[Project financing in public hospital trusts]. / Il project financing nel settore ospedaliero.

The growing debate in recent years over how to finance public works through private capital has progressively highlighted the role of project finance (PF) and publicprivate partnerships (PPP) in general. More and more European countries are turning to PF to finance their public infrastructure development. The UK, which pioneered the adoption of project finance in this field, has been followed by Italy, Spain, France, Portugal and Germany and more recently by Greece, Czech Republic and Poland. Beginning in the late 1990's, Italy has steadily amplified its use of PF and PPPs in key sectors such as healthcare as an alternative way of funding the modernisation of its health facilities and hospitals. The trend reveal an average annual growth of 10.9% since 2002 with peaks of varying intensity over the five year period. Project finance and PPPs represent an effective response to the country's infrastructure gap and support the competitiveness of local systems and the quality of public services. None of this will transpire, however without energetic new planning efforts and adequate policy at the centre.

[Evolution of hospital concept in Italy]. / Evoluzione del concetto di ospedale in Italia.

Hospital building trade was born before the origin of Healthcare System and followed the complex development of healthcare during all the past years to present day. At the beginning of 700's, when infective pathology was predominant and hygienic conditions was parameter of quality, pavilions structure took place. These hospitals required wide land to be built on, with a high surface area to volume ratio and a horizontal development. There were about 1200-1500 sleeping accommodations in large rooms (ward) where patients were split up. The typical pavilions structure were used until half 900's when it was replaced with a new concept of building trade, the mono-polibloc. They were buildings with vertical development that minimized horizontal distances and operating costs. Every floor has confinement and service rooms and represent a single and autonomous operating unit. Nowadays hospitals building trade point to use the flat-tower model that enhance the distinction between confinement area (with a vertical development-monobloc) and diagnosis, care and services area (with a horizontal development-flat). The challenge we willface in the future is to convert healthcare buildings to other uses like trading centres and services areas, to improve structures' flexibility, to better include them in the context of the urban and natural setting.

[Drug misuse in the community: factors which influence patients to self-prescribe antibiotics]. / L'abuso di farmaci nella comunità: fattori che influenzano i pazienti ad autoprescrivere gli antibiotici.

This study aimed at deepening our knowledge about patients' non-compliance with antibiotic treatment, at determining which patients in our community use antibiotics without consulting a physician and at examining patient characteristics associated with such antibiotic misuse. The study focused on the correlation between self-prescribing antibiotic and socioeconomic and cultural status. Data were obtained by using a questionnaire-based survey and we computed univariate and multivariate analysis using chi-square test and logistic regression model. Of 663 respondents, 18.7% admitted using non-prescribed antibiotics. Multivariate analysis identified four variables associated with self-prescribing antibiotic: age [p= 0.009; for patients aged 25-44 and over 65 OR: 1.87 (95% C.I.: 0.66-5.32) and OR: 0.55 (95% C.I.: 0.17-1.80) respectively], gender [p=0.027; for women OR: 1.67 (95% C.I.: 1.06-2.64)], socioeconomic (p=0.022) and cultural status (p=0.037) where classes associated with high risk are the most elevated [for highest socioeconomic class OR: 3.99 (95% C.I.: 1.47-10.85) and for highest cultural class OR: 1.37 (95% C.I.: 0.65-2.86)]. Our study demonstrates that high socioeconomic and cultural status is associated with self-administering antibiotics. These results can be used to design appropriate interventions and target future educational campaigns to control and correct use of antibiotics.

Role of socioeconomic conditions on outcome in kidney transplant recipients.

INTRODUCTION: While deaths with a functioning graft have occurred more frequently in recent years, other nonimmunologic factors may have an important role in late allograft loss. These variables include socioeconomic and cultural status as risk factors for posttransplantation noncompliance with therapy. We examined the effect of socioeconomic and cultural status on graft and patient survival in a population of kidney transplant recipients. PATIENTS AND METHODS: This retrospective study included 223 kidney transplantations performed between September 2000 and December 2006. RESULTS: A significant improvement in graft and recipient survival was observed with increased educational achievement level. Subjects with a high school diploma or college degree demonstrated significantly better outcome. Recipients who had attended intermediate or technical schools were also significantly more likely to have a better outcome than the lowest educational group. Using the lowest socioeconomic class as a reference, a proportional hazard model demonstrated statistically significant benefit for better outcome in patients with skilled occupations. CONCLUSIONS: Results of the present study showed a significant difference in kidney transplantation outcome between different socioeconomic and educational classes. These results could help physicians to educate patients with end-stage renal disease to better understand long-term recovery after transplantation.