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The origins of the modern hospital date back to the beginning of the XX century, following the developments in anaesthesia, control of infections, and medical science and technology. Despite continuing changes in medicine and specialisation advancements, the increasingly higher costs for medical care, the population ageing and the more demanding patient require new solutions. In many cases, primary care services can deliver minor acute disease and injury treatment, ambulatory surgery and intermediate care--such as home health and residential care--in settings that are more accessible for patients and their families. Therefore, it's impossible--as it was a century ago--to predict what the hospital of the future will look like, but the trend is towards a lean network of hospitals based on the "hub and spoke" model, with a patient-centered internal configuration and linked with a strong primary care system by shared goals, guidelines and telecommunications.

Due to the current population ageing in developed countries, the number of seriously disabled elderly people is on the rise, with a remarkable impact on health and socio-health public expenditure. In order to face such situation, governments should take two parallel roads: 1. adopting new models of health care offers through organizational schemes aimed at achieving not only effectiveness but also efficiency and compliance; 2. adopting new funding patterns, capable of fostering private resources through fiscal incentives.

To describe the dynamic of HIV-1 prevalence in Italian childbearing women and to estimate the future incidence of pediatric AIDS due to vertical transmission, dried-blood specimens collected from a consecutive sample of newborns in all Italian regions were examined for the presence of anti-HIV-1 antibodies (HIV-Ab) after the routine neonatal screening program was completed. Of 555,722 blood samples collected and examined for HIV-Ab between 1990 and 1993, 550 (0.099%) were positive. Nationwide, the HIV seroprevalence decreased between 1990 and 1992 (0.124% in 1990, 0.100% in 1991, 0.085% in 1992), and increased, as compared with that in the previous year, in 1993 (0.096%). In an univariate analysis, HIV seroprevalence was positively was positively associated with being born in regions having higher AIDS cumulative incidence and in metropolitan areas, but negatively associated with year of delivery. In a multiple logistic regression analysis, only the AIDS cumulative incidence level of the delivery area and being born in a metropolitan area remained independently associated with HIV seroprevalence. Our results show significant geographical variation in the spread of HIV infection among childbearing women in Italy and provide useful indications to target prevention and care strategies for HIV-infected women and their children and to estimate the potential impact of implementing programs aimed at preventing vertical transmission of HIV infection.

A prevalence assessment of HIV infection among parturients was performed in order to estimate the future incidence of pediatric AIDS cases and obtain data on the trend of the infection in Italy. Consecutive whole blood samples from newborns collected on filter paper from all regions of Italy (October-December 1990) for routine metabolic screenings, were anonymously examined for HIV-1 antibodies by an ELISA technique. Positive results were confirmed by Western blot. Among 97,658 blood samples tested, 121 (0.124%, 95% confidence interval Poisson distribution 0.103-0.148) were positive. A high prevalence of HIV infection (> 0.2%) was observed in four regions from North and Central Italy while, in some regions in the South, the seroprevalence was ten times lower. In the Lazio Region, namely in Rome, 5 inner-city hospitals with a particularly high prevalence of HIV infection were identified. Assuming that the prevalence of HIV infection observed in the population in this study may reflect the infection rate in the total population of childbearing women, we estimate that approximately 700 newborn babies were delivered from HIV-positive mothers in Italy during 1990. The identification of high prevalence areas could allow for the development of "targeted" testing programs to plan and provide adequate counselling and care of HIV-infected women and their infants.

Objectives: To evaluate the use of zidovudine prophylaxis in HIV-exposed health-care workers (HCW) in Italy and to determine its short-term toxicity., Design: Longitudinal, open study with retrospective and prospective collection of data., Setting: All Italian clinical centres that care for HIV-infected patients and are licensed by the Ministry of Health to dispense zidovudine and 30 hospitals participating in the Italian Multicentre Study on Occupational Risk of HIV Infection., Study Population: HCW and other individuals who accepted zidovudine prophylaxis after accidental exposure to HIV., Results: Data were collected for 224 HIV-exposed individuals until 30 June 1991. An increase in zidovudine prophylaxis was observed. All but 10 subjects received 1000-1250 mg zidovudine per day. Anaemia (five cases), neutropenia (one case) and an increase in serum alanine aminotransferase levels (two cases) were the only haematochemical side-effects observed; none of the subjects ceased prophylaxis because of side-effects. More than 50% of subjects had constitutional reactions; as a result, prophylaxis was stopped by 29 patients. These adverse effects began within 10 days of prophylaxis; all resolved after prophylaxis was stopped. No HIV-antibody seroconversions were observed after a mean follow-up of 8 months., Conclusions: Zidovudine prophylaxis has become a feature of the management of occupational exposures to HIV in health-care settings; short-term toxicity is mild, dose-related and reversible. Further studies are needed to assess the risk of long-term sequelae.

