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This paper discusses cultural difference as it emerges in bilingual health communication involving health professionals, migrant patients, and intercultural mediators at community healthcare facilities in Northern Italy. Drawing on a sample of authentic mediated health encounters, we will see how cultural differences surface and are made relevant to the overall goals of the interaction by its participants. Special attention is paid to the intercultural mediator's contributions and how these render the interlocutors' cultural presuppositions and related expectations mutually accessible (or not), thus arguably either favoring or hampering the attainment of quality and equality of care. [ABSTRACT FROM AUTHOR]

Several surveys and clinical studies report high prevalence of work-related musculoskeletal disorders (WMSDs) among sonographers and sonologists. Better performing ultrasound devices can increase the number and quality of examinations, but also reduce the user comfort and increase the risk of WMSDs. This should lead the choice of the device to buy and use. To support hospitals or diagnostic centres in selecting the best ultrasound device, this study provides a structured methodology based on a multi-criteria approach, the Analytic Hierarchy Process. It has a Goal (to optimise workers' well-being and satisfy company production objectives) and 45 evaluation elements. It was applied in an Italian hospital comparing 3 alternatives: wireless, portable, and cart-based. The latter proved to be the best in satisfying the Goal, whereas a previous study obtained that the wireless device was preferable considering only the ergonomic point of view. The case study validated the applicability of the methodology. Practitioner summary: This paper provides the decision-makers of hospitals or diagnostic centres with a multi-criteria methodology to select the best ultrasound device capable of optimising workers' well-being and satisfying company production objectives. The methodology can also support manufacturers of ultrasound devices in improving their products. Abbreviations: AHP: analytic hierarchy process; AIUM: American Institute of Ultrasound in Medicine; BSI: British Standards Institution; CEN: European Committee for Standardisation; EU-OSHA: EU Agency for Occupational Safety and Health; ISO: International Organisation for Standardisation; MCMD: multiple criteria decision-making; NIOSH: US National Institute for Occupational Safety and Health; SDMS: society of diagnostic medical sonography; WHO: World Health OrganizationWMSD: work-related musculoskeletal disorder [ABSTRACT FROM AUTHOR]

This paper presents multilevel models that utilize the Coxian phase-type distribution in order to be able to include a survival component in the model. The approach is demonstrated by modeling patient length of stay and in-hospital mortality in geriatric wards in Italy. The multilevel model is used to provide a means of controlling for the existence of possible intra-ward correlations, which may make patients within a hospital more alike in terms of experienced outcome than patients coming from different hospitals, everything else being equal. Within this multilevel model we introduce the use of the Coxian phase-type distribution to create a covariate that represents patient length of stay or stage (of hospital care). Results demonstrate that the use of the multilevel model for representing the in-patient mortality is successful and further enhanced by the inclusion of the Coxian phase-type distribution variable (stage covariate). [ABSTRACT FROM PUBLISHER]

Conclusion.Our results suggest a rapid diffusion of newborn hearing screening programs in Italy and indicate that three conditions seem to play a crucial role in the implementation of Universal Newborn Hearing Screening (UNHS) programs: the size (>800 births/year) and location (metropolitan urban areas) of the hospital, and the presence of an audiologist in the UNHS coordinating team Objectives. The aim of this paper is to provide data on the degree of implementation and coverage of UNHS programs in Italy Materials and methods. Data were collected through a Screening Survey Questionnaire that was sent to all birthing hospitals active in Italy in 2006 and was filled in by the chief of the hospital or by the UNHS program coordinator Results. In Italy UNHS coverage had undergone a steep increase from 29.3% in 2003 (156 048 newborns screened) to 48.4% in 2006 (262 103 screened). The majority of UNHS programs were implemented in the two most economically developed areas, i.e. in the north-west area (79.5%, 108 200 of 136 109 births), and in the north-east area (57.2%, 52 727 of 92 133 births), while a limited diffusion still remains in some areas, typically in the islands (11.3%, 7158 of 63 460 births). [ABSTRACT FROM AUTHOR]

