Oral health inequalities in preschool children in North-Eastern Italy as reflected by caries prevalence.

AIM: To investigate dental caries experience among preschool children aged 3-5 years living in 2 Health Districts in North- Eastern Italy and to compare caries experience between indigenous and immigrant children. STUDY DESIGN: Cross-sectional observational survey. METHODS AND STATISTICS: In this study 4,198, 3-5-year-old children, drawn from a total population of 9,829 were asked to participate. The examinations were performed at school between October 2004 and June 2005 and only lesions that penetrate the dentine were recorded (according to the BASCD criteria, 1997), by 2 calibrated examiners using artificial light, mouth mirrors and dental probes. The participants were categorised into 2 subgroups according to the country of origin of their mothers: indigenous mothers, almost all born in Italy, plus a very small number of mothers born in other highly developed western countries--"western origin"--(Nordic countries, Western Europe, North America, New Zealand and Australia), and immigrant mothers from Eastern Europe, Asia, Africa, Turkey, South and Central America, "non-western origin". Comparisons between groups were made using Pearson chi-squared test. Caries risk estimation was established by logistic regression analysis to assess the influence of gender, age and ethnicity on caries experience. Risk was summarised as odds ratio plus 95% CI. RESULTS: A total of 3,401 pre-school children were examined. The overall prevalence of dentinal caries was: 15.4% in 3-year-olds, 24.2% in 4-year-olds and 31.1% in 5-year-olds. At the same ages, children of immigrant mothers ("non-western origin") showed a significantly higher prevalence of caries compared with their counterparts of "western origin". As expected, older children had more caries. "Non-western origin" had a negative effect on caries experience. CONCLUSIONS: Inequalities associated with mothers with an immigrant background were observed in the distribution of caries experience among the children. These children represent the first generation settling in and growing up in Italy, and their dental status-related data are comparable to those observed at the same ages in first generation "non-western" children living in other industrialised countries.

A new model of integrated home care for the elderly: impact on hospital use.

The objective of the present study was to examine the effect of a home care program based on comprehensive geriatric assessment-Minimum Data Set for Home Care-and case management on hospital use/cost of frail elderly individuals. We determined all hospital admissions and days spent in hospital during the first year since the implementation of the home care program, and compared them to the rate of hospitalization that the same patients had experienced in the year preceding the implementation of such program. Following the implementation of this program, there was a significant reduction of the number of hospitalizations (pre 44% vs. post 26%, P < 0.001), associated with a reduction of hospital days, both at the individual patient level and for each admission. In conclusion, an integrated home care program based on the implementation of a comprehensive geriatric assessment instrument guided by a case manager has a significant impact on hospitalization and is cost-effective.

Impact of integrated home care services on hospital use.

OBJECTIVE: To examine the effect of a home care program based on comprehensive geriatric assessment and case management on hospital use and costs among frail older individuals. DESIGN: Quasi-experimental study with a 6-month follow-up. SETTING: Vittorio Veneto, a town in northern Italy. PARTICIPANTS: One hundred fifteen frail older people who applied for integrated home care services. INTERVENTION: Each patient was assessed with the Minimum Data Set for Home Care, and, subsequently, a case manager and a multidisciplinary team delivered social and health care services as indicated. MAIN OUTCOME MEASURES: We determined the hospital admissions and days spent in the hospital for all subjects during the first 6 months after the implementation of the home care program and compared them with the rate of hospitalization that the same patients had experienced in the 6 months preceding the implementation of the program. RESULTS: After the implementation of the integrated home care program, there was a significant reduction in the number of hospitalizations compared with pre-implementation (56% vs 46%, respectively; P < .001), associated with a reduction in the number of hospital days, both at the individual patient level (28+/-23 days vs 18+/-15 days, respectively; P < .01) and for each admission (16+/-12 days vs 12+/-8 days, respectively; P < .01). This resulted in a 29% cost reduction with an estimated savings of $1260 per patient. CONCLUSIONS: The implementation of an integrated home care program based on the use of a comprehensive geriatric assessment instrument guided by a case manager has a significant impact on hospitalization and is cost-effective.