Search

Background Violence against healthcare workers (HCWs) has gained increasing attention in recent years, both because it is on the rise and because there is growing concern about these incidents, which are classified as sentinel events by the Italian Ministry of Health. Since little is known about the actual burden of this phenomenon, especially during the stressful COVID-19 vaccination campaign, we decided to explore the problem in our region. Methods Between January and March 2022, in the 1.2 million-inhabitant Friuli Venezia Giulia region (Italy), we conducted an anonymous online survey to collected data on episodes of violence and their consequences for HCWs. Data from validated tools assessing characteristics of violent episodes and post-trauma impact were analyzed in conjunction with socio-demographic data of respondents. Results 200 HCWs participated in the survey, most of whom were women (72%), worked as nurses (107) or doctors (71), and had a mean age of 47 years. More than half of them (59%) reported at least one episode of violence, mainly in the form of a verbal assault (64%); there were no differences between victims. In 72 cases, these incidents affected the HCW’s private life, mainly disturbing sleep or concentration (68%). Most HCWs stated that inadequate communication was a trigger for the violence (97%). Although 80% of HCWs would readily report any violent incident, to improve the situation they called for certainty of action against the perpetrator (87%), more organizational support (85%), standard procedures (75%) and self-defense courses (75%). Conclusions Violence in COVID-19 vaccination campaign appears to be common and to affect both the personal and professional lives of HCWs. Improvements at the institutional and personal level could help to address this problem that affects the health workforce. Key messages • Given the growing public debate, violence in healthcare settings is an important issue that needs to be addressed in the coming years. • Assessing workplace violence and its associated risk factors will help focus on the strategies that can be usefully employed to prevent it in the future.

OBJECTIVE Second victims are defined as healthcare workers involved in an unanticipated adverse patient event, who experienced professional and psychological distress. The Second Victim Experience and Support Tool (SVEST) is a survey developed and validated in the United States, which describes the experience of second victims. This study aims to perform the cross-cultural adaptation of the SVEST and to evaluate its psychometric characteristics in the Italian context. METHODS Translation and cross-cultural adaptation process was performed according to the World Health Organization guidelines. Then, 349 healthcare workers, including nurses, doctors, residents, and technicians, involved in direct patient care-a potential second victim-completed the Italian version of SVEST in a validation survey at the Academic Hospital of Udine. The SVEST consists of 29 items, divided into 7 dimensions, 2 outcome variables, and 7 support options. The Italian version was assessed for internal consistency through Cronbach α, for content validity with content validity index for scales and for item and for construct validity with Confirmatory Factor Analysis. RESULTS The internal consistency of the instrument was adequate in its overall evaluation with Cronbach α value of 0.88 (95% confidence interval = 0.86). The content validity index for scales was 0.94 and that for item was 0.70. The confirmatory factor analysis results showed a good model fit for the 9-factor structure (χ2 = 676.18, df = 327, P < 0.001). Root mean squared error of approximation, Akaike information criterion, and comparative fix index Tucker-Lewis index values also suggested a good fit to the data. CONCLUSIONS The Italian version of the SVEST can be used to evaluate second victim experiences, demonstrating adequate validity, reliability, and good psychometric properties.

Introduction Clinical record (CR) is an appropriate source for adverse events (AEs) detection and Italian law requires its compilation. Its completeness is used as an indicator of the quality of care provided and offers guidance on system changes to improve professional practice. This study aimed at assessing the completeness of CRs, describing AEs' rate and triggers, and investigating the relationship between CR completeness and the occurrence of AEs. Methods A retrospective review of CRs was conducted, randomly selecting patients discharged from Internal Medicine (IM), General Surgery (GS) and Obstetrics (O) between June and September 2020 at the Academic Hospital of Udine (Italy). The completeness of CRs was assessed using a 65-items checklist developed by the hospital Quality Unit. Triggers and rate of AEs were detected by using Global Trigger Tool. Relationship between AEs and completeness of CR was analyzed using nonparametric tests. Results Among 93 reviewed CRs, 91.4% were from the GS, 5.4% from IM and 3.2% from O. Patient mean age was 64.6±18, women were 51.6%. The average completeness of CRs was 50.4% [30.4%-83.5%]. Identified triggers and AEs were 125 and 29 respectively, with at least one AE every 23.7% admissions, 31.2 AEs per 100 admissions and 40 AEs per 1000 patient-days. The most frequent AEs were surgical damage (51.7%; 15) and hospital-acquired infection (24.1%; 7). Hospitalization length for patients with at least one AE was 12.6 days, whereas it was 6.3 days without AEs. A significant positive correlation (R = 0.36; p < 0.001) was found between length of hospitalization and number of AEs. The increase in CR completeness is associated with the decrease of the total number of AEs (R=-0.18; p = 0.083). Conclusions These findings suggest a direct association between the number of AEs and the length of hospital stay. The correlation between CR completeness and AEs suggest that patient safety could benefit from the improvement of clinical record compilation. Key messages More studies are needed to understand if the occurrence of AEs to patients may cause a prolonged length of hospitalization. A better compilation of CRs should allow to reach a more effective communication between healthcare workers, creating a work environment less prone to errors and AEs.

Background Adverse patient safety events (AEs) can negatively impact on healthcare workers (HCWs) by causing emotional distress and affecting professional ability. The challenge of healthcare organizations is to support HCWs involved in AEs. This study aims to investigate the second victim phenomenon in a large Italian Academic Hospital (AH). Methods A cross sectional survey was conducted from June to November 2019 involving all HCWs working at the AH of Udine. HCWs' demographic characteristics and answers to the Second Victim Experience and Support Tool, Italian version (IT-SVEST; 29 items representing 7 dimensions and 2 outcome variables; Likert-scale: 1-5) were collected. Higher scores indicated a greater negative impact of the AEs and a perceived inadequacy of support resources. Median (M) and interquartile range (IQR) were assessed for each item. The agreement (AGR) (respondents with a mean score ≥4) was assessed for each dimension. Relationship between items score and demographic aspects was analyzed with non-parametric tests. Results A total of 349 HCWs joined the survey. Women were 79.4% and mean age was 39.4±10.7 years. 58.7% of respondents referred to be involved in a AEs. Lots of HCWs expressed feelings of psychological distress (AGR=26.9%) and less experienced HCWs were more affected by feelings of shame than senior ones (M = 4, IQR=1.5 vs M = 3, IQR=2; p < 0.01). Physical distress (AGR=10.9%) and professional self-efficacy (AGR=11.8%) did not had a great impact on HCWs, but younger (M = 3, IQR=2 vs M = 2, IQR=2; p < 0.01) and female (M = 3, IQR=2 vs M = 2, IQR=2; p < 0.01) HCWs were more inclined to question their skills. Support services offered by Hospital organization may be improved (AGR 8,9%). Conclusions Psychological impact of the AEs is relevant in our cohort and less experienced and female HCWs resulted more inclined to doubt their professional abilities when involved. Improvements in support resources should be desirable to create a safer working environment. Key messages HCWs’ psychological dimension and perceived professional self-esteem can be negatively affected by adverse events, especially for less experienced and female professionals. Healthcare organizations need to develop and to implement a second victim support program designed to provide emotional, psychological and professional support for HCWs.