The aim of this paper is to analyse the current situation in the Italian public healthcare sector, with special attention to aspects of facility management, in the light of the reorganisation necessary for the application of decentralisation and 'de-nationalisation' policies that have involved hospitals in recent years. We have traced a profile of the situation, for 2004, with regard to facility management procedures and to the maintenance of installations, focusing especially on contractual typologies, the efficiency of the adopted solutions and their economic character. The sample used for this work consisted of 50 medium to large size hospital facilities with fairly homogeneous distribution over the Italian territory. Hospitals, having been transformed into health authorities from public corporations, are faced with a gradual change that should allow them to have modern enterprise features, in which efficiency and effectiveness become a 'must' for survival in the health business. To this end it should be normal, particularly in the administrative and maintenance area, to have a change in direction with new management models and the creation of a facility department exclusively dedicated to the supply, management and control of services. The results obtained through this study indicate that these expectations are still a long way from being reached in a satisfactory manner. The territorial structures responsible for supplying the health service are still bound to the past, at least concerning the bureaucratic procedures to follow in relations with the 'outside world', at any level. [ABSTRACT FROM AUTHOR]

Background: Early recognition of post stroke aphasia is thought to be crucial to plan effective rehabilitation. The Aachener Aphasie Bedside Test (AABT) is a widely-used tool for aphasia assessment in acute phase. The AABT was translated into Italian (I-AABT) in 2011, but its psychometric properties had not yet been studied. Aims: The aims of the study were to assess the I-AABT 1) short-term test-retest and inter-rater reliability, 2) concurrent and construct validity, 3) responsiveness and 4) to develop preliminary Italian normative scores to stage aphasia severity. Methods & Procedures: Participants were recruited from three Italian hospitals and divided into four groups: 1) patients with acute aphasia (PwAA; n=116), 2) patients with post-acute aphasia (PwPA; n=54), 3) patients with right-hemisphere damage (PwRHD; n=48) and 4) patients without neurological disorders (PwND; n=30). The I-AABT was administered to all participants. The Aachner Aphasie Test (AAT) was administered to assess concurrent validity. Spearman's correlations and Intraclass Correlation Coefficient (ICC) were used to calculate reliability. Concurrent and construct validity were assessed through Spearman's correlations between I-AABT and AAT subscales and Mann-Whitney test, respectively. Wilcoxon signed test was used to assess responsiveness. Both normalized z and T scores were calculated to produce Italian normative scores. Finally, ROC curves were drawn to determine the diagnostic accuracy of the I-AABT Comprehension and Production subtests. Outcomes & Results. Test-retest and inter-rater ICCs were highly significant and strong (ICC >.837, ICC >.698, p<.001, respectively). Correlations between I-AABT and AAT Comprehension and Production subtests were significant and strong (rs>.611, p <.001). Mann-Whitney test confirmed statistically significant difference between PwAA, and both PwRHD and PwND for I-AABT Spontaneous Language, Comprehension and Production subtests. A significant improvement in the I-AABT items Semantic, Phonemic and Syntactic Spontaneous Language, Oral praxis, Object identification, Automatic Language and Naming (p <.05) was detected after intensive language therapy. Preliminary conversion tables were devised to classify comprehension and production impairment levels. I-AABT's AUC-ROC values for Comprehension and Production parts were significant to detect patients with aphasia with a cut value of 139.5 (sensitivity = 72.9%, specificity = 79.5%9) and 94.5 (sensitivity = 75.2%, specificity = 74.4%.), respectively. Conclusions: The I-AABT proved to be a reliable, valid and responsive tool for the assessment of aphasia in acute stroke patients; its use is recommended in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: The objectives of this study were to compare prevalence rates of different pathologies, ambulance system and emergency department management times, and patient survival and hazard ratios for codes 2 and 3 in two hub hospitals in Modena in the 36-month period across the stages of two major earthquakes in short sequence in Northern Italy in 2012. Methods: Clinical records pertaining to the emergency care of patients were analyzed and only those assigned status codes 2 and 3 by ambulance professionals were included (if the assessment was confirmed by emergency department triage). The statistical analysis of data was divided by three time periods studied: before, during/between, and after the earthquakes. Results: Among the 2,278 retained records, there were no statistically significant differences in the prevalence of the main pathologies presented at the two hubs in the studied period. A Cox regression model was used to analyze the survival of patients in the different stages of the emergency; there were no statistically significant differences in the hazard ratios of death before, during, and after the earthquake. The study found a significant increase in emergency department treatment times. Discussion: Redundancies in the Modena medical system were found to have compensated for damaged hospital facilities. In particular, they helped emergency systems reorganize themselves faster in order to bring medical assistance to people during and around seismic events with as a minimal amount of disruption as possible. Conclusion: The Modena medical system was redundant and ensured that disrupted emergency systems were reorganized and put back online while damaged hospital facilities were compensated for/reproduced elsewhere. [ABSTRACT FROM AUTHOR]

