Gender differences in health expenditure determinants: A follow-up study.

Researchers' aim was to investigate if patients/physicians characteristics could differently affect males/females health care expenditure. In 2009/2010, a health-related-quality-of-life (HRQL) measure was distributed to 887 general practitioners' (GP) patients in Siena's province-Italy. Severity of diseases was calculated through Cumulative Illness Rating Scale Severity Index (CIRS-SI). Information about GPs' gender and age and patients' gender, age, and socio-economic variables were recorded. 2012 data about pharmaceutical, outpatient and hospital expenditure were obtained. Multivariate regression was carried out. In males, hospital expenditure increased with higher CIRS-SI and female GP whilst in females it was not influenced by any of the variables. Outpatient and pharmaceutical expenditure increased with aging, higher CIRS-SI, and lower HRQL and education, both in males and females. Gender differences in health expenditure determinants emerged for hospital expenditure.

Reported experience of patients with single or multiple chronic diseases: empirical evidence from Italy.

BACKGROUND: More and more countries have been implementing chronic care programs, such as the Chronic Care Model (CCM) to manage non-acute conditions of diseases in a more effective and less expensive way. Often, these programs aim to provide care for single conditions instead of the sum of diseases. This paper analyzes the satisfaction and better management of single and multiple chronic patients with the core elements of chronic care programs in Siena, Italy. In addition, the paper also considers whether the CCM introduced in Siena has any influence on satisfaction and better self-management. METHODS: Survey data from patients with single chronic (N = 500) and multiple chronic diseases (N = 454), assisted by the Local Health Authority in Siena (Tuscany, Italy), were considered for the analysis. Variables on education, monitoring system, proactivity, relational continuity, model of care (CCM versus no CCM) and patient demographics were used to detect which strategies are associated with a higher patient-reported ability to better self-manage the disease and overall patient satisfaction. Logistic and ordinary logistic models were executed on data related to patients with both single and multiple chronic diseases. RESULTS: The results showed that monitoring was the sole strategy associated with overall satisfaction and better self-management for both single and multiple chronic patients. Relational continuity also showed a significant positive association with better self-management perception for both patient groups, but had a positive association with patient satisfaction only for single chronic patients. Enrolment in the CCM was not associated with both overall satisfaction and better management for the two patient groups. CONCLUSIONS: Strategies that are significantly associated with satisfaction and perception of better disease self-management were the same for both single and multiple chronic patients. The delivery of care based on the Siena CCM does not seem to make a difference in the perception of better self-management and overall satisfaction for all the patients. Other concurrent strategies implemented by the regional government in Tuscany on primary care monitoring and health promotion could partially explain why CCM does not have a significant influence.

Patients' evaluation of hospital foodservice quality in Italy: what do patients really value?

OBJECTIVE: Patients often do not eat/drink enough during hospitalization. To enable patients to meet their energy and nutritional requirements, food and catering service quality and staff support are therefore important. We assessed patients' satisfaction with hospital food and investigated aspects influencing it. DESIGN: We conducted a cross-sectional study collecting patients' preferences using a slightly modified version of the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire (ACHFPSQ). Factor analysis was carried out to reduce the number of food-quality and staff-issue variables. Univariate and multivariate ordinal categorical regression models were used to assess the association between food quality, staff issues, patients' characteristics, hospital recovery aspects and overall foodservice satisfaction (OS). SETTING: A university hospital in Florence, Italy, in the period November-December 2009. SUBJECTS: Hospital patients aged 18+ years (n 927). RESULTS: Of the 1288 questionnaires distributed, 927 were returned completely or partially filled in by patients and 603 were considered eligible for analysis. Four factors (explained variance 64·3 %, Cronbach's alpha α(C) = 0.856), i.e. food quality (FQ; α(C) = 0·74), meal service quality (MSQ; α(C) = 0·73), hunger and quantity (HQ; α(C) = 0·74) and staff/service issues (SI; α(C) = 0·65), were extracted from seventeen items. Items investigating staff/service issues were the most positively rated while certain items investigating food quality were the least positively rated. After ordinal multiple regression analysis, OS was only significantly associated with the four factors: FQ, MSQ, HQ and SI (OR = 17·2, 6·16, 3·09 and 1·75, respectively, P < 0·001), and gender (OR = 1·53, P = 0·024). CONCLUSIONS: The most positively scored aspects of foodservice concerned staff/service, whereas food quality was considered less positive. The aspects that most influenced patients' satisfaction were those related to food quality.

