Access to health services for undocumented immigrants in Apulia.

This paper, part of a larger epidemiological study carried out between 2004 and 2010, analyzed immigrants frequenting the largest Apulian regional hospital (Bari Policlinico). Our aim was to evaluate the perception on the part of undocumented immigrants of their rights of access to the National Health Care services and whether this privilege is actually utilized. An anonymous multi-language questionnaire was distributed to all patients with STP (code number for temporary presence of foreigners) at the immigrant outpatient Infectious Diseases Clinic of Bari from June 2009 to June 2010. Questions were related to nationality, date of arrival in Italy, use of health facilities in the 2 years prior to the compilation of the questionnaire, and their understanding of STP. The patients were also screened for infectious diseases (HIV-Ab, HBsAg, HCV-Ab, VDRL, TPHA and Mantoux). A total of 256/272 patients completed the questionnaire; the meaning of STP was unknown to 156/256 (60.9%) patients, only 54/256 (21%) knew the exact meaning of STP and only 42/54 (76.6%) of the latter knew how long STP was valid. Moreover, 128/256 (50.7%) were aware that doctors from the emergency unit were not allowed to notify police regarding presence of illegal immigrants. Regarding clinical data 3% were HIV+ (8/256), 5% (13 patients) positive for TPHA, 5% for HBsAg, 2% were HCV (five patients). A >10 mm diameter infiltrate of Mantoux test was noted for 44% of patients. A lower prevalence than expected for infections such as HIV, HBV or HCV was noted for immigrants compared to data from their countries of origin. At present, large-scale political solutions to the challenges of facilitating access to health facilities for undocumented immigrants are lacking in Italy. The development of communication systems is fundamental to improving access to health services and to creating links between immigrants and the healthcare system.

Ultrasonography in early assessment of elderly patients with polymyalgic symptoms: a role in predicting diagnostic outcome?

OBJECTIVE: To study the usefulness of ultrasonography (US) in predicting the diagnostic outcome in patients with polymyalgic symptoms. METHODS: Sixty-one elderly patients with polymyalgic syndrome were recruited in a secondary care setting and followed up in a prospective way. Clinical, laboratory, and US data obtained at onset were re-evaluated after 1 year when diagnostic outcome was defined. RESULTS: A diagnostic shift was observed in 32 polymyalgic patients (52%). Calcium pyrophosphate deposition disease (CPDD) was diagnosed in nine patients, elderly-onset rheumatoid arthritis (EORA) in 18, and elderly-onset spondyloarthritis (EOSpA) in five. In polymyalgia rheumatica (PMR) patients US demonstrated synovitis in 90% of cases, in both proximal (90%) and peripheral joints (41%). The best predictive US model for the definitive diagnosis of PMR comprised: the presence of subacromial-subdeltoid bursitis [odds ratio (OR) 5.603, p = 0.003], low frequency of wrist (OR 0.074, p < 0.001), metacarpophalangeal (OR 0.052, p < 0.001), and metatarsophalangeal effusion/synovitis (OR 0.107, p < 0.027), low frequency of knee menisci chondrocalcinosis (OR 0.091, p = 0.013), tendinous calcaneal calcifications (OR 0.078, p = 0.006), and Achilles enthesitis (OR 0.107, p = 0.027), and low power Doppler US (PDUS) scores at wrist (OR 0.052, p < 0.001). CONCLUSIONS: US and PDUS can be useful in distinguishing, at onset of disease, pure PMR from other diseases mimicking this condition.

Sonographic assessment of fetal spine and head position during the first and second stages of labor for the diagnosis of persistent occiput posterior position: a pilot study.

OBJECTIVES: The aim of this pilot study was to perform a preliminary investigation into the predictive values of the position of the fetal spine and of the occiput measured during the first and second stages of labor by intrapartum ultrasound for persistent occiput posterior (OP) position. METHODS: This was a prospective, cohort study, in which 100 women with singleton pregnancies were enrolled during the first or second stage of labor. The women underwent intrapartum transabdominal sonography and the positions of the fetal head and spine were recorded. The women were followed up until delivery and occiput position at birth was assessed. RESULTS: Eighty-four pregnancies were evaluated in the second stage of labor, with 74 of these also evaluated in the first stage. Fifty-one percent of fetuses were found to be in an OP position during the first stage of labor, but the majority of these rotated to an anterior position before delivery. There were six cases of OP at delivery, and all of these were among the 23 fetuses that were found to be in an OP position on ultrasound evaluation during the second stage of labor. All six were also found to have a posterior spine position during the second stage of labor, with this finding observed in only one fetus with occiput anterior position at delivery. CONCLUSIONS: The results of this study suggest that the position of the head and spine during the second stage of labor could be useful indicators for predicting the OP position at delivery. The results also suggest that the OP position at delivery results from a failure of rotation from the OP position, rather than a malrotation from the anterior position. Studies with larger sample sizes are needed to confirm these results.