Background Incident reporting (IR) is a system of spontaneous and voluntary reporting of events, important for assessing safety risks and for improving safety and quality of care. Since Covid-19 pandemic led to a change on the hospital organization, related to an overload of work and an increase of pressure in the wards, this study aims to evaluate the impact of Covid-19 on IR and on safety culture. Methods This retrospective study analyzed the data of IR in 2019 and 2020 in the academic hospital of Udine. Number of IR, severity of the events (near miss, events with no harm and events with harm) and IR'S topic were compared. Inappropriate IR were excluded from severity analysis. The chi-square test was used for statistical significance. Results IR in 2020 showed a reduction of 17.7% compared to 2019 (1097 vs 1334, p < 0,05). Furthermore, we observed a reduction in near misses (276 vs 390, - 4,81%, p < 0,05) and an increase in events with harm (226 vs. 219, + 4,52%, p < 0,05). Events with no harm showed no significant increase. The analysis of topics revealed an increase in 2020 of problems concerning assessment of patient (+ 4.47%), especially swab's results delays, organizational aspects (+ 4.88%), due to staff reassignment and ward reorganization, and infection prevention and control (+ 4.65%). This increase is significantly associated with Covid-related IR (p < 0,05). Conclusions In 2020 were collected fewer IR than 2019 and with an higher level of severity. This change may be associated to the increased workload of the staff who had less time to report incidents. Nevertheless 2020 showed an increase in reporting Covid-19 related issues concerning delay of diagnostic test, new work condition and infection prevention and control measures. This analysis suggests that the decreased number of IRs and near miss during the first year of the pandemic could represent a reduction in safety culture. Additional data are needed. Key messages Covid-19 disease influenced the safety culture by reducing the number of IR and near misses reported. New Covid-related issues emerged as critical during the pandemic.

Background Safety of care is an essential aim of a healthcare system, even during a pandemic. Incident reporting (IR) is an important safety tool to identify system failures. This study evaluates the impact of SARS-COV-2 pandemic on IR trend in the COVID-19 wards of an Italian Academic Hospital (AH) in Italy. Methods The study analyzed the IR submitted by the wards of Infectious Diseases (ID), Intensive Care Unit (ICU), Pneumology (P) and Emergency Room (ER) of the AH of Udine from 2016 to 2020. For each ward, IR of 2020 were compared to IR of 2016-2019 period, expressed as the mean value. The IR's topics of ER unit, classified according to the International Standards of Patient Safety, were compared between 2019 and 2020. Variation in reporting was assessed using Chi-square tests. Results During 2020, 180 incidents were reported, 81.7% of which submitted by ER unit. Three wards showed a decrease in reporting compared to 2016-2019 period: -18% (7vs8,5) for ID unit, -26% (16v21,7) for ICU and -44% (10vs18) for P unit. ER unit, instead, showed a great IR increase (147vs49; +200%). Considering the reporting from 2016 to 2019, 196 out of 389 (50.4%) of IR came from ER unit. Analyzing the difference in reporting in ER unit between 2019 and 2020, the IR topics regarding “Delay in execution and reporting exams” increase from 2 to 21 (p < 0,05), “Lack of human and/or instrumental resources” from 4 to 29 (p < 0,05) and “Prevention and Control of Hospital Infectious” from 0 to 13 (p < 0,05). Conclusions ER unit showed a higher attitude in reporting than the other considered wards, especially during the COVID-19 period, recognizing IR as an important tool to highlight critical issues. This aspect may reflect the stronger safety culture already present in this unit. SARS-COV-2 pandemic stressed in ER needs of human resources to cope with reorganization determined by COVID-19, rapid covid-test results for the patient's care path definition, implementation of infection control procedures. Key messages A solid safety culture may contribute to maintain high levels of IR even while during challenging times for healthcare systems. Difference in reporting among Covid wards could be explained by a different level of Safety Culture.

Background ”Second victims” are defined as “healthcare workers (HCWs) involved in an unanticipated adverse patient event, who experienced professional and psychological distress”. The Second Victim Experience and Support Tool (SVEST) is a survey developed and validated in the United States, which describes the experience of second victims. This study aims to perform the cross-cultural adaptation of the SVEST and to evaluate its psychometric characteristics in the Italian context. Methods The translation and cross-cultural adaptation process was performed according to the World Health Organization’s guidelines, from March to May 2019. Then HCWs involved in direct patient care (a potential second victim) were asked to complete the Italian version of SVEST in a validation survey, from June to November 2019 at the Academic Hospital of Udine. SVEST consists of 29 items, divided into 7 dimensions, 2 outcome variables and 7 support options. The IT-SVEST was assessed for internal consistency through Cronbach’s α, for content validity with Content Validity Index for Scales (S-CVI) and for Item (I-CVI) and for construct validity with Confirmatory Factor Analysis (CFA). Results Collected surveys were 349. Women were 79.4%. Nurses were 40.1%, 18.9% were doctors and 8.6% were residents. HCWs involved in a patients’ adverse event were 205 (58.7%). Out of these, 66.3% were near misses. The internal consistency of the instrument was adequate in its overall evaluation with Cronbach α = 0.88 (95% C.I.=0.86). S-CVI was 0.94 and I-CVI was 0.70. The CFA results showed a good model fit for the nine-factor structure (chi2=676.18, 327 df, p Conclusions The Italian version of the SVEST (IT-SVEST) can be used to evaluate second victim experiences, demonstrating adequate validity, reliability and good psychometric properties. Key messages Healthcare institutions need an instrument that can direct efforts to prevent and reduce the second victim experience. IT-SVEST is a reliable and valid instrument to obtain accurate information on second victim experience.

