectively reviewed (49 cases), and the pattern of venous drainage was analyzed in relationship with clinical presentation (benign/aggressive/hemorrhage). RESULTS: Thirty-five of 49 cases displayed cortical reflux (high-grade dAVFs). This subgroup displayed a benign presentation in 31.42% of cases, an aggressive in 31.42%, and hemorrhage in 37.14%. CONCLUSIONS: Our data confirm that within high-grade dAVFs, 2 distinct subpopulations exist according to severity of clinical presentation. Some indicators we examined showed correlation with aggressive nonhemorrhagic manifestations (outflow restriction and pseudophlebitic cortical vessels), while other showed a correlation with hemorrhage (dual thrombosis and venous aneurysms). Current classifications appear insufficient to identify a wide range of conditions that ultimately determine the organization of the cortical venous drainage. Intermediate degrees of venous congestion correlate better with the clinical risk than the simple definition of cortical reflux. The angiographic aspects of venous drainage presented in this study may prove useful to assess dAVF hemodynamic characteristics and identify conditions at higher clinical risk.

There is a growing interest regarding the attitudes of medical students towards people with mental illness, since discrimination and stigma may affect healthcare workers and education should be aimed to improve empathy and attitudes at medical school level. A cross-sectional study was conducted at medical schools in Rome and Foggia (Italy). We recruited 339 medical students who completed an anonymous self-report questionnaire including sociodemographic data, the 40-item Community Attitudes toward the Mentally Ill scale (CAMI) and the 60-item Baron Cohen’s Empathy Quotient. The questionnaires were administered before and after the yearly academic course of psychiatry. This study shows a significant improvement in some CAMI items and total score after the yearly academic course of psychiatry among medical students, especially among those who had personal experience with mentally ill people (including the training in a psychiatric ward). Female students reported higher empathy quotient and CAMI scores. Students who preferred medical disciplines to surgical ones seemed to be less stigmatizing towards mental illness. Our results confirm evidence from the scientific literature about medical students’ attitudes towards mental illness and highlight that the improvements in the attitudes increased improving students’ psychiatric knowledge, both theoretical and practical.

Background Undocumented migrants (UMs) are migrants without necessary documents and permits authorizing them to regularly stay in a country. According to estimates for 2002–2008, 1.9–3.8 million undocumented migrants live in the European Region. Their status may be considered an obstacle in accessing basic healthcare and social services, determining vulnerability to several health problems such as communicable diseases, occupational health hazards, poor mental health. Methods In response to the current refugee and migrant crisis in Europe, a systematic review of the best available scientific and grey literature was conducted to identify barriers to access to healthcare in order to design suitable policies that improve access to and quality of healthcare services for UMs. In particular two groups of 5 researchers carried out a review of available evidence, until August 2015, investigating the following databases or report sources: PubMed, Scopus, Cochrane, Econlit, HEN, European Observatory, OECD.Results The research resulted in 122 articles, which highlighted several critical aspects in the access to and quality of healthcare services for UMs. They mostly only have access to emergency care across the European Region. Furthermore, formal and informal barriers in the access to healthcare were found. Formal barriers regarded entitlement to health whereas informal ones included language, culture and communication, lack of social network and of knowledge about the health care system organization. Finally, inconsistency and uncertainty in data collection were common across the European Region. Conclusions On the basis of the evidence strong efforts should be put in place in order to reconsider entitlement to health care; increase public awareness; plan systems to disseminate information; promote an intersectoral approach and cross-border cooperation; improve communication services; launch specific training programmes; collect routinely data on UMs health status.

Social networks (SNs) were found to influence health behaviors and choices related to health. During school attendance adolescents establish and develop ties, creating their network. At the same time schools represent ideal places in which health promotion interventions could be implemented. We studied the relationship between students' SNs and the Knowledge, Attitudes and Behaviors (KAB) toward vaccinations in a school-based health promotion pilot project. ‘VacciniAmo Le Scuole’ project was performed in 4 Italian secondary schools, in collaboration with each Local Health Authorities (LHA). Students fulfilled a questionnaire before and after they attended a health promotion intervention in order to collect data on demographics, knowledge about vaccinations, their immunization status and students’ SN. Vaccination coverage was obtained by LHA. SN analysis techniques were used to explore the structural properties of pupils’ friendship during and after school time. 680 pupils fulfilled the questionnaire. The average degree (number of ties) was 8.6 within the school and 5.6 after-school networks. It was correlated (Pearson test) both with the knowledge level after intervention and responsiveness toward vaccinations both within the network during (Rho=0.17; p < 0.05; Rho=0.10; p < 0.05) and after (Rho=0.22; p < 0.05; Rho=0.11; p < 0.05) school time. Closeness was found inversely associated with post intervention knowledge and final project judgement both within school network (Rho=-0.21; p < 0.05; Rho=-0.22; p < 0.05) and after school network (Rho=-0.24; p < 0.05; Rho=-0.25; p < 0.05). Since students’ KAB toward vaccinations can be influenced by their networks, analysing SN can help to targeting better preventive strategies and health promotion interventions. School (during and after school time) could play an important role in promoting vaccination KAB. Key message: Deeper knowledge about students’ SN could improve the effectiveness of vaccination campaigns

Background Schizophrenia represents an important public health issue. An assessment of its costs would be useful to provide recommendations for policy and decision-making strategies. The aims of our study were to carry out a systematic review to assess the economic burden of schizophrenia in terms of direct and indirect costs and to perform a quality appraisal of the analysed studies. Methods A literature search was carried out on PubMed, Scopus and Cochrane Library to retrieve cost-of-illness (COI) analyses focused on schizophrenia and published up to December 2015. COI analyses that considered direct and indirect costs were included. Each included manuscript was independently appraised by three researchers on the basis of the British Medical Journal Drummond’s checklist. Results 2724 articles were initially retrieved, and 84 were included in the current review. The included studies showed a medium– high-quality level. The available studies seemed to be heterogeneous both in terms of methodology and results reporting. Extrapyramidal symptoms in patients with schizophrenia seemed to be associated with increased healthcare resource utilization and higher medical costs. Indirect costs were evaluated in 32 studies from a societal perspective and, in almost all these studies, their estimation exceed those provided for direct costs. High social costs of schizophrenia were also described for caregivers of schizophrenia patients. Conclusions The review confirmed that schizophrenia absorbs a huge amount of health-care resources. Further research is therefore needed to better understand the economic impact and to identify and promote public health strategies to tackle obesity

