RESUMEN
BACKGROUND: Cervical, breast and colorectal cancer (CRC) screenings are universally recommended interventions. High coverage of the target population represents the most important factor in determining their success. This systematic review aimed at assessing the effectiveness of population-based screening programs in increasing coverage compared to spontaneous access. METHODS: Electronic databases and national and regional websites were searched. We included all studies on interventions aimed at increasing screening participation published between 1999 and 2009; for those published before, we consulted the Jepson et al. review (2000). We compared spontaneous access (including no intervention) vs population-based screening programs actively inviting the target population. Among the latter, we compared GP-based vs invitation letter-based interventions. RESULTS: The invitation letter vs no intervention showed significantly more participation (RR=1.60 95%CI 1.33-1.92; RR=1.52 95%CI 1.28-1.82; RR=1.15 95%CI 1.12-1.19, for breast, cervical and CRC screenings, respectively). GP-based interventions, although more heterogeneous, showed a significant effect when compared with no intervention for breast (RR=1.74 95%CI 1.25-2.43), but not for cervical and CRC. No significant differences were found between invitation letter-based and GP-based organization (RR=0.99 95%CI 0.94-1.05; RR=1.08 95%CI 0.99-1.17, for breast and cervical cancer, respectively). CONCLUSION: Population-based programs are more effective than spontaneous screening in obtaining higher testing uptake. Both invitation letter-based and GP-based programs are effective.
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Promoción de la Salud/métodos , Tamizaje Masivo/estadística & datos numéricos , Neoplasias/diagnóstico , Prevención Primaria/métodos , Adulto , Anciano , Neoplasias de la Mama/diagnóstico , Neoplasias Colorrectales/diagnóstico , Femenino , Medicina General , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/prevención & control , Neoplasias del Cuello Uterino/diagnósticoRESUMEN
Waiting lists are one of the main Public Health issues within developed countries. To promote appropriateness about General Practitioners' (GPs) prescriptions, during 2009 the project "Priority setting in outpatient prescriptions" in Latium Region has been approved. Regional referees, Latium Public Health Agency managers and advisors, managers and advisors of three Local Public Health Units (LPHUs) within the Latium region and some voluntarily recruited General Practitioners (each one with more than 800 patients enrolled) were included in a team work with the duty to develop the project. During two selected months of 2010, 46 GPs have forwarded overall 2.229 medical prescriptions. The six most numerous prescriptions were picked out and analyzed by the team work. 42% of these prescriptions were identified as belonging to category D of the priority level--"standard", while 42% and 41% of prescriptions bore the expressions of "control" and "diagnostic purpose" respectively. Among these ones, 75% were represented by bilateral mammography, prescribed to women aged between 50 and 69 years: but for those people bilateral mammography is already provided free of charge within the regional program of breast cancer screening, making the routine prescription by their physician a useless duplication, unacceptable in a healthcare system of good quality. Therefore at the conclusion of the project, the team work suggests proper standards be applied by healthcare professionals and GPs to achieve a significant objective: mammography appropriateness prescriptions.
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Manejo de la Enfermedad , Médicos Generales , Pacientes Ambulatorios , Pautas de la Práctica en Medicina/normas , Prescripciones/normas , Salud Pública , Derivación y Consulta/normas , Listas de Espera , Logro , Anciano , Países Desarrollados , Prescripciones de Medicamentos/normas , Femenino , Médicos Generales/estadística & datos numéricos , Humanos , Italia/epidemiología , Masculino , Mamografía/normas , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Prescripciones/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud , Derivación y Consulta/estadística & datos numéricosRESUMEN
Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia and is an important risk factor for mortality and morbidity related mainly to an increased risk of cerebrovascular events and heart failure.An observational cross-sectional study was performed to evaluate the use of healthcare resources (including hospital and outpatient care) by patients with AF in the Lazio region (central Italy), from 1 January 2006 to 31 December 2008.Atrial fibrillation is an important source of healthcare resource utilization because of repeated emergency room visits, hospital admissions, outpatient consultations and procedures and extensive use of laboratory tests and pharmacological treatments.Results show that 55% of costs are attributable to hospital admissions and Emergency Room visits, 37% to pharmacological treatment and the remaining 8% to outpatient care. These results are consistent with the international literature.The impact of AF in terms of cost is not negligible and it is therefore desirable to implement an organizational scheme that safeguards the appropriateness of care, taking charge of the patient as early as possible. The aims of early diagnosis of AF are to improve the appropriateness of care and optimize the use of specialized tests, thereby reducing hospital admissions for complications or recurrences of AF.