Issue Incident reporting (IR) is an important tool to assess potential or current problems within health care facilities. To increase the number of IR should be an important issue of the risk manager. In the academic hospital Santa Maria della Misericordia (SMM) of Udine, in North-east of Italy, IR were anonymous paper forms handwritten by health-care workers (HCW) and sent to Clinical Risk Management by internal mail. Digitalization was carried out aiming to increase IR, making it simpler, more direct and perceived as more anonymous by HCW. Description of the problem January 1st 2019 the digitized system was initialized, between January and March two training sessions for HCW were carried out and from the 1st April HCW began to send IR with the new application which was installed on every hospital's PC. The objectives were to push HCW to report more, mostly on their own wards' incidents, and to receive complete IR through the insertion of some mandatory information fields. Results Comparison between the period from 1st April to 31th December 2018 and from 1st April to 31th December 2019 showed an increase of 22,6% of IR (from 678 to 831), an increase of 11,2% (from 331 to 368) of IR regarding problems with other wards or services and an increase of 33,4% (from 347 to 463) of IR regarding their own wards' incidents. Lessons Digitalization seems to be appreciated by HCW despite they are forced to give more information due to the mandatory fields. This could be explained considering that a direct incident reporting system ensures privacy of the HCW which feels more warded also when he reports an internal problem of his own ward. Finally, mandatory fields facilitate risk management work giving all the relevant information about the incident. Key messages Digital reporting seems appreciated by HCW and could be a mean to increase the number of incident reporting. To guarantee the anonimity of incident reporting should be a priority and every way to make the HCW feel anonymous seems to be appreciated.

Introduction Identification and measurement of adverse events (AEs) is crucial for patient safety in order to monitor them over time and to implement quality improvement programs, testing if they are effective. Global Trigger Tool (GTT) has been proposed as a low-cost method, being also the most effective to detect AEs. This study aims to describe the number of triggers, the rate and level of AEs identified by GTT and the most frequent type of AE. Methods The Italian version of the GTT was used. Ten paper-based clinical records (CRs) randomly selected every 2 weeks were reviewed from January to April 2019 by three independent reviewers (two nurses, one doctor) at the Academic Hospital of Udine. The AEs rates calculated are: AEs per 1,000 patient-days, AEs per 100 admissions, percentage of admissions with an AE. AEs were classified by harm levels according to National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). Results CRs reviewed were 80. Mean age of the patients was 69.3±16.4, women were 37.5%. Mean hospitalisation was 16.8±15.3. Nine were the cases of re-hospitalisation within 30 days (11.3%). The total number of trigger was 156. AEs were 31, with at least one AE on 27.5% of admissions, 38.8 AEs per 100 admissions and 23 AEs per 1,000 patient-days. AEs with harm level E, F and H were respectively 5 (16.1%), 24 (77.4%) and 2 (6.5%). The most frequent type of AE were hospital acquired infections with 15 cases (48.4%). Conclusions The most frequent type of AE was the hospital acquired infections. Rates and levels of AEs were higher than other international studies, probably because of the limited number of CRs reviewed. Key messages Global Trigger Tool is an effective method to detect adverse patient safety events in order to monitor them over time. The most frequent type of adverse events was the hospital acquired infections.

Introduction Healthcare workers (HCWs) can experience psychological distress if involved in adverse patient events, becoming second victims. The aim of this study is to determine the extension of the second victim phenomenon and the preference of the support resources of the HCWs working in the Department of Maternal and Child Health (DMC) at the Academic Hospital of Udine. Methods A cross-sectional survey was carried out from June to November 2019. All HCWs involved in direct patient care working in the three units of DMC [Obstetrics and Gynaecology (OG), Neonatology (Neo), Pediatrics (Ped)] were included. A validated version in Italian language of the Second Victim Experience and Support Tool (SVEST) was used to assess the experience of second victim and the support resources preferred by the HCWs (Likert-scale: 1-5). Agreement of the support options were considered with an overall mean subscale score of ≥ 4.0. The Wilcoxon signed rank sum test was used to calculate the statistically significant differences (p Results The response rate was 44,9% (120/267). Women were 95.8%. Mean age was 38.7±9.7; HCWs from OG were 48.3%, 26.7% from Neo and 25% from Ped. Nurses were 34.2%, 32.5% were obstetrics, 15.8% were doctors and 8.3% were residents. HCWs who experienced adverse patient events were 80 (66.7%). Out of these, 63 (52.5%) were near-miss events. The overall mean score of the first two dimensions of SVEST (”Psychological distress” and “Physical distress”, as representative of the trauma experience) was respectively 3.3±1.0 and 2.3±1.1. The difference between their scores was statistically significant (p Conclusions The study highlights that HCWs of the DMC are frequently involved in adverse patient events. Psychological distress was significative more impactful than physical distress. The majority of HCWs preferred a peer for colleagues support. Key messages SVEST is an instrument that helps to determine the support resources preferred by HCWs in order to develop a support program for second victim. A peer for colleagues support is the support resource preferred by the HCWs working in the Department of Maternal and Child Health.

Background No studies have assessed the differences in the incidences of falls and other patient safety events (PSEs) during handovers performed away from patients compared with when nurses are on the unit. Purpose The primary aim was to explore the incidence of falls and their severity during handovers compared with during nonhandover times; the secondary aim was to explore the occurrence of other PSEs during handover versus nonhandover times. Methods This was a retrospective study of all PSEs that occurred from 2013 to 2017 in a large Italian academic trust. Results There were 1966 falls and 1523 other PSEs. The incidence of falls per 100 hours was 4.9 during handovers and 4.4 during nonhandover times. The incidences of other PSEs were 2.9 and 3.5, respectively. No significant differences in fall outcome severity emerged. Conclusions No differences emerged in the occurrence of falls during handovers performed away from patients and when nurses were on the unit. Other PSEs decreased in occurrence during handovers as compared with other times during the shifts.

