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Introduction: Falls in hospitals are a major problem also in pediatric settings. No Pediatric Fall Risk Assessment Scales (PFRAS) are validated in Italian., Goals: to perform the Italian validation of the Humpty-Dumpty Falls Scale (HDFS); to assess its predictive performance; to estimate the frequency of falls in hospitalized children and to analyze possible associations between children's clinical variables and falls., Methods: The study's first step was the cultural-linguistic validation of HDFS in Italian. Second, evaluation of the Italian HDFS's performance on 1500 hospitalized children. Third, modifications of the Italian HDFS to improve its performance. Fourth, analysis of falls frequency and associations between falls and patients' clinical variables., Results: The Italian HDFS (HDFS-ita) showed good Validity (SCVI=0.92) and inter-rater Reliability (Cohen's kappa=0.965), but poor Sensitivity (77.8%) and Specificity (36.6%). A new 3-item version of the HDFS-ita (HDFS-ita-M) was set, with a cut-off of 7, only for subjects 1 to 15 year-old. Although better, the HDFS-ita-M's performance remains poor (Sensitivity=77.8%, Specificity=53.3%, ROC curve's AOC=0.670). The frequency of pediatric falls was 6.38 per thousand children (CI95% 3.36-12.08) with a maximum frequency in children aged 3 to 6 years (11.28 per thousand children, CI95% 3.84-32.63). Motor/walking disorders (p=0.005), enuresis (p=0.0002), being in single room (p=0.04), admittance to pediatric neuropsychiatry/neurology wards (p=0.001), and neurological disorders (p=0.02) were associated to falls., Discussion: HDFS-ita-M has a better but still poor performance than HDFS-ita. This study provides useful data about pediatric falls and their possible risk factors which will help pediatric hospitals in determining patient safety policies. Further studies are needed to determine an adequate panel of variables to estimate pediatric falls risk.

Introduction: The colorectal cancer screening program in the Local Health Unit n. 6 of Livorno is running since July 2000 and is meant to residents, aged between 50 and 70, who are invited to perform the test for faecal occult blood every 2 years. The aim of this work is an evaluation of the screening activity in the period 2000-2011., Methods: The evaluation is based on the analysis of the main quality indicators formulated by GISCoR (Italian Group for Colorectal screening)., Results: The screening activity extension reached 93% in 2006 and 100% in 2009. The compliance level was maintained above the acceptable GISCoR value (> 45%) with a maximum of 54.9%. Values around 80% were recorded for the compliance to colonoscopy. The detection rate (DR) for cancer and advanced adenoma showed, as expected, the highest values in the early years and then move on values consistently lower than the regional average. In 2011, the raw DR for cancer was 0.9 x 1000 and the raw DR for advanced adenoma 5.3 x 1000. The distribution by stage at diagnosis of screen-detected carcinomas shows that 58.1% of these were identified at stage I while the proportion of cases in stage III+ is 19.5%., Conclusions: The overall analysis shows a good performance of the program. The proportion of colonoscopies performed on the total number of positive subjects remains a critical point of the system. The distribution by stage of screen-detected cancers shows an excellent diagnostic anticipation of the screening program.

Aims: To test the impact of a multi-coloured non-conventional attire on a population of children admitted to a paediatric hospital., Design: Quasi-experimental before-after controlled study., Background: It has been suggested that non-conventional nurses' uniforms in paediatric settings may contribute to lowering children's distrust towards healthcare providers and reduce fear. Little formal research has investigated on the impact of nursing attire in a paediatric setting. No study has so far analysed the effects in actual use of a non-conventional, other than the traditional type of uniform, on a paediatric hospitalised population. Design: A quasi-experimental study., Methods: We introduced multi-coloured nurses' attire in two wards of a paediatric hospital. Using open questions and semantic differential scales (SDS), we evaluated the effects of this non-conventional attire on a group of hospitalised children, compared to sex-and-age-matched controls interviewed before the introduction. Parents were also interviewed., Results: One hundred and twelve hospitalised children and their parents (n = 112) were studied. The percentage of positive words used by children to define their nurse was higher in children interviewed after the introduction of non-conventional uniforms (96.2% vs. 81.8%, p = 0.01). Children's perception of nurses was significantly improved by the use of multi-coloured attire ('bad'-'good' SDS: p = 0.01; 'disagreeable'-'nice' SDS: p = 0.001). Children's perceptions regarding hospital environment did not change. Parents' perception of nurses' uniform adequacy to the role and capability to reassure resulted improved (p < 0.0001, p = 0.0003)., Conclusions: Multi-coloured non-conventional attire were preferred by hospitalised children and their parents. Their introduction improved the perception children have of their nurses. Moreover, the coloured uniforms improve the parents perception about the reliability of the nurse., Relevance to Clinical Practice: The use of non-conventional nurses' attire can contribute to improve the child-nurse relation, which has the potential to ease the discomfort experienced by children due to hospitalisation.