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Fibrilación Atrial/economía , Costos de la Atención en Salud/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
We report preventive measures adopted after tuberculosis(TB) transmission from a nurse to a newborn assessed in late July 2011. All exposed neonates born between January and July 2011 were clinically evaluated and tested by QuantiFERON TB gold in-tube; newborns testing positive were referred for prophylaxis.Of 1,340 newborns, 118 (9%) tested positive and no other active cases of TB were found. Active surveillance for TB will be continued over the next three years for all those exposed.
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Brotes de Enfermedades , Hospitales Pediátricos , Hospitales Universitarios , Transmisión de Enfermedad Infecciosa de Profesional a Paciente , Enfermería Maternoinfantil , Servicio de Ginecología y Obstetricia en Hospital , Tuberculosis Pulmonar/transmisión , Tuberculosis Esplénica/transmisión , Adulto , Antituberculosos/uso terapéutico , Trazado de Contacto , Salud de la Familia , Femenino , Humanos , Inmunidad Celular , Lactante , Recién Nacido , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Interferón gamma/metabolismo , Masculino , Tamizaje Masivo , Mycobacterium tuberculosis/aislamiento & purificación , Vigilancia de la Población , Embarazo , Ciudad de Roma/epidemiología , Esputo/microbiología , Prueba de Tuberculina , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/prevención & control , Tuberculosis Esplénica/prevención & controlRESUMEN
This article aims to explore some key issues relating to the health districts of the Lazio Region, in particular the major critical aspects as well as some strengths highlighted by the operators. In the Lazio Region there are 12 Local Health Units, divided into 55 health districts. In recent years, the majority of the authors analized theoretical models proposed by regional standards, while the strengths and weaknesses of the district, as well as the organizational difficulties and problems experienced daily by the operators have not been investigated. It was decided to use qualitative methods of research, through open interviews with 50 operators in 15 health districts of the Region. Interviews were analysed utilizing software Nvivo. Some codes were identified to guide interviews. We can summarize the emergency issues at least in three major areas: 1) the organization of the district, 2) the management of personnel and resources, 3) the care pathways. It is hoped that, during next years, the research directed at health district analysis will grow, with particular reference to quantitative and qualitative investigations, in order to build a body of knowledge from practical experience of health professionals.
Asunto(s)
Áreas de Influencia de Salud , Personal de Salud , Entrevistas como Asunto , Atención a la Salud/organización & administración , Atención a la Salud/normas , Humanos , ItaliaRESUMEN
Triage is an efficient system that emergency departments (EDs) use to sort out presenting patients on the basis of the speed with which they need treatment. Because triage is not used consistently in the EDs of Latium, a region in central Italy, the regional Public Health Agency (PHA) planned and implemented a regional model of triage in all EDs. This manuscript describe the regional implementation strategy. The PHA activated the "Regional Triage Program--RTP" including: development and testing of a "triage section" in the computerized EDs clinical chart; production of an operational handbook for the RTP for triage health professionals (HPs); implementation of an continuum educational program on the "RTP" in all EDs of Latium. The computerized triage section was tested and implemented in all EDs in the region. The handbook for triage HPs was produced. The educational program, has been ongoing since 2008 in all regional EDs. Selected HPs, identified as "facilitators", were trained on how to implement the RTP. They will organize, in their own EDs, small groups of nurses to conduct on-site training of the RTP. The RTP was received with enthusiasm by most HPs, however its introduction into current practice could be hampered by organizational/structural problems and conflicts between nurses and doctors. Next actions of the regional program will be to overcome the possible above mentioned troubles.
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Servicio de Urgencia en Hospital/organización & administración , Triaje/organización & administración , Adulto , Femenino , Implementación de Plan de Salud , Humanos , Italia , Masculino , Persona de Mediana Edad , RegionalizaciónRESUMEN
Hip replacement (HR) is a very effective procedure for chronic hip diseases especially in elderly. The aims of this study were: 1) to describe the typology of HRs; 2) to assess short and long term outcomes; 3) to evaluate the relationship between both individual and hospital characteristics with the outcomes. Regional hospital discharge data and mortality register were used. The study population included residents of the Lazio region, over 17 years of age, who underwent HR in any private or public hospital in Italy. We used logistic regression analysis to examine in-hospital mortality, 30-day mortality, 90-day mortality. Cox regression analysis was run to investigate revision and 3-5 year mortality. Out of 8159 HRs, 69.5% were total hip replacements (THR) conducted predominantly on females over 70 years of age. We observed 262 in-hospital deaths (7.4% endoprothesis, 1.4% THR). Thirty and 90-day mortality also showed a different pattern among the two procedures (endoprothesis 8.0% and 15.8%, THR 1.3% and 2.2%). At the end of the follow-up, 21% of patients had died and 204 revisions had been carried out (1.4% endoprothesis, 3.0% THR). Overall, 1898 patients (23.3%) had a revision or died. The main short and long term mortality risk factors were: age, male gender and comorbidities. Hospital volume was not associated with a significant mortality risk. For endoprothesis, waiting time before surgery longer than 7 days was associated with a 30-day mortality risk of 2.83. The present study prompted us to test methodologies to evaluate quality levels in orthopaedic surgery units throughout the region using information systems. Further studies are needed to better understand the variability in the characteristics of care that emerged in Lazio hospitals.