Objective To describe rates and types of critical incidents in Intensive Care Units. Research methodology A retrospective study in four intensive care units of an Academic Hospital located in the North-East of Italy. All critical incidents recorded in an incident reporting system database from 2013 to 2017 were collected. Results 160 critical incidents emerged. The rate was 1.7/100 intensive care-patient admissions, and 2.86/1000 in intensive care-patient days. Nurses reported most of the critical incidents (n = 113, 70.6%). In 2013 there were 19 (11.9%) critical incidents which significantly increased by 2017 (n = 38, 23.7%; p = 0.034). The most frequent critical incidents were medication/intravenous fluids issues (n = 35, 21.9%) and resources and organisational management (n = 35, 21.9%). Less frequently occurring incidents concerned medical devices/equipment (n = 29, 18.1%), clinical processes/procedures (n = 18, 11.3%), documentation (n = 14, 8.8%) and patient accidents (n = 13, 8.1%). Rare incidents included behaviour, clinical administration, nutrition, blood products and healthcare associated infection. Conclusion Over a five-year period, documented incidents were steadily increasing in four Italian intensive care units. A voluntary incident reporting system might provide precious information on safety issues occurring in units. at both policy and professional levels.

Issue Blood components transfusion is a high-risk process due to its complexity and possible consequences in case of error. Preventing mistakes and acting promptly if they occur is a duty of healthcare organizations. The Italian Ministry of Health has drafted a specific recommendation with the aim of reducing transfusion errors. Description of the problem Following a transfusion error occurred in July 2018, a multidisciplinary group including professionals from Clinical Risk Unit (CRU) and Transfusion Department of the Academic Hospital of Udine, carried out an analysis of the blood components issuing process. The 20 most critical steps were identified and grouped into 3 areas: 1)single samples processed individually, 2)appropriate application compliance, 3)environmental interferences. For each step shared solutions were identified and then implemented as new standard practices. From February to March 2019, CRU randomly observed 23 blood components assignments using tracer methodology, evaluating staff’s compliance with the new recommended practices (NRP). Results For the sample processing (area 1, n.10 practices), adherence to all ten NRP was 100% (26/26). For the appropriate application compliance (area 2, n.8 practices), adherence to 7 NRP was 100% (11/11), whereas for one (punctual registration of non-conformities) adherence was 86% (6/7). For the environmental interferences (area 3, n.2 practices), adherence to one practice was 100% (2/2), whereas for the other one (avoid answering to incoming phone calls) adherence was 75% (3/4). Overall, professionals behaviour was consistent with the NRP in the observed period. Lessons Identification of critical issues by a multidisciplinary team and measuring the adherence to new practices is crucial in managing the complexity of blood transfusion process. Tracer methodology, used by CRU to verify adherence to new standard, also allows the hospital to monitor the progress of the achieved performances over time. Key messages Multidisciplinary analysis of the blood transfusion process and shared development of new standard by all professionals favours their compliance in the practice. Tracer methodology is a useful tool to evaluate adherence to recommended practices and monitor the complexity of transfusion process over time.

The study analysed two key questions: (i) the prevalence of informal caregiving in medical and surgical wards of a high specialization hospital; (ii) the reasonable cost for the structure that would have to pay to replace informal caregiving? The study was conducted in June 2006 as a prevalence survey, using a questionnaire administered to informal caregivers and nurses working in medical and surgical wards of a high specialization hospital by ad hoc trained personnel. Questionnaire consisted in three sections: the first focused on patient's characteristics, the second on caregivers and the third on nurses' perception on caregiving phenomenon. One hundred and twenty-four eligible caregivers were identified. During the study patients admitted to hospital medical and surgery wards were 520. Among these 16.5% (86/520) was assisted by one or more caregivers. Caregivers' response rate was 69.4% (86/124), corresponding to 66 patients. This study yielded an average of 455.9 minutes per day (SD = 370.2; range = 120-1440) or 52.9 hours per week. Caregiver's presence was recognized in 88.9% (56/63) of patients. Despite the societal perspective, the costs and effects of informal caregiving to the informal caregiver are often ignored in economic evaluation. The costs of informal care are an important extent related to time inputs by relatives and friends of the care recipients. Our approach has been to monetize the informal activity care contribution of family members and/or caregivers.

The aim of the study was to evaluate the impact of a 2-year vaccination program on the compliance of healthcare workers (HCWs) employed in an acute care university hospital to influenza vaccination. The study was carried out in October/November from 2004 to 2006 in a 286-bed acute care university hospital located in northern Italy employing 523 HCWs. The study cohort consisted of 473 HCWs continuously present in the hospital from 2004 to 2006. In 2005 and 2006, a vaccination campaign was made available in the wards that supplemented a pre-existing (2004) employee health service program. A personalized informative letter was sent to all HCWs explaining the risks and benefits of influenza vaccination for both patients and HCWs and indicating the scheduling of the additional vaccination service. The additional 2005 and 2006 campaigns produced significantly higher vaccination rates among HCWs than those achieved in previous years, from 10.4% in 2004 to 36.6% in 2005 and 23.2% in 2006. The year 2005 was characterized by an avian flu threat, which likely accounted for the highest vaccination rate of the 3-year study period. Physicians had the highest vaccination rates in the 3-year period (20.8%), while nurses in 2005 had the highest single vaccination rate (42.5%). Providing easy access to vaccination in the wards is a useful approach for improving vaccination rates among HCWs, but further tailored interventions are needed because overall vaccination rates remain too low. Subgroups, such as nurses and ancillary staff, should be considered as specific targets of such vaccination programs.

Transurethral vaporisation of the prostate plays a leading role among the techniques for BPH treatment. Between April and December 1995 the authors treated 49 patients with BPH, all of whom benefited immediately. Assessment at the 12-month follow-up highlighted a reduction in IPSS to 7 and an increase in mean PFR to 23 ml/s. Complications were minimal. The immediate advantages of EVAP are widely acknowledged: little bleeding, absence of TUR syndrome, short catheter drainage, shorter hospitalisation and lower costs. The good PFR and IPSS values at 12 months confirm the effectiveness and safety of this technique, making it, in our opinion, even more interesting and less invasive for the surgical management of BPH.