Patient mobility for cardiac problems: a risk-adjusted analysis in Italy.

BACKGROUND: The Italian National Health System was revised in the last 20 years, introducing new elements such as efficacy, efficiency and competitiveness. Devolution to regional authorities has created a quasi-market system where patients can choose the hospital in which to be treated. Patient mobility therefore becomes an indicator of perceived hospital quality and of financial flows between the regions of Italy. Previous studies analyzed patient mobility in general or by specific disease/diagnosis-related groups but there is a lack of research on the influence of severity of patient condition. The aim of the study was to describe patient mobility, crude and stratified by disease severity, in cardiac surgery units of three health areas (HAs) in Tuscany (Italy). METHODS: In this retrospective observational study, data was gathered from hospital discharge records obtained from the Tuscan Regional Health Agency, Italy. The three HAs (HA1, HA2, HA3) recorded 25,017 planned hospitalizations in cardiac surgery units in the period 2001-2007. Patients were stratified in four All Patient Refined Diagnosis Related Group (APR-DRG) severity levels. Gandy's nomogram was used to describe how HAs met health care demand and their capacity to attract patients. Cuzick's test was used to identify significant differences in time trends. RESULTS: Raw data showed that the HAs met their own local health care demand. Stratifying by APR-DRG severity, it emerged that capacity to meet local demand remained unchanged for zero-to-minor severity levels, but one HA was less able to meet demand for moderate severity levels or to attract patients from other HAs and Regions of Italy. In fact, HA3 showed a decrease in admissions of local residents. CONCLUSIONS: The study highlights important differences between the three HAs that were only revealed by severity stratification: unlike HA3, HA1 and HA2 seemed able to deal with local demand, even after severity stratification. Planners and researchers can benefit from risk stratification data, which provides more elements for correct comparisons and interventions. In the context of patient mobility, the present study is a step in that direction.

Is it possible to evaluate addiction from clinical records? Testing a retrospective addiction severity evaluation measure.

AIM: To compare an addiction severity score estimated from clinical records to addiction severity index (ASI) scores. METHODS: During April-May 2004, 31 patients treated in a therapeutic community in the Piedmont region (Italy) were interviewed using the ASI questionnaire and their clinical records were used to obtain severity scores in seven areas: physical health, occupational functioning, alcohol use, drug use, legal problems, family/social relationships, psychological health. Correlation, agreement, and discriminatory capacity of the clinical records score in correctly classifying persons with low or high severity were investigated using Spearman, Kappa coefficient, and receiver operating characteristics curves. CONCLUSIONS: Clinical records score showed good correlation, agreement, and discriminatory accuracy with respect to ASI scores, especially in the drug use and legal problems areas. Further research is suggested to study the use of the score in other settings.

Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era.

In May 2018, the non-governmental organization (NGO) Doctors with Africa CUAMM began to implement an intervention to strengthen Chiulo Hospital's public health section to deliver immunization services in Mucope Comuna, Ombadja District. We aimed to evaluate the effect of this intervention. During the intervention period, actions such as staff training, improvement in the monitoring of vaccine stockpile, and the involvement of Community Health Workers were performed. The effects of the intervention on the number of vaccine doses administered were examined using negative binomial regression. Doses administered were 14,221 during the intervention period and 11,276 in the pre-intervention one. The number of administered doses was 26% higher (95% CI 9%-45%) in the intervention period than in the pre-intervention period. This was driven by vaccine doses administered during outreach sessions, where a statistically significant increase of 62% (95% CI 28%-107%) was observed. Regarding individual vaccines, statistically significant increases in the number of doses were observed for OPV2 (76%), OPV3 (100%), Penta3 (53%), PCV3 (53%), and Rota2 (43%). The NGO interventions led to improved delivery of immunization services in the study area. Greater increases were observed for vaccine doses that are more likely to be missed by children.

