Validation of the prevalence to incidence conversion method for healthcare associated infections in long-term care facilities.

INTRODUCTION: Residents of long-term care facilities (LTCFs) are a population at high risk of developing severe healthcare associated infections (HAIs). In the assessment of HAIs in acute-care hospitals, selection bias can occur due to cases being over-represented: patients developing HAIs usually have longer lengths of stays compared to controls, and therefore have an increased probability of being sampled in PPS, leading to an overestimation of HAI prevalence. Our hypothesis was that in LTCFs, the opposite may occur: residents developing HAIs either may have a greater chance of being transferred to acute-care facilities or of dying, and therefore could be under-represented in PPS, leading to an underestimation of HAI prevalence. Our aim was to test this hypothesis by comparing HAI rates obtained through longitudinal and cross-sectional studies. METHODS: Results from two studies conducted simultaneously in four LTCFs in Italy were compared: a longitudinal study promoted by the European Centre for Disease Prevention and Control (ECDC, HALT4 longitudinal study, H4LS), and a PPS. Prevalence was estimated from the PPS and converted into incidence per year using an adapted version of the Rhame and Sudderth formula proposed by the ECDC. Differences between incidence rates calculated from the PPS results and obtained from H4LS were investigated using the Byar method for rate ratio (RR). RESULTS: On the day of the PPS, HAI prevalence was 1.47% (95% confidence interval, CI 0.38-3.97), whereas the H4LS incidence rate was 3.53 per 1000 patient-days (PDs, 95% CI 2.99-4.08). Conversion of prevalence rates obtained through the PPS into incidence using the ECDC formula resulted in a rate of 0.86 per 1000 PDs (95% CI 0-2.68). Comparing the two rates, a RR of 0.24 (95% CI 0.03-2.03, p 0.1649) was found. CONCLUSIONS: This study did not find significant differences between HAI incidence estimates obtained from a longitudinal study and through conversion from PPS data. Results of this study support the validity of the ECDC method.

The medicolegal, psycho-criminological, and epidemiological reality of intimate partner and non-intimate partner femicide in North-West Italy: looking backwards to see forwards.

This paper addresses femicide in Italy. The assumption is that femicide is not a discrete act of killing a woman. It is assumed that depending on the types of relationship between the victim and the perpetrator (e.g., known versus unknown, intimate versus acquaintance), the risk processes may differ. When femicide involves the killing of an intimate partner, it is likely to be characterized by sustained and escalating intimate partner violence (IPV) that can reach its climax with extreme acts of violence that lead to intimate partner femicide (IPF). Eighty-six cases of femicide that occurred in North-West Italy between 1993 and 2013 were examined in this study. Findings suggest that femicide was disproportionately perpetrated by intimate partners (current or past), rather than strangers. IPF was likely to be the epilogue of an abusive relationship, with high levels of contentiousness and conflicts being the frequent significant precursors. Non-intimate partner femicide (NPF) was more likely to be characterized by antisocial or predatory motives, highly frequent when the victims were prostitutes.These preliminary findings suggest that joint scientific, professional, and political efforts are paramount in order to address strategies aimed at assessing the differential risk of IPV early in time so as to prevent it from escalating into IPF or NPF and to provide the appropriate support for victims and their families.