This study examines the socio-demographic characteristics of first-year students on first degree healthcare courses at Udine University (Italy). The survey tried to elicit useful information in a field where literature is scarce. Every student starting healthcare courses in the 2007/08 academic year was contacted and asked to fill in a questionnaire. Two hundred and sixty students were identified, belonging to six different courses: Nursing Sciences, Obstetric Sciences, Physiotherapy, Radiography, Neurophysiopathology Techniques, Biomedical Laboratory Techniques. Each questionnaire included 26 items (25 closed and one open) and had four sections: personal data, family data, training background, criteria affecting the decision to attend a healthcare course. The overall response rate was 87% (226 out of 260). Major findings were: women prevail on men (77% vs. 23%), many students chose these courses because some family member worked in the healthcare field (22.1%), 19.9% of students are older than 26 and 7.1% of them are postgraduates, 12% come from foreign countries, and job opportunities and former work experience influenced the choice of course. This database provides an important benchmark for comparing future trends among students in the healthcare profession in terms of socio-demographic characteristics and personal attitudes.

A voluntary professional quality improvement project involving preventive departments and vaccination centres of an Italian region was carried out through two surveys (in 2001 and in 2006) performed using a quality assessment manual including 12 standards and 157 criteria. After the first survey, a feedback was sent to all participating centres. All six local health authorities participated, as well as all regional vaccination centres, 48 in 2001 and 41 in 2006. The overall adherence rate to the criteria was 56.0% (3258/5820) in 2001 and 74.4% (3784/5085) in 2006. The improvement was obtained without mandatory interventions from regional authorities.

Objective: To know how Italian nursery and primary schools survey and manage children with food-related problems.Design: A pilot study during the period March-May 2005, filling out a questionnaire.Setting: All nursery and primary schools in a Northern Italian region (Friuli Venezia Giulia).Subjects: There were 479 eligible schoolsResults: Global response rate was of 29.6%. In 77.5% (110/142) of the schools there were children with food-related pathologies. Programs about nutrition were carried out by 44.4% (63/142) of the schools in the previous two years; 9.5% (6/63) dealt with food-related pathologies and 57.1% (36/63) required the intervention of outside experts to have these projects realized. In the same period training courses about nutrition for teachers were conducted in 9.2% (13/142) of the schools.Conclusions: Data provide a first overview of the situation in Italy on food-related topics in children attending nursery and primary schools. Therefore many programs could not rely on funds to be deve...

In Italy NHS Prevention Departments (PDs) are central in Public Health (PH) management. Objective was to describe profile of Medical Doctors (MDs) working at Italian PDs. The study, part of another survey, was conducted in 2003, using a phone questionnaire to administer to a sample of Italian MDs in PH. Response rate was 72.3% (603/833). Physicians of PDs were 255, 42.3% of whole sample. Job satisfaction mean (scale: 0-100) was 66.6 (SD = 19.3). 81.6% (208/225) of MDs said that Regions must monitor health status to identify collective risks and problems, while 77.3% (197/255) of them answered that function of State is to develop politics and planes to pursue individual and collective health. The study gives a positive frame of MDs at PDs. They were satisfied and persuaded of importance of State and Regions in PH management.

In the framework of the "1000-kV Project", it was agreed between ENEL and Societa Cavi Pirelli to carry out an extensive experimentation on an assembly including a 1100 kV self-contained, oil-filled cable and accessories, with a view to assess the reliability of such system intended for connections in power stations as well as for feeding areas with particular environmental constraints.

Un tema di centrale importanza, per conferire rilevanza scientifica ai risultati ottenuti nelle ricerche condotte adottando la tecnica della content analysis, è rappresentato dalla dimostrazione dell’affidabilità dell’indagine svolta. L’affidabilità di un’analisi di contenuto secondo Krippendorf (2004; 215) è legata all’osservanza di tre principi: - la stabilità, conferita dalla possibilità di attribuire le medesime codifiche in caso di replica dell’analisi in tempi diversi; - la riproducibilità, attribuita dalla possibilità di replicare l’analisi da parte di analisti differenti, che si trovano in condizioni diverse, sia temporali che spaziali, o utilizzando metodi di misurazione equivalenti ma non identici; - l’accuratezza, generata dalla conformità del processo di codifica posto in atto rispetto alle sue specifiche, da una parte, e dalla rispondenza dei risultati ottenuti dal processo di codifica effettuato rispetto a quelli che ci si aspettava che esso fornisse, in funzione di standard preesistenti o di studi precedentemente effettuati.

Il presente lavoro ripercorre alcune tra le principali ricerche nell'ambito della psicologia dell'età evolutiva, avviate dai primi allievi di Renzo Canestrari a partire dagli anni '50 del secolo scorso. In particolare, rilegge il percorso accademico degli allievi Marco Walter Battacchi e Giuliana Giovanelli, che hanno ricoperto la I e la II Cattedra di Psicologia dell'Età Evolutiva, poi Psicologia dello Sviluppo, nell'Ateneo di Bologna, ricordandone i principali contributi scientifici e didattici.Tra questi, i contributi, su numerosi temi, di Battacchi (il ritardo mentale, le difficoltà dei figli degli immigrati italiani in Germania, il pregiudizio etnico, la delinquenza minorile, lo sviluppo del pensiero e delle emozioni e i rapporti con il linguaggio e la teoria della mente) e di Giovanelli (modalità di valutazione e comunicazione tese a valorizzare le potenzialità di ogni bambino/a, psicologia della percezione, del tempo, del neonato a termine e pretermine e dei primi processi percettivi, cognitivi e linguistici) hanno dato un apporto innovativo e ampiamente riconosciuto a questa disciplina e ai primi 50 anni di storia dell'Istituto, poi Dipartimento, di Psicologia. Le loro idee e i loro lavori pioneristici hanno costituito un fondamentale riferimento per i nuovi gruppi di ricerca in ambito evolutivo sia nell'Ateneo di Bologna che a livello nazionale e internazionale.