Night work and quality of life. A study on the health of nurses.

BACKGROUND: Job quality and evaluation of workers' health have both medical and social important implications. We studied health-related quality of life (HRQL) in nurses who perform their activity in night shifts. METHODS: A cross-sectional study was conducted between October and November 2014. Nurses who attended night shift in the Siena Teaching Hospital (Azienda Ospedaliera Universitaria Senese - AOUS) were sampled using EpiInfo software (confidence interval 95%) and investigated using the SF-36 Questionnaire. Our results were compared with the Italian general population (Apolone, 1997). A Descriptive analysis was conducted. Wilcoxon test, Pearson coefficient, t-test, Wilcoxon signed-rank test and logistic regression were used for the statistical investigation. RESULTS: 197 questionnaires were analyzed. Females were 71.7%; mean age was 39.2 years (DS 8.6); smokers were 37.8%. Males scores were higher than those of females in all dimensions of physical and mental health (p <0.05). The time taken to reach the place of work appeared to influence the dimension of General Health (coeff. -0.17); we found a worsening of 0.17 points of this dimension for every minute spent in travel. Men and nurses with more working years had a better score in Physical Pain dimension. AOUS nurses scored significantly (p <0.05) less compared with the correspondent Italian general population in General Health, Energy-fatigue, Social functioning, Physical functioning and Bodily pain. CONCLUSIONS: There is a significant relationship between night work and HRQL of nurses. The health profile of AOUS nurses' ranks below the values of the Italian general population in various dimensions.

Is it possible to sanitize athletes' shoes?

CONTEXT: Footwear should be designed to avoid trauma and injury to the skin of the feet that can favor bacterial and fungal infections. Procedures and substances for sanitizing the interior of shoes are uncommon but are important aspects of primary prevention against foot infections and unpleasant odor. OBJECTIVE: To evaluate the efficacy of a sanitizing technique for reducing bacterial and fungal contamination of footwear. DESIGN: Crossover study. SETTING: Mens Sana basketball team. PATIENTS OR OTHER PARTICIPANTS: Twenty-seven male athletes and 4 coaches (62 shoes). INTERVENTION(S): The experimental protocol required a first sample (swab), 1/shoe, at time 0 from inside the shoes of all athletes before the sanitizing technique began and a second sample at time 1, after about 4 weeks, April 2012 to May 2012, of daily use of the sanitizing technique. MAIN OUTCOME MEASURE(S): The differences before and after use of the sanitizing technique for total bacterial count at 36 °C and 22 °C for Staphylococcus spp, yeasts, molds, Enterococcus spp, Pseudomonas spp, Escherichia coli , and total coliform bacteria were evaluated. RESULTS: Before use of the sanitizing technique, the total bacterial counts at 36 °C and 22 °C and for Staphylococcus spp were greater by a factor of 5.8 (95% confidence interval [CI] = 3.42, 9.84), 5.84 (95% CI = 3.45, 9.78), and 4.78 (95% CI = 2.84, 8.03), respectively. All the other comparisons showed a reduction in microbial loads, whereas E coli and coliforms were no longer detected. No statistically significant decrease in yeasts (P = .0841) or molds (P = .6913) was recorded probably because of low contamination. CONCLUSIONS: The sanitizing technique significantly reduced the bacterial presence in athletes' shoes.

Which factors influence functional patients improvements during rehabilitation?