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Artroplastia de Reemplazo de Cadera , Hospitales , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/mortalidad , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Áreas de Influencia de Salud , Demografía , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Factores de Tiempo , Resultado del TratamientoRESUMEN
To describe different doctors' attitudes in drug prescribing in case of influenza-Like-Illness during 2001-2002 influenza season in Lazio region, with regard to consumption and expenditure and its adherence to Italian Guidelines on ILI Management. Prospective study aimed to assess doctors' behaviour in prescribing in respect with the following events: (a) ILI and subsequent controls after diagnosis, (b) complications, (c) adverse events to influenza vaccine. 7,629 subjects, have been identified and only 17% presents one or more comorbidities. There are totally 7,766 cases of ILI: 23% are complicated and out of the remaining 77%, only 14% presents comorbidities. Almost all elderly people have been vaccinated. Antibiotics were prescribed to complicated cases (82%) with comorbidities (55%); 1,075 patients (12%) had second or third contact with doctors in a period longer than 7 days and about 65% of them received antibiotics in case of acute bronchitis; children received mainly ibuprofen and paracetamol for fever control; acetylsalicylic acid in children group has been delivered only in 1% of cases. Overall, doctors' attitude in prescribing is generally coherent with Italian Guidelines on ILI even though a high variability still persists.
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Prescripciones de Medicamentos/estadística & datos numéricos , Medicina Familiar y Comunitaria , Adhesión a Directriz/estadística & datos numéricos , Gripe Humana/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Italia , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
UNLABELLED: We aimed at describing the epidemiology of femur fracture in elderly hospitalized for femur fracture in Lazio (Italy), and evaluating the association between patient's and hospital characteristics on in-hospital mortality. We conducted a population- and hospital-based study (Lazio region: 5.233.233 inhabitants) among people 65+ years aged. SOURCE OF DATA: regional hospital register 2002-2003; ICD-9-CM codes for patients' selection 820 e 821. Direct standardization (rate x 1000) and logistic regression analysis (OR, 95% CI) were performed. Overall hospitalization rate in elderly was 7.5%o (10.l%o females vs. 3.9%0 males). 12.033 patients with femur fractures were enrolled in the study period; 21,6% were not treated surgically: in comparison with those who underwent surgery, they were males, residents out of Rome, older and with worst health status. In-hospital mortality rate was 7,97%. In-hospital mortality determinants were: male gender (OR=0.56), older age (85+, OR=3.30), living out of Rome (OR=0.50), comorbidities (Charlson 'index 3: OR=4.44), "others and unspecified parts of femur" as site of fracture (OR=1.84), admission to a private hospital (OR=O. 79) and a surgical treatment (OR=0.20). In conclusion, this study showed the effect of selected individual characteristics on in hospital mortality and suggested a role of early surgical treatment and access to private sector. Regional hospital information systems represent useful tools to address epidemiological impact of hip fracture and its health care resources utilization.
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Fracturas del Cuello Femoral/mortalidad , Hospitalización/estadística & datos numéricos , Hospitales Generales , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Femenino , Fracturas del Fémur/mortalidad , Fracturas del Cuello Femoral/epidemiología , Fracturas del Cuello Femoral/cirugía , Mortalidad Hospitalaria , Humanos , Lactante , Recién Nacido , Clasificación Internacional de Enfermedades , Italia/epidemiología , Masculino , Registros Médicos , Persona de Mediana Edad , Estudios Retrospectivos , Ciudad de Roma/epidemiología , Distribución por SexoRESUMEN
The aim of the study is to measure and to describe organizational appropriateness of a Paediatric Temporary Observation Ward in the Emergency Department. We selected hospital discharges related to 43 DRGs at high risk of inappropriateness (DPCM 29/11/2001); we studied the relationship between appropriateness and patient's or discharge characteristics. We also investigated the inappropriateness to find tools for improving ward's efficiency. Assessment of selected paediatric clinical records was performed using PRUO protocol and showed that 41.5% of hospital discharges are completely appropriated and only 13.8% are completely not appropriated and, consequently, could be provided in a different organizational setting. Inappropriateness in our study is lower than the expected one; this finding shows that the ward under investigation is able to provide health assistance with good level of appropriateness. The used tool to evaluate appropriateness is a modified PRUO version, specific for pediatric hospital stays. Pediatric PRUO protocol is easy to be applied even if reasonable and shared evaluation criteria do not seem able to recognise some peculiar characteristics of Pediatric Temporary Observation Ward in the Emergency Department.