This chapter presents a case study on the sustainability reporting and practices of CBD, a financial institution, and its journey of disclosure. The material presented explores CBD’s need to establish trust and legitimacy after a scandal forced them to their subsequent journey. In this setting, has its origins in corporate social responsibility and sustainability reporting initiatives (Dumay et al. 2016). Previous researchers have considered the evolution of the ESG reporting process at CBD but have not specifically focused on the years during which CBD participated in the Pilot Program or after it adopted the IIRC’s Guidelines (IIRC 2011), the Prototype (IIRC 2012), and the Framework (IIRC 2013), or their most recent reporting years up to 2016. Existing literature examines in its early stages and the limitations and shortcomings of the IIRC’s framework and practices (de Villiers et al. 2014). Therefore, studying companies in the process of implementing is valuable for identifying improvements to both the framework and how it is practised. Identifying improvements to both the Framework and ESG reporting practice is the motivation for this research. In doing so, this study picks up from where prior research by Beck et al. (2017) left off through an analysis of CBD’s integrated reports from 2010 to 2016. We analyse how CBD aligned its reporting to the IIRC’s principles during this period, considering the fact that CBD started its transition to before in 2010. Beck et al. (2017) explore the reasons why CBD began their journey toward and examine how their reports developed over the years. Their findings indicate that CBD’s reporting practices mainly focused on investors and other stakeholders to repair lost legitimacy after a scandal in 2004. It was not until 2010 that CBD seems to have regained trust and re-established legitimacy with its shareholders and stakeholders. However, despite deploying the framework, CBD, once again, became embroiled in further major scandals. It appears that implementing reporting practices only affected the public face of CBD; the organisational culture that allowed these scandals to happen did not change in line with the changes to reporting. Moreover, scandals are endemic to Australia’s financial industry, which further adds to the validity of our findings. The data used to develop this chapter was sourced through a review of publicly available documents published by the IIRC and CBD and builds on research by Dumay et al. (2015) and Beck et al. (2017). CBD is a pseudonym used to preserve anonymity in the previous studies and is continued here. The fact that CBD is an avid reporter and supporter of the Framework helps us understand the impact of .

PurposeThis paper seeks to analyse social report guidelines and practices within Italian local governments (ILGs). First, it compares the contents of the two Italian governmental guidelines for developing social reports in public sector organisations with the Global Reporting Initiative (GRI) guideline, to determine similarities and differences in disclosures. Second, it examines a group of social reports issued by ILGs, to explore the incidence, frequency, and quality of disclosure, as against the GRI guideline.Design/methodology/approachThe study uses content analysis to test the nature/content of the governmental guidelines, and to determine what was disclosed in a group of ILGs' social reports. The paper analyses the social reports by applying the Guthrie and Farneti coding instrument, extended by including the Italian governmental guidelines.FindingsSeveral observations emerge from the present study. First, from the comparison of the GRI and the Italian governmental guidelines, it emerges that only a few categories of the latter are similar to the GRI and these concern mainly general aspects. Second, the disclosure of categories and elements in the social reports, as against the coding instrument, was found to be fragmentary. The paper concludes that the Italian governmental guidelines are of a managerial nature, and they have little to do with sustainability, except for aspects related to labour.Originality/valueLittle research has been published on social reporting practices within the public sector, unlike the private sector. In Italy social reports are an emerging practice, with a growing interest paid by the government and academia. Nevertheless, published research is mainly of a normative nature, and there is a gap on what actually is in social reports.

The article is located in the social and environmental accounting research (SEAR) literature. A considerable body of work in the SEAR literature investigates the accounting and management practices and motives of businesses that report on their social, environmental or sustainability impacts. The potential value that researchers might derive in turning their attention to public services, social, environmental or sustainability practices, however, has been largely overlooked. The main objective of the article is to review relevant literature and ideas concerning accounting and accountability as key processes in advancing sustainability practices. The article also reviews the contributions to this PMR Special Issue and draws several conclusions.

Purpose: This case study explores how a global company does or does not adapt to climate change through changes in managerial action. Specifically, the research concerns a travel project in a global consulting company based in London, the stated aim of which was a 25% reduction of carbon emission generated by air travel in one year. The research explores the actions undertaken to achieve carbon emission reduction. Design: A case study method is employed to follow the travel project over one year to examine its contributions, if any, to carbon emission reduction. Findings: Several solutions were implemented by management aimed at reducing carbon emission by air travel. Travel incentive schemes to reduce flight travel were implemented, with a focus on new communication technology. Despite significant managerial effort, carbon was not reduced. When, at the completion of the analysis, the stated objective of achieving 25% carbon emission reduction had not been met, the company instead changed its targets to adapt too much higher levels of carbon emissions to meet its actual levels, which had increased significantly. Research limitations: This case study is limited to a branch of a global organisation, and the research focus was on air travel reduction over 12 months. Practical implications: The evidence suggests that voluntary corporate actions to reduce carbon emissions may not be workable in practice. Originality: This research examined a branch of a global company and how it tried to manage and account for a voluntary reduction of carbon.

Il processo di riforma della pubblica amministrazione, in particolare degli enti locali, che è iniziato nel 1990 e che tutt’ora è in piena fase di svolgimento, ha contribuito a introdurre in Italia principi e strumenti di accounting e di management provenienti dal contesto internazionale. L’azienda, infatti, privata o pubblica, deve sempre creare utilità, intesa rispettivamente, nei due settori, come profitto (ma non solo) o come soddisfazione ritraibile dai servizi resi disponibili ai cittadini (clienti-utenti). Per realizzare le rispettive finalità è opportuno servirsi degli strumenti manageriali che si ritengono più idonei, siano essi imposti dal dettato legislativo, oppure mutuati da best practice provenienti dal settore pubblico e da quello privato. Per far fronte alle esigenze dei cittadini, per realizzare in conseguenza le proprie finalità istituzionali, gli enti devono dar vita ad un razionale processo decisionale, individuando le strategie che saranno a loro volta articolate in obiettivi e sub-obiettivi, al fine di avere quale risultato la soddisfazione del cliente-cittadino. Nell’intendimento di ottenere concreti risultati, in termini di efficienza, efficacia ed economicità, che costituiscono i criteri gestionali attraverso i quali si deve affermare il principio costituzionale del Buon Andamento, è di conseguenza necessario innescare il circuito virtuoso della pianificazione, programmazione, gestione e, infine, del controllo che rialimenterà il circuito, iniziando ancora una volta dalla fase di pianificazione. La nuova opportunità che si è qui esaminata, è costituita dalla possibilità di utilizzare uno strumento che consente l’attuazione del processo appena espresso, permettendo di seguire la strategia dal momento della sua formazione a quello della sua realizzazione tramite la delineazione della balanced scorecard , (BSC) o scheda di valutazione bilanciata. Inoltre, lo scopo di questo capitolo è quello di delineare, anche per le amministrazioni pubbliche italiane, una via da seguire. Lo strumento è quello della BSC che, se applicato con correttezza, é in grado di permettere il traghettamento dalla tradizionale cultura burocratica, attenta agli adempimenti, a quella cultura manageriale, attenta ai risultati, che vuole essere l’obiettivo da realizzare attraverso il complessivo processo riformatore. Sulla base di queste indicazioni è stato analizzato il caso dell'Ente di Christchurch (Nuova Zelanda) come ente vincitore di un awrd per la miglior applicazione della BSC. I risultati raggiunti dalla città di Chirstchurch, guardando agli aspetti di maggiore rilievo, sono così individuati: 1. il livello dei servizi, atteso che la fornitura di servizi costituisce la ragione d’essere della municipalità, in seguito all’adozione della BSC, in circa quattro anni, dal 2006 al 2010, è cresciuto, nella percezione dei cittadini, da poco più del 60%, a oltre il 90%; 2. nel contempo i tassi d’incremento delle entrate sono diminuiti, sia con riferimento alla gestione passata sia a quella futura; 3. nel complesso questi due risultati, un aumento nella quantità e qualità dei servizi resi disponibili, unitamente a una riduzione dei costi, hanno cambiato lo scenario di riferimento. Chi scrive ha avuto modo d’intervistare nel corso del febbraio del 2011 alcuni dei maggiori protagonisti di questo straordinario risultato.