Purpose: To study the correlation between right (RE) and left eye (LE) keratometry readings (K) and axial lengths (AL) in a population-based sample of normal subjects.Methods: In a cross-sectional retrospective study conducted at S. Giuseppe Moscati Hospital, Avellino, Italy, 4516 eyes of 2258 patients with a mean age of 67 ± 16.36 years (range 18-96 years) were included. Partial coherence interferometry data obtained in right (RE) and left (LE) eyes were analyzed and correlated.Results: The average K was 44.01 ± 1.50 diopters (D) (range 39.09-49.89 D) in the RE and 44.04 ± 1.53 D (range 39.63-51.89 D) in the LE (p = 0.0075). 4.5% of the patients (101) presented with differences in the corneal power ≥ 1 D, corresponding to a difference of roughly 1 D in the IOL power. The average AL was 23.89 ± 1.77 mm (range 19.09-35.15 mm) in the RE and 23.84 ± 1.68 mm (range 19.23-35.04 mm) in the LE (p = 0.0018). 19.2% of the patients (433) presented with differences in the AL ≥ 0.4 mm, corresponding to a difference of roughly 1 D in the IOL power.Conclusions: In calculating the IOL power, we must be aware of these results when we measure the fellow eye to validate the measurements in the first eye. In the case of postcataract refractive error, the outcome could be used for the second eye only when symmetric biometric findings are present. [ABSTRACT FROM AUTHOR]

This research wants to verify the effectiveness of couple's treatment, when a neurodegenerative disease affects one of the two partners. The disease affects not only the ailing individual, but also the dynamics within the couple. Fourteen patients affected by neurodegenerative diseases participated in an emotionally focused couple therapy (EFT) with their spouses. We collected a measure of the quality of life (SF-36) and relationship satisfaction (DAS) at the beginning and at the end of the treatment for both partners. The results show an improvement in quality of life and couple contentment, underlining the usefulness of such a psychotherapeutic intervention on the couple. [ABSTRACT FROM AUTHOR]

Theoretical research on public–private partnerships has emphasised their ability to address agency problems in infrastructure projects. Despite this, there is a substantial body of empirical research which documents the tendency of such projects to create budgetary problems for the state authorities involved. This article seeks to explore how and why these problems occur through case studies of PPP hospital projects in England and Italy. It shows how features of the PPP approach encourage and facilitate strategic behaviour by state employees during financial appraisals, and provides evidence that this has undermined the quality of investment decisions and given rise to contractual structures which have failed to minimise the long-run costs to the government. It hypothesises that the PPP approach encourages the commissioning of unaffordable projects, and suggests that future research should focus on the financial appraisal process to identify the political and organisational pressures that are particularly salient in this process and to further evaluate the outcomes. [ABSTRACT FROM AUTHOR]

This study examines multilevel relationships between perceived organizational support (POS), affective commitment and voluntary turnover among nurses. We explored the mediation role of affective commitment between POS and turnover behavior at both individual and work-unit levels. This cross-level study involved 945 Italian nurses from 60 work units. We hypothesized and showed that collective affective commitment fully mediated the impact of climate for POS on individual and collective turnover among nurses. This study helps explain the variance in turnover among nurses in healthcare organizations by analyzing the influence of unit-level climate on individual behavior. Results stress that social environments within wards are important in explaining the processes by which nurses decide to quit their work unit. [ABSTRACT FROM PUBLISHER]