Background Public reporting (PR) of health-care provider’s quality was proposed as a public health instrument for providing the transparency and accountability in health-care (HC) which could enable patients to make informed and rational choices about their health-care. The aim of this study was to perform a systematic review of literature to assess the impact of PR on improvement, market share and unintended consequences. Methods Literature search was performed by accessing MEDLINE, ISI Web of Science, SCOPUS and EconLit databases to identify studies that investigated relationship between PR and quality improvement, changes in market share and unintended consequences, published in English or Italian until 01/04/ 2016. Additional publications were identified from the references of initially retrieved articles. GRADE derived approach was used to assess quality of the studies and narrative review was used for describing the results.Results Forty-tree studies published between 1994 and 2016 were included in this review. Nineteen studies had quality improvement as main outcome, 16 unintended consequences and remaining 8 tackled market share and economic outcomes. Most of the studies were conducted in USA (86%) and in hospital settings (76.7%) with cohort design used throughout the studies. Performance information was presented in the form of ‘‘report cards’’ in the majority of the studies. The body of evidence was characterized by moderate to low quality level. Mainly, the effect of PR was positive on quality improvement (57.9%), unintended consequences (56.3%) and market share (37.5%). Conclusions PR is associated with changes in HC provider’s behavior and can influence the market share. Unintended consequences are concern of PR and should be taken into account when allocating the HC resources. The experiences collected in this paper could make an impact on HC user’s perception of the providers’ quality and help them make empowered choices.

Undocumented migrants (UMs) are at higher risk for health problems because of their irregular status and the consequences of economic and social marginalization. Moreover, the emergent reality of undocumented migration in Europe calls for action in the field of management of UM's health demands as their access to health services has become a sensitive political and social issue. In this light, this paper aims to address UMs' entitlement and barriers to healthcare and related policies citing evidence from peer-reviewed and grey literature concerning people living in a country within the European Union without the legal right to be/remain in the destination country. A systematic review was performed using several databases and websites, and a total of 54 publications in English, with full text available, were taken into consideration. Between 2000 and 2015, Europe hosted the second largest number of international migrants (20 million, 1.3 million per year) after Asia. Even though there is limited evidence specifically focused on UMs' health, it is possible to state that infectious diseases, chronic illnesses, mental disorders, maternal-child conditions, dental issues, acute illnesses and injuries are the most common pathologies. In most cases across Europe, UMs have access only to emergency care. Even in countries where they are fully entitled to healthcare, formal and informal barriers hinder them from being or feeling entitled to this right. Socio-cultural barriers, such as language and communication problems, lack of formal and informal social and healthcare networks and lack of knowledge about the healthcare system and about informal networks of healthcare professionals are all common impediments. From the healthcare providers' perspective, there can be difficulties in providing appropriate care and in dealing with cultural and language barriers and false identification. Communication strategies play a central role in addressing the inequalities in access to healt

OBJECTIVE: Antibiotic prophylaxis (AP) is useful to prevent antimicrobial overuse, misuse and abuse, as well against the occurrence of surgical site infections (SSIs). This study aimed to describe the implementation of a quality improvement intervention on AP for elective surgery, as informal interviews showed a lower than expected compliance with internal recommendations, and to evaluate intervention's effect in terms of main drug consumption. DESIGN: A quality improvement intervention on all elective cases within 14 main surgical departments was performed. SQUIRE 2.0 guidelines were used in designing and reporting. SETTING: The intervention was implemented in an Italian Teaching Hospital 2 years after the adoption of internal evidence-based AP recommendations. PARTICIPANTS: Professionals involved in elective surgery. INTERVENTIONS: The intervention was structured into two phases: a survey was conducted during two non-consecutive weeks period (April-May 2013) to assess the adherence to the international guidelines in AP; survey's results were presented and discussed with all the surgical teams (December 2013-April 2014). MAIN OUTCOME MEASURES: Impact on cefazolin consumption (in defined daily doses per 100 procedures). RESULTS: Data of AP for 653 surgical procedures in terms of type, timing, duration, excess and defect were analyzed. An optimal AP rate resulted in 48.1% cases. Reduction in cefazolin use (-21.5%) and cost (-22.9%) was registered. CONCLUSIONS: Though results cannot be generalized to all hospital populations, the implemented intervention is likely to improve AP consequently improving quality of care and reducing costs. Further studies are needed to evaluate specific outcomes such as rate of SSIs and antibiotic resistance.

BACKGROUND: To assess both qualitatively and quantitatively the impact of Public Reporting (PR) on clinical outcomes, we carried out a systematic review of published studies on this topic. METHODS: Pubmed, Web of Science and SCOPUS databases were searched to identify studies published from 1991 to 2014 that investigated the relationship between PR and clinical outcomes. Studies were considered eligible if they investigated the relationship between PR and clinical outcomes and comprehensively described the PR mechanism and the study design adopted. Among the clinical outcomes identified, meta-analysis was performed for overall mortality rate which quantitative data were exhaustively reported in a sufficient number of studies. Two reviewers conducted all data extraction independently and disagreements were resolved through discussion. The same reviewers evaluated also the quality of the studies using a GRADE approach. RESULTS: Twenty-seven studies were included. Mainly, the effect of PR on clinical outcomes was positive. Meta-analysis regarding overall mortality included, in a context of high heterogeneity, 10 studies with a total of 1,840,401 experimental events and 3,670,446 control events and resulted in a RR of 0.85 (95 % CI, 0.79-0.92). CONCLUSIONS: The introduction of PR programs at different levels of the healthcare sector is a challenging but rewarding public health strategy. Existing research covering different clinical outcomes supports the idea that PR could, in fact, stimulate providers to improve healthcare quality.