Il problema economico ha accompagnato la storia della civiltà sin da epoche remote. Allora, e tuttora in parte nei paesi in via di sviluppo, era rappresentato dal binomio risorse limitate e bisogni illimitati da soddisfare. Grazie alla produzione in serie e a prezzi più contenuti e, contestualmente, all’utilizzo della moneta come merce di scambio (e comune denominatore dei valori), si è potuto osservare una diversificazione dei bisogni degli individui, con l’aumentare del divario tra risorse a disposizione e bisogni da soddisfare. Inoltre si sono estremizzati comportamenti che oggi, in un diverso contesto culturale, possiamo definire in contrasto con la realizzazione del “bene comune”, con l’etica, quali l’utilizzazione delle risorse e la produzione di beni e servizi senza considerare il danno all’ambiente (per es., l’inquinamento), o senza considerare gli effetti sulla società (per es., lo sfruttamento del lavoro minorile). In sostanza, il problema economico consiste nella capacità di soddisfare i bisogni degli individui producendo beni e servizi che siano considerati i più soddisfacenti rispetto alle risorse disponibili, che per definizione sono limitate, trovando nelle aziende il principale strumento per soddisfarlo. Le aziende utilizzano infatti beni, o risorse/mezzi, che sono definiti “economici”, in quanto limitati e producono i beni e i servizi necessari per soddisfare i bisogni degli individui. “In questa capacità di soddisfare i bisogni degli individui e dunque di dare concreta soluzione al problema economico, è da riconoscere la finalità sociale dell’azienda, in quanto istituzione”. Nell’azienda, in particolare tramite il processo di acquisto-trasformazione-vendita e collocamento, i beni utilizzati perdono la loro utilità. Si può pertanto parlare di utilità consumata, poiché tale utilità non potrà più essere utilizzata nell’ambito di altri processi aziendali. A tale perdita si contrappone l’utilità resa disponibile attraverso la produzione di nuovi beni e/o di servizi. Il fine di tutte le aziende è pertanto quello di creare utilità attraverso lo svolgimento della loro attività, che è economica, poiché impiega beni scarsi. Ad esempio, in un’azienda industriale si consumano diverse tipologie di beni o servizi (beni a fecondità semplice e beni a fecondità ripetuta), che così perdono le loro rispettive utilità, quali il lavoro delle persone, i materiali impiegati, i servizi acquisiti dall’esterno. D’altra parte si producono però nuovi beni e servizi, che hanno una loro specifica utilità, ad essi riconosciuta dal mercato, attraverso il meccanismo della formazione dei prezzi, superiore (come dovrebbe essere) a quella consumata. Anche in una cooperativa si riproduce lo schema appena richiamato, in questo caso l’utilità consegue anche dalla “soddisfazione” ricavata dai produttori attraverso la cessione delle materie prime che loro stessi hanno prodotto, o dai lavoratori, attraverso le loro prestazioni, o dai consumatori attraverso i processi di acquisto ai quali partecipano. In una cooperativa sociale, invece, l’utilità relativa ai servizi prodotti viene direttamente percepita dagli utilizzatori, espressi da collettività predeterminate, molto spesso non solamente sulla base del prezzo pagato. In una pubblica amministrazione il più delle volte non vi è alcuna formazione dei prezzi all’interno di un mercato dei servizi prodotti e l’utilità è direttamente percepita dai cittadini utenti dei servizi rivolti alla soddisfazione dei bisogna della cittadinanza. La creazione di utilità nel lungo termine, che rappresenta la finalità per l’azienda, pur nell’ambito della eterogeneità del fenomeno aziendale, deve però essere considerata, secondo una concezione evoluta, che consegue da un’aggiornata concezione istituzionale che vede l’azienda come cellula della società civile, nel rispetto dell’etica, dei valori sociali e più in generale dello sviluppo sostenibile (SS).

Il contributo presenta l’aggiornamento e la revisione di un articolo dell’autrice, già pubblicato nel 2012 per la serie AMS Acta, sul tema dell’amministrazione di sostegno, introdotto nel nostro ordinamento quale risposta all’esigenza di offrire assistenza alle persone disabili. Il lavoro affronta il problema della distinzione tra la misura di protezione dell’amministrazione di sostegno e quelle ormai desuete dell’interdizione e dell’inabilitazione, per la soluzione del quale vengono presi in esame gli orientamenti espressi dalla Corte costituzionale, dalla Corte di Cassazione e dalla recente giurisprudenza di merito, nonché le opinioni espresse dalla dottrina. L’autrice individua quindi i soggetti deboli, beneficiari dell'amministrazione di sostegno che può contribuire a lenire le piaghe della vita delle persone fragili e vulnerabili attraverso il pieno rispetto della dignità e dell'identità e con la minor limitazione possibile della capacità di agire. Il contributo prende inoltre in considerazione il ricorso per l’istituzione dell’amministrazione di sostegno, con particolare riguardo al ruolo del giudice tutelare, alla scelta dell’amministratore di sostegno e all’oggetto dell’incarico. Particolare attenzione è dedicata alle direttive anticipate di trattamenti sanitari, espresse dal beneficiario.