Assessment of the QoL in Italian menopausal women: comparison between HRT users and non-users.

OBJECTIVES: The aim of this cross-sectional study was to describe QoL in a large sample of women attending menopause centres and compare untreated postmenopausal women and matched HRT users by employing the Women's Health Questionnaire (WHQ) and two generic instruments, the SF-36 and the EQ-5D. METHODS: Overall, 2906 women were recruited by 64 menopause centres throughout Italy, of whom 2160 filled in the questionnaire (1093 on HRT and 1067 not on HRT; response rate: 74%). RESULTS: HRT users tended to be younger, healthier and with shorter menopause duration as opposed to non users, while no major socio-economic differences were present. At multivariate analysis, the presence of chronic diseases, low socio-economic status and living in Southern Italy represented the most important predictors of poor QoL. Furthermore, HRT users showed a lower probability of reporting problems in usual activities and pain/discomfort (EQ-5D), role limitations due to emotional problems (SF-36) and anxiety/fears (WHQ). HRT users also showed highly significant better outcomes in those areas that are more directly attributable to hormonal changes of mid age, namely vasomotor symptoms and sexual problems. CONCLUSIONS: Although QoL is mainly influenced by socio-economic and cultural factors, HRT has the potential for improving not only symptoms, but also more general aspects of physical and psychological well-being of symptomatic postmenopausal women.

Validation of Italian version of the Women's Health Questionnaire: assessment of quality of life of women from the general population and those attending menopause centers.

OBJECTIVES: The Women's Health Questionnaire has been developed and validated in Anglo-Saxon and Swedish populations. The purpose of this study was to evaluate the Italian version of the questionnaire to determine whether cross-cultural differences exist in the perception of quality of life, and to use it to compare the quality of life in women attending menopause centers with that of women in the general population. METHODS: An Italian version of the Women's Health Questionnaire (WHQ) was produced, using the forward-backward translation method to ensure conceptual equivalence, and approved by the originator. Women were recruited by random selection from the general population and from menopause centers, those taking hormone replacement therapy being ineligible. The questionnaire was completed anonymously at home and mailed to the co-ordinating center. Psychometric evaluation included tests of item convergent and discriminant validity, internal-consistency reliability, test-retest reliability, construct validity and the discriminative properties of the questionnaire. RESULTS: The completeness of the data was good, with missing-value rates consistently low for most items. Item-scale correlations, used to evaluate internal consistency, were also good and the scaling success rate, used to measure item discriminant validity, was high for all scales. Scale scores were reliable for seven out of nine scales and test-retest reliability was excellent. There were few significant differences between the two populations of women in most of the WHQ areas. A comparison of Italian data with published data on English women showed great similarity. CONCLUSION: The Italian version of the WHO is valid and reproducible. The subjective perception of the menopause and its related problems is similar in geographically and culturally different populations.

The use of a starting dose of recombinant follicle stimulating hormone for controlled ovarian hyperstimulation: a randomized pilot study.

The aim of this study was to compare the costs and effects of two different controlled ovarian hyperstimulation treatments: a starting dose of recombinant follicle stimulating hormone (FSH) followed by highly purified urinary FSH; or highly purified urinary FSH alone. Forty-six infertile patients, after being given luteal gonadotropin-releasing hormone (GnRH) agonist, were randomly assigned to the two stimulation protocols. During the ovarian stimulation regimen the patients underwent transvaginal ultrasonographic evaluation of follicular number and size. The retrieved oocytes were classified on the basis of the criteria of Acosta and colleagues. To study the impact of embryo quality on implantation, the embryos were graded morphologically before replacement. Pregnancy rates were ascertained and the costs of the two different protocols were analyzed. The number of days of FSH stimulation and the cost of gonadotropin treatment were similar in both groups. The number of follicles > 17 mm in size, the number of collected oocytes, and pregnancy rate per cycle were significantly higher in the group partially treated with recombinant gonadotropin. We conclude from these results that the use of recombinant FSH in the early phase of controlled ovarian hyperstimulation leads to significant improvements in pregnancy rate per cycle without increasing the costs of treatment.

Effect of long-term local or systemic hormone replacement therapy on post-menopausal mood disturbances. Influences of socio-economic and personality factors.