To acquire essential knowledge and skills for Public Health practice, residents in Hygiene and Preventive Medicine programs should be provided with excellent training. On behalf of the Roman Public Health Academy (ARSP), the authors, representing the three Hygiene and Preventive Medicine residency training programs in Rome (Italy) aimed to propose a training program to be shared by the above three schools. Firstly, they performed a scientific literature review to identify the core competencies that a public health specialist should have acquired at the end of training. Ten areas (macro-areas or domains) relevant to Public Health practice were defined. The authors then identified the main characteristics that the proposed training program should have, which include: enhancement of community healthcare services and optimization of local resources to create/strengthen exchange and cooperation networks; possibility to adapt the training proposal to an international setting; adoption of a training approach that can respond effectively to a changing health system; customization of training on the basis of residents' individual abilities and motivations, so that their individual strengths can be enhanced; achievement of educational excellence, in compliance with ethical requirements.

BACKGROUND: Clinical governance (CG) is an approach to quality improvement in healthcare aimed at achieving a patient-centered health care system. The main objective of this study was to highlight human centered healthcare latent factors underlying the results of a CG assessment performed in the teaching hospital "A. Gemelli" of Rome, Italy. MATERIALS AND METHODS: CG implementation levels were assessed through OPTIGOV© (OPTimizing healthcare GOVernance), a CG scorecard methodology. In order to identify the variables generating latent factors that can influence the governance of the Hospital, the multiple correspondence analysis (MCA) was applied. RESULTS: The application of OPTIGOV© showed a good CG implementation level in the Gemelli Hospital. By applying MCA, the variables aggregated so as to define 3 latent factors (F1: assessment for people oriented improvement strategy; F2: assessment for people targeted management; F3: tracking for timely accountable people) explaining as a whole 82.68% of the total variance and respectively 48.09% (F1), 24.95% (F2) and 9.64% (F3). CONCLUSIONS: The heuristic interpretation of the three latent factors could bring back to the concept of humanization in healthcare. This study shows that in the teaching hospital "A. Gemelli" humanization in healthcare is the driver of health care quality improvement.

Introduzione: La Clinical Governance (CG) è un approccio teso al miglioramento della qualità in sanità nelle more della patient-centeredness. Obiettivo di questo studio è stato analizzare i risultati dellavalutazione della CG nel Policlinico Gemelli per identificare leve strategiche atte al miglioramento dell’assistenza erogata, valutandone il grado di “umanizzazione”. Materiali e metodi: La CG nel Policlinico Gemelli è stata valutata nel 2012 con la metodologia OPTIGOV. Al fine di individuare le variabili generatrici di fattori latenti in grado di influenzare la governance dell’ospedale è stata applicata l’analisi delle corrispondenze multiple (MCA). Risultati: L’applicazione di OPTIGOV ha evidenziato un buon livello d’implementazione della CG. La MCA tramite l’aggregazione delle variabili ha definito 3 fattori latenti: F1=48,09%; F2= 24,95%; F3=9,64%, che spiegano l’82,68 % della varianza totale. In relazione alla loro interpretazione euristica sono stati definiti: F1: “VALUTAZIONE PER STRATEGIE DI MIGLIORAMENTO ORIENTATE ALLA PERSONA” à con focus su professionisti sanitari e pazienti, per individuare strategie di miglioramento continuo tramite la produzione di evidenze e feedback sulle performance. F2: “VALUTAZIONE PER UNA GESTIONE FINALIZZATA ALLA PERSONA” à con focus su sanitari e pazienti, per migliorare la qualità dell’assistenza attraverso l’empowerment dei lavoratori, tramite la valutazione delle performance tesa alla programmazione. F3: “TRACCIABILITÀ PER UN’ACCOUNTABILITY PUNTUALE DEI PROFESSIONISTI” à con focus sulla qualità dell’assistenza, per migliorare la comunicazione e la cooperazione tra i professionisti sanitari, la relazione medico-paziente, la sicurezza di operatori e pazienti. Conclusioni L’interpretazione euristica dei risultati riconduce al concetto di umanizzazione dell’assistenza sanitaria. Dallo studio emerge come all’interno del Policlinico A. Gemelli l’umanizzazione delle cure continua ad essere il driver del miglioramento d

Introduzione: Il Diabete è un problema globale in Sanità Pubblica e le ospedalizzazioni per le sue complicanze sono definite come potenzialmente evitabili (PE) nel contesto di una buona assistenza primaria. Lo scopo dello studio è di valutare diseguaglianze nell’appropriatezza del trattamento territoriale del diabete misurando l’ospedalizzazione evitabile per complicanze del diabete tra gruppi socioeconomici diversi. Metodi: E’ stata effettuata una revisione sistematica della letteratura fino a Marzo 2015, utilizzando Medline e Scopus. Le parole chiave sono state: “preventable”, ”avoidable”, “hospitalization”, “disparities”, “inequalities”, “chronic disease“, “diabetes”. E’ stata poi effettuata una meta-analisi dei risultati utilizzando un modello ad effetti random. Risultati. La revisione ha incluso 22 lavori scientifici, per un totale di circa 11 milioni di ospedalizzazioni, che hanno indagato la relazione tra le diseguaglianze in diverse popolazioni (generale vs. coorti diabetiche) e ricoveri PE per complicanze del diabete. Il 63% degli articoli (14/22) aveva un disegno trasversale, il 37% (8/22) erano studi di coorte. Le diseguaglianze sono state analizzate per le seguenti variabili: genere (18/22, 82%), età (18/22, 82%), etnia (12/22, 54.5%), reddito (12/22, 54.5%), area di residenza (5/22, 23%). A causa dell’elevata eterogeneità tra gli studi, è stata possibile una meta-analisi solo per l’etnia. La combinazione di 5 studi ha confermato un incremento del rischio nelle ospedalizzazioni PE per complicanze del diabete tra gli individui con una condizione di svantaggio per etnia (neri o altre minoranze vs. bianchi caucasici) in un setting di popolazione generale con un Rischio Relativo di 2.54 (IC95%: 1.94-3.33). Conclusioni. Le diseguaglianze dei ricoveri per complicanze diabetiche indicano una offerta iniqua di assistenza primaria che va affrontata con un approccio proattivo di programma di population medicine.

