The Role of Maternal Citizenship on Pediatric Avoidable Hospitalization: A Birth Cohort Study in North-East Italy.

OBJECTIVE: Avoidable hospitalization (AH) has been widely studied as a possible measure of primary health care performance. Since studies evaluating AH in migrant children, particularly in Europe, are lacking, the aim of this study was to investigate the role of maternal citizenship on the risk of AH in children. METHODS: The cohort study included all live newborns recorded in the Medical Birth Register (MBR) of Friuli-Venezia Giulia Region (Italy) in the years 1989-2012, followed from 30 d after their birth up to the 14th year of life. Cox regression models were used to estimate Hazard Ratios (HRs) for any AH and for specific conditions. RESULTS: Among the 213,635 children included in the cohort, authors identified 23,011 AHs in 16,744 children, most of which occurred between 1 and 4 y of age. Children born to mothers from High Migration Pressure Countries had a higher risk of AH for any condition (HR 1.35; 95% CI = 1.27-1.44) than children born to Italian mothers. The risks were higher concerning gastroenteritis (HR 1.74; 1.57-1.94), upper respiratory tract infections (HR 1.58; 1.35-1.84), asthma (HR 1.53; 1.12-2.06) and bacterial pneumonia (HR 1.18; 1.01-1.37). There were no differences in urinary tract infections, short term complications of diabetes and perforated appendix. CONCLUSIONS: Despite the inclusiveness and universality of the Italian healthcare system, children born to immigrant mothers experienced more need of avoidable hospital care than children born to Italian mothers. Access barriers to primary care are plausible causes for the observed disparities.

[Individual and health care factors, and one-year hospital readmission of elderly patients in Friuli Venezia Giulia, Northeastern Italy]. / Fattori individuali e legati all'assistenza associati ai ricoveri ripetuti entro un anno da un precedente ricovero nella popolazione anziana del Friuli Venezia Giulia.

OBJECTIVE: we investigated both individual and health care risk factors for one-year readmissions of medical patients in the Friuli Venezia Giulia Region, Northeastern Italy. DESIGN: we conducted a retrospective cohort study based on administrative databases. SETTING AND PARTICIPANTS: the cohort was made of all the patients who were admitted for any cause to non surgical wards of any regional or extraregional hospital and discharged from 01.01.2008 to 31.12.2009, excluding one-day stays, and who were 65 years of age, residing in Friuli Venezia Giulia upon admission, and still alive one year after discharge. MAIN OUTCOME MEASURES: we measured the frequency of one-year readmission or death and identified patient-level risk factors and Health Districts and Hospitals performing differently from the average. Multivariable logistic regression was used, accounting for data clustering. RESULTS: over 30% of the patients who were still alive one year after the index discharge were readmitted to hospital. Individual risk factors include age, comorbidity, cause of the index admission. Furthermore, being admitted to nursing homes or hospice after discharge is associated with increased risk of readmission. We identified an area of the region where five Districts performed worse than the average. CONCLUSION: we identified groups of the elderly population at high risk of poor outcomes after hospital discharge and a source of possible disparity in post-discharge health care in the Friuli Venezia Giulia region. These results are the starting point for further inquiries and for improvement of the regional systems of health care delivery.

Extension of organised cervical cancer screening programmes in Italy and their process indicators.

Since 1996, Italian national guidelines recommend that Regions implement organised screening programmes for cervical cancer. As in previous years since 1998, we have collected from Italian organised cervical screening programmes aggregated tables of data in order to centrally compute process indicators. In 2006, the target population of Italian organised screening programmes included 11,362,580 women, corresponding to 69% of Italian women aged 25-64 years. However, taking into account the proportion of women invited, the actual extension was 52.9%. Compliance to invitation was 38.5%, with a clear North-South decreasing trend. It should, however, be considered that many women are screened outside the organised programmes. The remaining process indicators deal with women invited during 2005 and screened up to April 2006 Of these, 6.1% were recommended to repeat cytology and 57% of them complied; 2.3% of screened women were referred to colposcopy. Compliance to colposcopy was 84.7% among women referred because of ASCUS or more severe cytology and 90% among those referred because of HSIL or more severe cytology. The positive predictive value (PPV) of referral because of ASCUS or more severe cytology for CIN2 or more severe histology was 16.8%. There was a relevant variability of both referral rate and PPV that were inversely related. The unadjusted detection rate of histologically confirmed CIN2 or more severe was 2.7 per 1,000 screened women (2.6 standardised on the Italian population, truncated 25-64).