OBJECTIVES: To clarify the effect exerted by hormone replacement therapy (HRT) versus socio-economic and personality factors in improving postmenopausal mood disorders. STUDY DESIGN: The effect of the 1-year administration of systemic hormone replacement therapy (HRT; n = 22) or a vaginal cream of estriol (n = 14) versus no treatment (n = 26) was evaluated on mood states of anxiety, depression, somatization and inadequacy, as evaluated by the symptom rating test (SRT) scale. Results were correlated with the woman socio-economic status, and her capability to cope with daytime distresses, as evaluated by the Coping Style questionnaire. RESULTS: A spontaneous decline of all SRT scores, except that of inadequacy, was observed in the group with no treatment. In comparison HRT induced a greater improvement of only the SRT score of inadequacy (P < 0.01) and to a lesser extent of anxiety (P < 0.06). Similarly, vaginal estriol induced a greater decline of the SRT score of inadequacy (P < 0.01). Multiple regression analysis showed that modifications of the total SRT score and the SRT score of anxiety were related mainly to socio-economic factors, while those of the SRT score of depression were related only to the coping style of the woman. The decline of somatization was related only to time since the menopause while, the reduction of the SRT score of inadequacy was only the consequence of therapy, either systemic or local. CONCLUSIONS: In a 1-year period improvement of post-menopausal psychological discomfort, is spontaneous and independent of therapy. Only symptoms of inadequacy are improved by the hormonal therapy. Likely, the perceived menopausal 'losses' make the woman to feel inadequate and the use of sex-related hormones is capable to improve this feeling.

[Computerized tomography and magnetic resonance in the evaluation of patients with Crohn disease. Their role in the identification, assessment of extent and management of the disease]. / Valutazione con tomografia computerizzata e risonanza magnetica dei pazienti con morbo di Crohn. Ruolo nella identificazione, nel bilancio di estensione e nella gestione della malattia.

In this study we evaluated the role of barium examinations and above all computed tomography and magnetic resonance imaging in the study of Crohn's disease. CT is most often requested for patients with suspected or known intraabdominal or pelvic abscesses. MR plays a very important role in the localization of perirectal and perianal abscesses.

[Magnetic resonance in the diagnosis, characterization, and assessment of renal carcinoma extension]. / La RM nella diagnosi, nella caratterizzazione e nel bilancio di estensione del carcinoma renale.

Many authors discussed the reliability of MR imaging in the diagnosis of small tumoral masses (less than 1.5 cm) affecting the kidney, and stressed its low diagnostic power. On the other hand, MR imaging is a useful technique in the study of renal masses, for its capability in the differentiation of adipose tissue (angiomyolipomas), fluid content (cystic lesions), parenchymatous tissues (neoplastic lesions). The distinction between malignant and benign masses is often impossible on the basis of MR except in the cases of invasion of the adjacent structures. MR imaging is, at present, the most accurate method in the staging of neoplastic masses of the kidney.

Caries experience, treatment needs and treatment supplied among an adult Israeli population.

Information on coronal and root caries in an Israeli adult population including treatment needs has never been conducted. A sample of 2,931 adults ranging in age from 20 to 65 were selected for this longitudinal survey. The sample included both city and kibbutzim dwellers. All examinations were performed by one experienced epidemiologist utilizing the method of Radike for coronal caries. A method outlined by the National Institutes of Health was utilized for scoring of root surface recession and caries. Results indicate a 6.94 decayed and filled teeth (DF-T) mean score for the coronal caries experience and a 2.48 missing teeth (M-T) score. The total decayed and filled surfaces (DF-S) score for the examined population was 11.91. Root DF-S was found to be 1.10 among males and 0.99 among females with a total mean of 1.04. Premolars were found to have more crowns than other teeth, while molars had the highest missing score (1.53). DF-S score of 6.78 was indicated for molars, in addition to a high missing surfaces (M-S) value of 7.63 for molars. Main obstacles to dental care are lack of knowledge and financial barriers. These findings recognize an immediate need for public educational programs and regular professional care in order to increase public awareness of their dental status, encourage improved primary prevention, and seek secondary and tertiary care.

[Target cimetidine treatment of peptic ulcer. Considerations and assessment of a new dosage]. / Terapia cimetidinica mirata dell'ulcera peptica. Considerazioni e valutazioni su un nuovo dosaggio.

32 patients suffering from peptic ulcer have been selected. Of these 12 formed part of a previous series treated with cimetidine and subsequently relapsed; the other 20 were selected on the basis of endoscopic and functional examinations and were treated for the first time with cimetidine. The drug doses used were 1.2 g for 30 days and 0.3 g for a further 60 days. The purpose of the study was to check for possible recurrences by comparing the results obtained and their maintenance in the long term using these doses. 2 months after suspension of maintenance treatment there has not been any recurrence of the acute pain and dyspeptic symptomatology.