Background Public reporting (PR) has been recommended as a useful public health strategy for stimulating improvement of quality and reduce inequalities in healthcare (HC) by adding transparency and addressing accountability in the interaction between HC providers and users. The aim of this study was to perform a systematic review of scientific literature in order to assess qualitatively and quantitatively the impact of PR on clinical outcomes. Methods Literature search was performed by accessing MEDLINE, ISI Web of Science, SCOPUS, and Cochrane Library databases to identify studies that investigated the relationship between PR and clinical outcomes, published from 1991 to 2014. Metaanalysis was performed to assess the PR effect on overall mortality rate. Subgroup analyses were performed for different study design and setting. Results Twenty-seven studies that evaluated the effect of PR on clinical outcomes were included in the systematic review. The metaanalysis involved 10 studies with a total of 1,840,401 experimental and 3,670,446 control events and resulted in a RR of 0.85 (95% CI, 0.79–0.92), p for heterogeneity <0.01; I2 = 99.1%. In a subgroup analysis, six publications were included reporting mortality rates in the same facilities during different periods and a RR of 0.85 (95% CI, 0.76–0.94) was obtained with reported high heterogeneity (p < 0.01; I2 = 100%). When comparing different facilities that recorded mortality rates during the same period from four studies, a RR of 0.91 (95% CI, 0.85-0.97) was calculated, with heterogeneity I2 = 95% (p < 0.01). Conclusions Meta-analysis reported a positive effect of PR on mortality, with reduced rates when combining data from the same facilities during different periods of PR, as well as for comparing different facilities that recorded mortality rates during the same period. The experiences descripted in this paper can represent a framework of opportunities for changing the relationship between HC providers and users.

Background Childhood obesity (CO) is a global public health issu. 1 out of 10 children is obese or overweight, with differences among geographical areas. CO impact is impressive for morbidity, expectation of life reduction, direct and indirect costs. Integrated actions to face this issue are needed. Highly integrated prevention programs are proactive multi-tiers/ multi-setting/multi-component interventions tailored to specified targets. The aim of this study is to assess these programs to highlight their effectiveness in reducing prevalence of overweight and obesity in childhood population. Methods A systematic review has been conducted up to February 2015. The search was performed querying Medline and Scopus databases through the keywords: prevention and control, childhood obesity, coordinated program, community based, integrated approach. Meta-analysis was carried out with RevMan 5.3. Begg and Egger tests, one-way sensitivity analysis, when appropriate, and subgroup analyses for different geographical areas were performed. Results Out of the 335 retrieved studies 25 were finally included describing 13 ‘highly integrated’ community prevention programs all facing childhood overweight and obesity with a multi-component and multi-setting approach, based on diet and physical activity. Meta-analysis confirmed the reduction of overweight and obesity prevalence among the participants in the communities of intervention (RR = 0.90; 95%IC = 0.84– 0.96) with a p for heterogeneity=0.01; I2 = 58%. Differences were found related to geographical area with a RR = 0.80 (95%IC = 0.64–0.99; p = 0.03; I2 = 72%) obtained for Europe and a RR = 0.80 (95%IC = 0.68-0.95; p = 0.004; I2 = 82 %) for Australia. Conclusions Highly integrated targeted prevention programs have been shown to be effective in facing CO. The goal is to build an activated community in a single public health program coordinated across the partner organisations and the three different tiers (strategic, delivery, communi

Issue/problem Decision-making in hospitals is evolving from being opinionbased to being evidence-based. Whilst clinical guidelines provide evidence-based recommendations, evidence-based practice needs to address the local structure, systems and time-frames. Clinical pathways are document-based tools that provide a link between the best available evidence and clinical practice. Problem During a meeting with the professional from all ‘A. Gemelli’ teaching hospital units involved in the care of stomach cancer patients as well as primary care representatives, the Clinical Governance Unit presented the project of developing a clinical pathway for the care of stomach cancer patients. Professionals were divided in three groups: a first group analyzed the specific epidemiological context of stomach cancer patients attending the hospital, a second group designed on the basis of evidence and current practice the pathway flowchart in a diagram that shows on vertical axis stages of care and on orizonal axis the places of care and a third group selected quality indicators useful for future audits. After joint debates, the complete clinical pathway was reviewed by the whole group of involved professionals. Results A report including the pathway flowchart of activities articulated in clinical episodes and 28 indicators covering 5 quality dimensions was approved. Multidisciplinary team meetings as well as joint surgeon/medical oncologist examinations were introduced in hospital practice. Case management and cooperation between hospital and primary care were enhanced. The use of hospital resource and the timing between the different care stages as well as patients’ satisfaction resulted improved. Preliminary results show also improvements in clinical outcome measured. Lessons Clinical pathways are an effective instrument to decrease undesired practice variability and improve clinician performance. The early involvement of all professionals in the development of clinical pathways is