Objective: To compare the hospital management of childbirth with respect to women’s perception and satisfaction. Method: Semi-structured interviews were conducted with 20 first-time Italian mothers, who were recruited in the obstetrics and gynaecology operative unit of a large public hospital in Northern Italy during the 3 days following the births of their children. Data were electronically coded with ATLAS.ti software and a qualitative analysis was conducted. Women’s childbirth narrations were compared with the formal procedures stated in the corporate documents of the hospital. Results: Expectations, control-medicalisation, and the relationship with the caregivers were the main themes that emerged from the interviews. The women’s expectations were related to the hospital’s reputation, which centred on medical specialisation and humanisation. Their actual experiences were characterised by their trust for hospital staff and willingness to give up internal control in order to accept medical interventions. These factors were related to the external control that the women accepted in order to preserve their child’s and their own safety. Although the hospital organisational model was centred on the humanisation of care and patient-centred service, these directives did not correspond to the women’s actual experiences. Conclusions: Health services should take into account the consumers’ perspective and address personal agency in order to increase satisfaction and guarantee a more respectful childbirth care. [ABSTRACT FROM PUBLISHER]

Background: Staphylococcus aureus is a leading cause of community-acquired infections and healthcare-associated infections. Epidemiological data are useful for understanding the dynamics of the diffusion of this pathogen, and to plan control activities and monitor their efficacy. Methods: S. aureus isolates were collected in 13 public hospital laboratories of Emilia-Romagna (northern Italy region) during February-March 2009; phenotypic and molecular characterizations of these isolates were performed. Results: The study sample included 267 isolates, 57 from blood, 81 from respiratory tract, and 129 from wounds; 106 (40%) were methicillin-resistant S. aureus (MRSA). MRSA showed a limited number of circulating clones with 2 predominant spa types - t008 and t041 - accounting for 36% and 27% of MRSA isolates, respectively. The t041 type had a higher prevalence of antimicrobial resistance compared to other spa types and accounted for most of the retrieved hetero-vancomycin-intermediate S. aureus (h-VISA), while t008 was more frequently detected in non-hospital isolates. A higher degree of genetic diversity was observed in methicillin-susceptible S. aureus (MSSA), with no predominant clones and low prevalence of antimicrobial resistance. The occurrence of community-acquired MRSA infection appears to be rare in Emilia-Romagna. Conclusions: In contrast to previous studies reporting Italian data, t008 was the most frequent spa type among MRSA isolates in Emilia-Romagna. The prevalence of antimicrobial resistance of different MRSA spa types could influence their ability to cause infections with hospital onset. The presence of only 2 major MRSA clones circulating in Emilia-Romagna increases the chances that a regional strategy aimed at MRSA prevention will be effective. [ABSTRACT FROM AUTHOR]

Since the enactment of the Mental Health Law of 1904, which institutionalized manicomi (centers for the mentally ill people), the elimination of the mechanical restraint in managing psychiatric patients has constituted a target and a quality indicator of Italian psychiatry. Currently, to verify if--and, if so, in what measure--this target is still significant despite the large use of psychomedicines in the clinical practice, the coordination center for the Psychiatric, Diagnosis, and Cure Services (SPDC) for the Lazio Region sponsored research on the use of mechanical restraints and characteristics in emergency situations, as well as on the risk factors that underlie its use. Subsequent research results have outlined the increased diffusion of restraint used as an emergency therapeutic-welfare practice and an increased variability frequency and duration in several SPDC regions. Finally, studies have statistically proved the significant influence of environmental risk factors both at the psychiatric unit level and at the territorial context in determining the use of restraint. [ABSTRACT FROM AUTHOR]

We study practice variation in scheduling of caesarean section (CS) delivery across public and private hospitals in Italy. Adopting a novel perspective, we look at the role played by patients' preferences for the treatment. The recursive probit model is revisited as a useful tool to assess the presence of assortative mating of patients and provider driven by style of practice. According to our evidence, the propensity to schedule a CS is codetermined with patient self-sorting into hospital types. We measure a significantly higher inclination to practice CS scheduling in private hospitals and conclude that assortative mating is of minor relevance in our case, even if we cannot exclude it to be present. [ABSTRACT FROM AUTHOR]