BACKGROUND: Rehabilitation in patients with disabilities is an important aspect of tertiary prevention. Severity of disability, evaluated by global measures of autonomy, are essential for functional outcome evaluation. AIM: To determine the effectiveness of a rehabilitation programme in terms of percentage functional improvement (PFI); to verify the role of gender, age and length of stay (LOS), by motor and cognitive domains, on PFI. DESIGN: longitudinal study. SETTING: An intensive rehabilitation hospital. POPULATION: 305 inpatients. METHODS: The disability has been investigated using the Functional Independence Measure (FIM). Percentage differences between discharge and admission were calculated for FIM score. Wilcoxon matched pair test for the six areas and the two domains of the FIM score were calculated. The effect of LOS, gender and age on PFI were studied with Robust regression. RESULTS: Neurological and Orthopaedic patients had improvements on Motor and Cognitive domains. The greatest gains were in the Self Care, Sphintere Control, Transfer and Locomotion Areas (p ≤ 0.001). LOS was associated (p < 0.001) with PFI while age resulted borderline significant (p=0.049) in the cognitive domain in Neurological patients. CONCLUSION: The rehabilitation improved the overall conditions of neurological and orthopaedic patients. LOS emerged as the most important determinant in PFI.

The effect of healthcare delivery privatisation on avoidable mortality: longitudinal cross-regional results from Italy, 1993-2003.

BACKGROUND: During the 1990s, Italy privatised a significant portion of its healthcare delivery. The authors compared the effectiveness of private and public sector healthcare delivery in reducing avoidable mortality (deaths that should not occur in the presence of effective medical care). METHODS: The authors calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy's regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of spending on public versus private healthcare delivery, controlling for potential demographic and economic confounders. RESULTS: Greater spending on public delivery of health services corresponded to faster reductions in avoidable mortality rates. Each €100 additional public spending per capita on NHS delivery was independently associated with a 1.47% reduction in the rate of avoidable mortality (p=0.003). In contrast, spending on private sector services had no statistically significant effect on avoidable mortality rates (p=0.557). A higher percentage of spending on private sector delivery was associated with higher rates of avoidable mortality (p=0.002). The authors found that neither public nor private sector delivery spending was significantly associated with non-avoidable mortality rates, plausibly because non-avoidable mortality is insensitive to healthcare services. CONCLUSION: Public spending was significantly associated with reductions in avoidable mortality rates over time, while greater private sector spending was not at the regional level in Italy.

Importance of sociodemographic and morbidity aspects in measuring health-related quality of life: performances of three tools: comparison of three questionnaire scores.

BACKGROUND: Since health-related quality of life (HRQL) measures are numerous, comparisons have been suggested. AIM: To compare three HRQL measures: SF6D, HUI3 and EQ5D. METHODS: Three questionnaires (SF36, HUI3, EQ5D) were administered to 1,011 patients attending 16 general practices in two Italian cities. Information about patients' gender, age, education, marital status, smoking, body mass index (BMI) and chronic diseases (hypertension, diabetes, cardiovascular and musculoskeletal diseases) were also collected. Questionnaires scores were calculated using the appropriate algorithms; in particular SF6D scores were obtained from SF36 items. Agreement and correlation between questionnaires scores were investigated using Bland and Altman method and Spearman coefficient. The influence of socio-demographic and morbidity indicators on scores was analysed using the nonparametric quantile regression. RESULTS: The Spearman coefficient was about 0.6 for all questionnaires. The 95% limits of agreement of the scores were approximately from -0.5 to 0.3 except for SF6D and EQ5D when they were from -0.4 to 0.2. The measures were influenced by socio-demographic and clinical variables in a similar way, especially SF6D (the index obtained from SF36) and EQ5D, which appeared to be influenced by the same pattern of factors, including gender, chronic diseases, smoking and BMI. CONCLUSIONS: Overall, the agreement between questionnaires scores was quite low, whilst the correlation level was good. Questionnaire scores were influenced by socio-demographic and clinical variables in a similar way, especially SF6D and EQ5D. Therefore, the descriptive capacity of SF6D and EQ5D was found to be similar.