Background Childhood obesity (CO) is a global public health issue. 1 out of 10 children is obese or overweight, with differences among geographical areas. CO impact is impressive for morbidity, expectation of life reduction, direct and indirect costs. Integrated actions to face this issue are needed. Highly integrated prevention programs are proactive multi-tiers/ multi-setting/multi-component interventions tailored to specified targets. The aim of this study is to assess these programs to highlight their effectiveness in reducing prevalence of overweight and obesity in childhood population. Methods A systematic review has been conducted up to February 2015. The search was performed querying Medline and Scopus databases through the keywords: prevention and control, childhood obesity, coordinated program, community based, integrated approach. Meta-analysis was carried out with RevMan 5.3. Begg and Egger tests, one-way sensitivity analysis, when appropriate, and subgroup analyses for different geographical areas were performed. Results Out of the 335 retrieved studies 25 were finally included describing 13 ‘highly integrated’ community prevention programs all facing childhood overweight and obesity with a multi-component and multi-setting approach, based on diet and physical activity. Meta-analysis confirmed the reduction of overweight and obesity prevalence among the participants in the communities of intervention (RR = 0.90; 95%IC = 0.84– 0.96) with a p for heterogeneity=0.01; I2 = 58%. Differences were found related to geographical area with a RR = 0.80 (95%IC = 0.64–0.99; p = 0.03; I2 = 72%) obtained for Europe and a RR = 0.80 (95%IC = 0.68-0.95; p = 0.004; I2 = 82 %) for Australia. Conclusions Highly integrated targeted prevention programs have been shown to be effective in facing CO. The goal is to build an activated community in a single public health program coordinated across the partner organisations and the three different tiers (strategic, delivery, commun

Background The three Roman Schools of specialization on Public Health (PH), on behalf of the Roman Academy of Public Health (ARSP), started a project to provide a common training to their residents. The aim of this study was to define the educational needs and gaps of PH professionals through a review of the PH competencies worldwide. Methods A Literature search was performed. Moreover, relevant documents produced by PH training and teaching associations and core curricula of Masters in PH were retrieved. Web sites of international PH organizations have been investigated and relevant documents were collected. The competencies were then revised and supplemented in the light of the guidelines for programming teaching of Schools of Specialization in PH detailed in Italian Ministerial Decree 68/2015. Results Ten main areas, reflecting skill areas within PH, were identified: analytical and assessment area; policy development and program planning; communication; social determinants and health inequalities; health promotion at community dimension; public health sciences; financial planning and management; leadership, systems thinking and capacity building; prevention of communicable and non-communicable diseases; environment, food and occupational health. For each area a set of skills, called core competencies, were delineated and listed. The core competencies are in agreement with the desirable skills for the broad practice of PH. The main gaps were referred to three domains: social determinants and health inequalities, communication, leadership, systems thinking and capacity building. Conclusions Common core competencies are useful to understand, assess, and meet training and workforce needs and also obtain a nationwide PH professional profile enhancing the role of PH in the European Community. However, we need to take into account the diversity of the health care systems and the social and economic trends among Countries. Key message Common and supranational public heal

La Clinical Governance (CG) è un approccio teso al miglioramento della qualità in sanità nelle more della patient-centeredness. Obiettivo di questo studio è stato analizzare i risultati dellavalutazione della CG nel Policlinico Gemelli per identificare leve strategiche atte al miglioramento dell’assistenza erogata, valutandone il grado di “umanizzazione”. Materiali e metodi: La CG nel Policlinico Gemelli è stata valutata nel 2012 con la metodologia OPTIGOV. Al fine di individuare le variabili generatrici di fattori latenti in grado di influenzare la governance dell’ospedale è stata applicata l’analisi delle corrispondenze multiple (MCA). Risultati: L’applicazione di OPTIGOV ha evidenziato un buon livello d’implementazione della CG. La MCA tramite l’aggregazione delle variabili ha definito 3 fattori latenti: F1=48,09%; F2= 24,95%; F3=9,64%, che spiegano l’82,68 % della varianza totale. In relazione alla loro interpretazione euristica sono stati definiti: F1: “VALUTAZIONE PER STRATEGIE DI MIGLIORAMENTO ORIENTATE ALLA PERSONA” à con focus su professionisti sanitari e pazienti, per individuare strategie di miglioramento continuo tramite la produzione di evidenze e feedback sulle performance. F2: “VALUTAZIONE PER UNA GESTIONE FINALIZZATA ALLA PERSONA” à con focus su sanitari e pazienti, per migliorare la qualità dell’assistenza attraverso l’empowerment dei lavoratori, tramite la valutazione delle performance tesa alla programmazione. F3: “TRACCIABILITÀ PER UN’ACCOUNTABILITY PUNTUALE DEI PROFESSIONISTI” à con focus sulla qualità dell’assistenza, per migliorare la comunicazione e la cooperazione tra i professionisti sanitari, la relazione medico-paziente, la sicurezza di operatori e pazienti. Conclusioni L’interpretazione euristica dei risultati riconduce al concetto di umanizzazione dell’assistenza sanitaria. Dallo studio emerge come all’interno del Policlinico A. Gemelli l’umanizzazione delle cure continua ad essere il driver del miglioramento della qualità

Background A sufficient consumption of fruit and vegetables has proven to have an important protective effect towards different diseases and mortality. Nevertheless, some studies reported insufficient daily consumption of fruit and vegetables. Aim of the study is to analyse breakfast consumption, regularity of meals, and fruit and vegetable consumption in the Italian University Student population. Methods The study evaluates data taken from the ‘‘Sportello Salute Giovani’’ questionnaire, based on the ‘‘Health Behaviour in School-aged Children’’ (HBSC) questionnaire. The data regarding age, sex, BMI, number of breakfasts consumed per week, number of eating episodes per day, number of portions of vegetables consumed, number of portions of fruit consumed, intended weight loss, self-reported economic status was analyzed. A descriptive analysis was conducted. Gender and age differences are tested by Chi2 test and Mann-Whitney test. 162 European Journal of Public Health, Vol. 25, Supplement 3, 2015 Logistic regression analyses were used to study the association between eating episodes and fruit and vegetable consumption. Results 8.292 questionnaires were analyzed. 67% of responders were female and 33% were male. Results show that only 15,8% of males and 26,3% of the females declared to consume at least one portion of fruit every day (p < 0.01) and similar results were found for vegetable consumption. Age does not influence fruit or vegetables consumption, frequency of eating episodes or breakfast habit. Both a regular breakfast and a higher number of eating episodes are significantly associated with a higher frequency of fruit intake (OR = 2.19 and 1.83, respectively) and a higher frequency of vegetables intake (OR = 2.08 and 1.69, respectively). Conclusions This study underlines the need to promote nutritional education campaigns to increase adherence to nutritional guidelines. Promoting the consumption of breakfast and of the recommended 5 daily eating episodes may prov