Secondo gli autori il patto di famiglia, con il quale l’imprenditore trasferisce l’azienda o la partecipazione societaria ai discendenti, costituisce un contratto a effetti reali risolutivamente condizionato all’adempimento del dovere di liquidazione delle quote ai legittimari e necessariamente aperto alla partecipazione di questi ultimi. Gli autori ipotizzano, inoltre, che il dovere di liquidazione delle quote ai legittimari che grava sui discendenti assegnatari dia origine a un’obbligazione indivisibile ai sensi e per gli effetti degli artt. 1316 e 1317 c.c., con risultati utili ai fini della stabilizzazione degli effetti successori del patto. In base a queste premesse, si ritiene che il patto di famiglia non costituisca un nuovo tipo contrattuale né una donazione, bensì una nuova fonte di rapporti obbligatori alternativa al testamento (e alla donazione) certamente assimilabile, quanto a contenuto ed effetti, alle liberalità ex art. 809 c.c. Gli autori ne concludono che con il patto di famiglia viene sancita in via definitiva l’inidoneità del diritto successorio alla gestione (competitiva) del passaggio generazionale della ricchezza produttiva, consentendo altresì di ricondurre il contenuto del patto nell’ambito dell’attività svolta dall’imprenditore nell’esercizio dell’impresa.

Internationally, social and sustainability reporting has been widely debated (Adams and McNicholas 2007), both within the academic literature and at a political and practical level. Within this debate, the accounting and reporting techniques used are also central to discussions about sustainability (Unerman, Guthrie, and Striukova 2007). The various Global Reporting Initiative (GRI) guidelines (GRI 2006) are of particular interest because of their attempts to provide an international framework of reporting for all types of organisations. In Italy, a recent study demonstrated that there is a trend for Italian local governments to produce social reports, with 14 percent of municipalities and 38 percent of provinces producing social reports in 2005 (Siboni 2007). The current study aims to explore the social reporting in a selection of “better practice” Italian local government organisations and, in particular, to observe what has and has not been reported in comparison to the GRI guidelines. It uses an analytical framework developed in a prior study, in which the voluntary sustainability practices of a sample of Australian public sector organisations were examined (Guthrie and Farneti 2008). The specifi c research questions considered are: 1. What has been reported in Italian local government social reports? 2. What has or has not been reported in terms of the GRI guidelines? This examination of Italian local government organisations establishes that their stand-alone social reports are actually “social reports” in name only. There were relatively few environmental, social, labour, product, or wider societal disclosures when compared to the GRI guidelines.

Perché la PA dovrebbe intraprendere la rendicontazione di sostenibilità (RS) o rendicontazione sociale? In cosa consiste il concetto di RS e quali sono i contenuti dei report di RS (quali bilanci di sostenibilità, sociali, ma non solo)? Quali sono i contenuti delle best practice italiane nel 2011 poste in essere dagli enti locali (EL) in termini di RS? Le linee guida finora sviluppate, nazionali e internazionali, relative alla rendicontazione economico-sociale e ambientale, sono sufficienti a mettere gli EL nella condizione di assumere comportamenti virtuosi nella elaborazione dei documenti di RS? Quali sono i contenuti dei documenti di RS rispetto alle linee guida GRI? Quali sono le motivazioni che hanno determinato gli enti ad avviare pratiche di RS dal momento che si tratta di un’attività volontaria? Quali sono le riflessioni, relativamente agli aspetti critici e innovativi, con riferimento ai documenti di RS, emerse dall’analisi svolta? Si può pensare di parlare di creazione di valore pubblico sostenibile nell’ambito della PA e degli EL? Cosa sottende il concetto di “insostenibilità delle aziende” e della correlata necessità di un approccio “ecologically - and eco-justice” per la RS? La monografia risponde a questi interrogativi, approfondendo i concetti di sviluppo sostenibile, di insostenibilità, di RS, di sustainable management e di creazione di valore pubblico sostenibile, come specifica finalità dell’azienda pubblica, con particolare riferimento agli enti locali. Inoltre, analizza e discute i contenuti delle best practice 2011, mettendo in evidenza gli aspetti positivi, innovativi e le criticità rilevate. Le criticità e gli aspetti innovativi costituiscono la base per iniziare a riflettere su come dovrà essere la RS del prossimo futuro. I contributi dello studio potranno essere utilizzati dagli studiosi che si occupano del tema della RS, dai policy maker, dalle organizzazioni professionali e di ricerca che fanno riferimento alla RS, da tutti gli operatori (politici e tecnici) interessati a studiare, approfondire, realizzare e a mettere in pratica un management sostenibile e una RS della PA, in particolare, degli enti locali.

This study contributes to an understanding of the practice of social reporting in Italian bank foundations. Specifically, the study examines the views of the preparers of social reports. In Italy, the development of social reports for non-government organizations (NGOs) is voluntary. The research question is informed by a review of the relevant literature, which highlights key issues in relation to social reports. On the basis of this literature review the research question developed is: What is the perspective of those who prepare social reports and how did the issues identified influence in developing social reports? The research was conducted using a survey submitted to the preparers of social reports of all Italian bank foundations (BFs). The study found that social reports are mainly developed internally and there is little external assurance. Also, the study found that BFs used different media to communicate social information (e.g. internet and hard copy reports mailed to the main stakeholders). Finally, several benefits and constraints have been perceived in the preparation of social reports.

Il breve saggio prende in esame il progetto di Antonio Basoli per una villa reale destinata a Napoleone Bonaparte da realizzarsi a Zola, nel contado bolognese. Si presentano alcuni documenti inediti nel quadro di una pubblicazione destinata alla prima mostra monografica dedicata al Basoli.

This article analyses voluntary sustainability reporting practices in seven Australian public sector organizations which use the Global Reporting Initiative (GRI) guidelines. Reporting practices are diverse and the use of the GRI public agency supplement fragmented, with the annual report being only one of several media used by organizations for sustainability disclosures.