Human immunodeficiency virus (HIV) infection has spread to almost every country so as to show the characteristics of a pandemic. According to WHO estimates, there are over 10 million infected subjects all over the world of whom two thirds are believed to be Africans. The infection is transmitted mainly heterosexually, and therefore spreads especially among young people, hence the growing number of seropositive infants, particularly in Africa. In certain European nations including France, Spain, and Italy, the percentage of infected babies is associated with maternal drug addiction whereas in Romania pediatric transmission is horizontal. According to WHO estimates, AIDS will become the main cause of death for children in many African and American Countries in the next few years. In addition, there will be a considerable number of orphans below the age of 10 whose number is expected to rise to 10 million in the course of the nineties.

In Italy, drug abusers are the major risk category for HIV infection, representing 67% of all the reported cases of AIDS. This can in part explain the higher incidence of the infection observed in Italian females (17.7%) in comparison with the data reported in Europe (11.5%) or in the U.S. (8.5%). Therefore, anti-HIV screening in newborns reflects the serologic pattern of the respective mothers and can provide a useful tool in evaluating the incidence of the infection in a relatively unselected population. Furthermore, the data collected can provide a good predictive parameter for the rate at which pediatric AIDS will develop. Blood samples were collected on filter paper for routine screenings from 39,102 consecutive newborns in 92 hospital nurseries, from eight different Italian regions, during the period June 1988-April 1989. Blood-saturated disks were screened for anti-HIV antibodies (HIV Ab) using an ELISA; positive results were confirmed using a Western blot. Among the 39,102 blood samples tested, 51 (0.00130, 95% confidence intervals, Poisson distribution of 0.00097-0.00171) were found to be positive for HIV Ab. The distribution pattern of the positive samples among the different regions correlates to the cumulative AIDS incidence rate, with a higher prevalence in urban and industrialized areas.

Among 5005 Navy recruits aged 18-26 years from all sections of Italy, whose blood was tested in 1981, regional prevalence of serologic markers for hepatitis B was higher in southern Italy and in the Italian islands as compared with northern Italy and central Italy (4.3% vs. 2.3% for hepatitis B surface antigen (HBsAg) and 23.5% vs. 10.5% for any B marker). Social-demographic variables such as region, family size, and education were associated with hepatitis B as were the more traditionally associated variables related to blood or medical care such as history of intravenous injection, history of blood transfusion, or exposure to hospital. Number of siblings was positively related and educational attainment inversely related to prevalence of hepatitis B markers. The prevalence of HBsAg among Italian males aged 18-26 years with residence in southern Italy or in the Italian islands, whose education was limited to lower middle school, and who were from a family of eight siblings or more, is 14.6%. These are among the highest prevalence rates for hepatitis B antigen ever reported for a general population group in Europe. Good correlation exists between incidence of reported cases of hepatitis and prevalence of markers in the different regions of Italy.

A study to evaluate the extent of Hepatitis B among Hospital Staff in two hospitals in central Italy, blood tested 1212 individuals (80.2% of the staff). 33.7% of staff tested was positive to at least 1 marker of prior B hepatitis infection. The study confirms that B hepatitis is an occupational hazard for those exposed to blood. Specific risks in terms of odds ratios are estimated to be about 2.0 for professional nurse compared to other nursing categories, about 1.7 for staff in high risk departments compared to low risk departments and about 5.0 for professional nurses in high risk departments compared to clerks or nurses aides in low risk departments. The computation of attributable risk indicates that working in a hospital contributes only a minor fraction of the total national burden of this disease. However, immunization of hospital workers in Italy can prevent every year as many as 6,500 new Hepatitis B infections in this high risk group.