BACKGROUND: Students' ability of learning is influenced by study habits. Among these, the use of technologies has assumed a controversial role. The aim of this paper is to analyse studying approach, the use of technologies and how they affect study habits in a population of university students addressed by the "Sportello Salute Giovani" ("Youth Health Information Desk") questionnaire. METHODS: 16 questions referred to the approach to studying and the use of technologies (number 77-93) were analyzed. Absolute and relative frequencies were calculated. Stratification for sex, age and socio-economic status were performed and Chi square test was used to test the difference between sex, age class and socio-economic groups. RESULTS: 99.7% of students declared to have at least one mobile phone and 68.7% to use smartphones, i-phones and i-pads. Males (20.9% vs 14.9% female, p < 0.05), older students (31.7% among 25-30 years old students vs 21.3% among 18-21 years old, p < 0.05) and students with the highest socio-economic level (87.8% vs 54.2% of the lowest) seem more likely to use digital technologies/Internet for educational purposes. CONCLUSION: Our survey revealed that most college students still prefer approach the study using books instead of digital tools, but this attitude is conflicting with how many hours they use computers and surf Internet per weeks. Therefore, further studies are needed to understand better technology influence on study habits and its implication on health.

BACKGROUND: The use of psychoactive substances is one of the most important public health issues. Tobacco, alcohol and illicit drugs are among the top risk factors for ill-health defined by World Health Organisation. The risky behaviours acquired in teenage can be magnified or decreased during university when a person starts having more awareness about the importance of own wellness. This paper describes the results of the project "Sportello Salute Giovani" ("Youth Health Information Desk") with respect to risky behaviours in a large sample of Italian university students. MATERIALS AND METHODS: 18 questions of the survey "Sportello Salute Giovani" dealing with risky behaviors, the use of psychoactive substances such as tobacco, alcohol and illicit drugs were included. Absolute and relative frequencies were calculated. Besides, chi square test were used to test the differences in sex, age class and socio-economic status. RESULTS: About 24% of the interviewed students currently smokes. 89% and 42.2% respectively drinks at least rarely or weekly beer, wine or spirits. About 40% of students smoked at least a joint and about 2% used other drugs (mostly cocaine). CONCLUSION: The "Sportello Salute Giovani" survey suggests that the frequency of risky behaviours in Italian university students is not reassuring, although they should be aware about the negative consequences on their and others health because of their educational level.

BACKGROUND: Obesity represents an important public health issue. An assessment of its costs would be useful to provide recommendations for policy and decision-making strategies. The aims of our study were to carry out a systematic review to assess the economic burden of adult obesity in terms of direct and indirect costs and to perform a quality appraisal of the analysed studies. METHODS: A literature search was carried out on PubMed, Scopus and Cochrane Library to retrieve cost-of-illness (COI) analyses focused on adult (aged 18 years or more) overweight or obese people and published up to 2013. COI analyses that considered direct and indirect costs were included. Each included manuscript was independently appraised by three groups of researchers on the basis of the British Medical Journal Drummond's checklist. RESULTS: Approximately 2044 articles were initially retrieved, and 17 were included in the current review. The included studies showed a medium-high-quality level. The available studies seemed to be heterogeneous both in terms of methodology and results reporting. However, as many studies have been conducted from the payer perspective, just direct medical costs can be considered exhaustive. As only three studies included considered also indirect costs, there is no strong evidence to give a comprehensive picture of this phenomenon also from the societal perspective. CONCLUSION: The review confirmed that obesity absorbs a huge amount of health-care resources. Further research is therefore needed to better understand the economic impact and to identify and promote public health strategies to tackle obesity.

Background Obesity is one of the biggest public health challenges of the 21st century. Excess weight and obesity are major public health issues in high income countries but are increasing also in developing countries. Obesity has been demonstrated to have important social and economic consequences, so an assessment of its economic burden is required. The main aim of this study was to assess the economic burden of adult obesity and overweight in terms of direct and indirect costs. A secondary purpose was to provide a quality appraisal of the reviewed studies. Methods A systematic review of the economic impact of adult obesity was performed on PubMed by developing a specific algorithm, in order to find out articles on the economic evaluation of adult obesity impact. Cost-of-illness (COI) analyses of overweight or obese people aged 18 years or more published up to May 2013 were considered. Furthermore, with the aim to appraise the quality of the included studies, each of the included COI analyses was assessed on the basis of the British Medical Journal Drummond’s checklist. Results About 1,052 COI analyses were initially found and 16 were finally considered in the current review, of which 7 have been carried out in the US, 2 in Brasil, 2 in Germany, 1 in Japan, 1 in United Kingdom, 1 in Australia, 1 in Korea and 1 in China. Twelve studies were carried out from the Payer’s perspective, 2 from both societal and Payer’s perspective and 1 only from the societal perspective. The type of costs mostly considered were direct medical costs, 3 studies included also indirect costs and 1 study took into account also direct non-medical costs. Total direct medical costs due to overweight and obesity ranged from US$ 2,152 billion in Brazil to US$ 2.74 billion in China to US$ 8,56 billion in United Kingdom. The average quality of the included analyses was medium-high. Conclusions The analysis confirmed that obesity absorbs a huge amount of health care resources and heterogeneity among

Objectives: Clinica Governance provides a framework for assessing and improving clinical quality into a single coherent program. Organisational appropriateness is aimed to the best health outcomes and a proper use of resources. This study aims to verify the likely relationship between Clinical Governance and appropriateness of hospital stay. Methods: A cross-­‐sectional study was conducted in 2012 in an Italian Teaching Hospital. The OPTIGOV© (OptimisingHealthCareGovernance) methodology was used to quantify the level of implementation of Clinical Governance and its main dimensions. Organisational appropriateness was measured retrospectively by analysing through the Italian version of the Appropriateness Evaluation Protocol 1460 medical records random selected. Spearman-­‐correlation and multiple linear regression were used to test the relationship between the percentage of inappropriate days of hospital stay and the Clinical Governance implementation levels. Results: 47 Hospital Units were assessed. The percentage of inappropriate days of hospital stay showed an inverse correlation with all the main Clinical Governance dimensions, except Risk Management. Adjusted multiple regression analysis showed a significant association between the percentage of inappropriate days and the overall Clinical Governance score (β=-­‐0.28;p<0.001;R-­‐squared=0.8). EBM and Clinical Audit represented the Clinical Governance dimensions most associated with organisational appropriateness. Conclusion: The study suggests that the evaluation of both Clinical Governance and appropriateness through standardised and repeatable tools, such as OPTIGOV and AEP, is a key strategy for healthcare quality. The relationship between them underlines the central role of Clinical Governance, and especially of EBM and Clinical Audit, in determining a rationale improvement of appropriateness levels.

Background Surgical site infections (SSIs) are a major contributor to patient injury, mortality and health care costs. There is a strong evidence of effectiveness of antimicrobial prophylaxis and the spread availability of national and international guidelines, its use is often suboptimal. Classically inappropriateness in antibiotic prophylaxis is associated with lower safety, efficiency and higher cost. Our study evaluates the appropriateness of prescription of antibiotics prophylaxis in surgical hospitalized patients in a big Italian research and teaching hospital (R&TH). Methods An observational-retrospective study was conducted through the investigation of the medical records of all the patients undergoing surgery in two not-consecutive weeks period from March to April 2013. Medical records were investigated on day 3 and 7 after surgery in order to evaluate the appropriateness of administration of antibiotic prescription. Patients with a suspected or established infection before surgery were excluded from the evaluation. Appropriateness was measured in terms of adherence to type, time and duration according to surgical antimicrobial prophylaxis guidelines (Bratzler 2013). Results 672 surgical procedures were evaluated. We observed in 12.9% of the cases a prophylaxis not performed even if indicated by guidelines. Conversely, an antibiotic prophylaxis was performed, even if not indicated in 21% of cases. A complete adherence to guidelines was observed in 57.3% of the cases. The right type of antimicrobial agent, according to guidelines, was chosen in 94.1% of the cases. The appropriateness of “timing” (from 180 to 15 minutes before the procedure) was detected in 71.4% of the records while the appropriateness of duration (one-shot therapy in almost all the operations but cardiac surgery) was found in 69.3% of the cases. Conclusion The appropriateness of antibiotic prophylaxis in the R&TH, even if comparable with other international experiences, still needs to be im

Background Obesity is one of the biggest public health challenges of the 21st century. Excess weight and obesity are major public health issues in high income countries but are increasing also in developing countries. Obesity has been demonstrated to have important social and economic consequences, so an assessment of its economic burden is required. The main aim of this study was to assess the economic burden of adult obesity and overweight in terms of direct and indirect costs. A secondary purpose was to provide a quality appraisal of the reviewed studies. Methods A systematic review of the economic impact of adult obesity was performed on PubMed by developing a specific algorithm, in order to find out articles on the economic evaluation of adult obesity impact. Cost-of-illness (COI) analyses of overweight or obese people aged 18 years or more published up to May 2013 were considered. Furthermore, with the aim to appraise the quality of the included studies, each of the included COI analyses was assessed on the basis of the British Medical Journal Drummond’s checklist. Results About 1,052 COI analyses were initially found and 16 were finally considered in the current review, of which 7 have been carried out in the US, 2 in Brasil, 2 in Germany, 1 in Japan, 1 in United Kingdom, 1 in Australia, 1 in Korea and 1 in China. Twelve studies were carried out from the Payer’s perspective, 2 from both societal and Payer’s perspective and 1 only from the societal perspective. The type of costs mostly considered were direct medical costs, 3 studies included also indirect costs and 1 study took into account also direct non-medical costs. Total direct medical costs due to overweight and obesity ranged from US$ 2,152 billion in Brazil to US$ 2.74 billion in China to US$ 8,56 billion in United Kingdom. The average quality of the included analyses was medium-high. Conclusions The analysis confirmed that obesity absorbs a huge amount of health care resources and heterogeneity among

INTRODUZIONE: L'obesità rappresenta una delle più grandi sfide per la sanità pubblica del 21° secolo. Il sovrappeso e l'obesità rientrano tra i principali problemi di salute pubblica nei Paesi ad alto reddito, ma sono in aumento anche nei Paesi in via di sviluppo. È dimostrato come l'obesità abbia importanti conseguenze sociali ed economiche, in ragione delle quali è necessaria una valutazione del suo peso economico. L'obiettivo principale di questo studio è stato quello di valutare il burden economico dell'obesità e del sovrappeso nell’adulto in termini di costi diretti e indiretti. Un obiettivo secondario è stato quello di effettuare una valutazione della qualità degli studi esaminati. MATERIALI E METODI: È stata effettuata una revisione sistematica dell'impatto economico dell’obesità nell’adulto, consultando il database della letteratura scientifica PubMed attraverso lo sviluppo e l’utilizzo di uno specifico algoritmo di ricerca: ("body weights and measures"[MeSH] OR "obese" OR “obesity” OR “overweight” OR “obes*”[MeSH] OR “overweight”[MeSH] OR “Body Mass Index”[MeSH] OR “Body Mass Index” OR “BMI”) AND (“medical costs” OR “cost of illness”[MeSH] OR “health expenditures”[MeSH] OR “health care costs” OR “cost of illness” OR “health expenditures” OR “indirect cost*" OR “direct cost*”). Sono state considerate analisi di cost of illness (COI) dell’obesità e del sovrappeso in soggetti di età maggiore o uguale a 18 anni, pubblicati fino a maggio 2013. Inoltre, con lo scopo di valutare la qualità degli studi inclusi, ciascuna delle analisi COI incluse è stata valutata sulla base della checklist di Drummond (British Medical Journal). RISULTATI: Sono state inizialmente reperite 1.052 analisi COI, 16 delle quali sono state infine considerate in questa revisione (Figura 1). Di queste 7 sono state effettuate negli Stati Uniti, 2 in Brasile, 2 in Germania, 1 in Giappone, 1 in Regno Unito, 1 in Australia, 1 in Corea e 1 in Cina. Dodici studi sono stati condotti

Background Surgical site infections (SSIs) are a major contributor to patient injury, mortality and health care costs. There is a strong evidence of effectiveness of antimicrobial prophylaxis and the spread availability of national and international guidelines, its use is often suboptimal. Classically inappropriateness in antibiotic prophylaxis is associated with lower safety, efficiency and higher cost. Our study evaluates the appropriateness of prescription of antibiotics prophylaxis in surgical hospitalized patients in a big Italian research and teaching hospital (R&TH). Methods An observational-retrospective study was conducted through the investigation of the medical records of all the patients undergoing surgery in two not-consecutive weeks period from March to April 2013. Medical records were investigated on day 3 and 7 after surgery in order to evaluate the appropriateness of administration of antibiotic prescription. Patients with a suspected or established infection before surgery were excluded from the evaluation. Appropriateness was measured in terms of adherence to type, time and duration according to surgical antimicrobial prophylaxis guidelines (Bratzler 2013). Results 672 surgical procedures were evaluated. We observed in 12.9% of the cases a prophylaxis not performed even if indicated by guidelines. Conversely, an antibiotic prophylaxis was performed, even if not indicated in 21% of cases. A complete adherence to guidelines was observed in 57.3% of the cases. The right type of antimicrobial agent, according to guidelines, was chosen in 94.1% of the cases. The appropriateness of “timing” (from 180 to 15 minutes before the procedure) was detected in 71.4% of the records while the appropriateness of duration (one-shot therapy in almost all the operations but cardiac surgery) was found in 69.3% of the cases. Conclusion The appropriateness of antibiotic prophylaxis in the R&TH, even if comparable with other international experiences, still needs to be im

ntroduzione Gli ambienti "confinati", dove la maggioranza della popolazione trascorre tra l'80 ed il 90% del proprio tempo, sono sempre più oggetto di preoccupazione in relazione ai fattori di rischio "indoor". Tra questi, il radon, seconda causa di tumore al polmone, merita un attenzione particolare, specie in quegli ambienti, come la scuola, dove la permanenza è prolungata ed i soggetti esposti particolarmente fragili. Il presente lavoro riporta i risultati di un'attività di monitoraggio di questo gas all’interno di un campione di scuole italiane al fine di valutare l’esposizione di docenti e studenti, promuovendo al contempo la cultura della prevenzione. Materiali e Metodi La diffusione ambientale del Radon è stata valutata attraverso l’impiego di un rilevatore attivo di tipo “Continuous Radon Monitor - 1028” della “Sun Nuclear Corporation" in 7 scuole italiane. Il periodo minimo di monitoraggio è stato di 48 ore consecutive con frequenza di campionamento continua. Medici in formazione specialistica e Tecnici della prevenzione dell'istituto di Igiene dell'Università Cattolica del Sacro Cuore di Roma, dopo aver registrato in una specifica scheda le informazioni strutturali relative all'edificio ed alla percezione del fenomeno da parte dei residenti, ponevano lo strumento ad altezza respiratoria (tra 1 e 1,20 mt da terra) in una stanza rappresentativa del "worst case" della scuola. I dati sono stati interpretati in accordo alla normativa vigente (D. Lgs. 241/00, recepimento della Raccomandazione 90/143/EURATOM) e sono stati elaborati mediante analisi statistica descrittiva ed inferenziale attraverso i software: "Microsoft Excel 2007" e “Stata IC 9.2 for Mac” (Intercooled Stata 9.2 per Mac Intosh, Stata Corporation Lakeway, USA, 2007). Risultati Sono state monitorate complessivamente 7 scuole in 6 città di 5 regioni italiane. Le concentrazioni medie rilevate nel nostro studio [80,87±72,4Bq/m3 ] sono in linea con altri studi epidemiologici già condotti in Ita

Background Low rates in the application of organizational appropriateness (OA), ranging in Europe from 14 to 30% in medical wards, represent a threat on proper use of resources within the best health outcomes. At the same time, Clinical Governance (CG) provides a framework for bringing together all local activities for assessing and improving clinical quality into a single coherent program. The purpose of this study was to verify possible correlations between implementation level of CG areas and OA of hospital stay, as measured within a large Teaching Hospital. Methods The study was conducted between July and December 2012 in a Italian third level Teaching Hospital to have a simultaneous representation of CG implementation and OA within hospital wards. The CG level was assessed through the OPTIGOV© methodology, that is a CG scorecard aimed at investigating the main CG dimensions (Evidence Based Medicine (EBM), Accountability, Clinical Audit, Resources and Risk Management, Patient Involvement) by assigning each of them a score. OA was measured by analyzing 1460 random medical records through the Italian version of the Appropriateness Evaluation Protocol (PRUO 2002ed). Spearman correlation and multiple linear regression were used to test the relationship between the percentage of inappropriate days of hospital stay and CG scores. Results 46 Units were assessed. The percentage of inappropriate days of hospital stay showed an inverse correlation with all the main CG dimensions, except Risk Management. The strongest correlation was found with EBM (rho=0.32, p<0.05). The multiple regression analysis adjusted for type of hospital ward (surgical/medical) and admission (elective/urgent) showed a significant association between the percentage of inappropriate days and the overall CG score (β= -.005; p = 0.03; R-squared = 0.20) and the EBM score (β= -.006; p = 0.01; R-squared = 0.32). Conclusions This study underlines the importance of the evaluation, through standardized and