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Grupos Diagnósticos Relacionados/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Adolescente , Niño , Preescolar , Eficiencia Organizacional , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Tiempo de Internación/estadística & datos numéricos , Masculino , Registros Médicos , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Ciudad de Roma , Índice de Severidad de la EnfermedadRESUMEN
Home care customer satisfaction has been, until now, rarely evaluated. After illustrating the main italian regional surveys on this issue, the article presents a customer satisfaction survey carried out in the district of Civitavecchia (Local Health Unit 'Rome F'), Lazio, regarding 30 home care beneficiaries. Methodological aspects emerging from the survey are basically focused on: advantages and disadvantages of quantitative and qualitative approaches (possibly associated each other); main criteria of eligibility of people selected for interviewing, both patients or caregivers; conditions that maximize answers reliability, including training on interviewers. Authors highlight opportunity of using such kind of survey, integrated with other different tools, into a systemic vision, for promoting management changes coming from suggested problems, aimed at total quality management.
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Comportamiento del Consumidor , Evaluación Geriátrica , Servicios de Atención de Salud a Domicilio , Calidad de la Atención de Salud , Anciano , Encuestas Epidemiológicas , Servicios de Atención de Salud a Domicilio/organización & administración , Servicios de Atención de Salud a Domicilio/normas , Humanos , Italia , Satisfacción del Paciente , Encuestas y Cuestionarios , Gestión de la Calidad Total/normasRESUMEN
In the Lazio Region, it has been put into effect a plan of clinical Risk Management for the Breast Cancer Screening Regional Program (BCSP), involving all of the 12 Local Health Units and the Public Health Agency of Lazio (ASP). Being the BCSP a health care service, it consists of a perfect integration of health care structures, professionals and skills working for the citizens. This program originates from an unexpressed health need and leads to a evidence-based health benefit. The BCSP provides free breast screening for 700,000 women aged between 50 and 69 in the Lazio region; the Public Health Agency carries out the clinical governance of the BCSP The prevention of errors and incidents represents a fundamental basis of governance: it is a contribution to the achievement of efficacy in breast cancer screening. The BCSP deals with screening incidents from a systemic point of view and actively involves several Local Health Units staff going through each step of the whole patient's clinical path, from the identification of the target population, to the oncological treatment of positive cases. The programme is an integration of different tools: literature research, process analysis using the HFMEA methodology and reporting system. The results reached so far are the following: the regional severity rating scale, the regional Master-List of possible adverse events, occurrence and detection rating scale.
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Neoplasias de la Mama/diagnóstico , Mamografía , Tamizaje Masivo/métodos , Gestión de Riesgos , Anciano , Neoplasias de la Mama/diagnóstico por imagen , Medicina Basada en la Evidencia , Femenino , Humanos , Italia , Tamizaje Masivo/organización & administración , Persona de Mediana Edad , Proyectos Piloto , Salud Pública , Índice de Severidad de la EnfermedadRESUMEN
The aim of the present work is to describe the characteristics of digestive endoscopy centers and the physicians that work there, with particular attention to their attitudes and practices in colorectal cancer screening. A questionnaire was sent to all 80 digestive endoscopy centers in the Lazio region, identified by the annual census of Italian Society of Digestive Endoscopy (Società Italiana di Endoscopia Digestiva, SIED). Seventy-one centers (89%), returned the questionnaire. Screening activity on average represents 14% of the centers' colonoscopy workload. Colonoscopy was considered to be a "very effective" screening test by 96% of physicians, the faecal occult blood test "very effective" by 20%, and flexosigmoidoscopy "very effective" by 11%. Ninety-seven percent (97%) of physicians reported recommending any test for screening: 80% colonoscopy, 61% faecal occult blood test, 14% double contrast barium enema and 11% flexosigmoidoscopy. Despite the fact that almost all physicians reported recommending screening, the centres are only marginally involved in screening practice. Endoscopy centers' physicians tend to have an aggressive strategy for colorectal cancer prevention and exclusive trust in colonoscopy; an attitude more consistent with a clinical-diagnostic approach than with real mass screening of a healthy population.
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Actitud del Personal de Salud , Colonoscopía , Neoplasias Colorrectales/diagnóstico , Pautas de la Práctica en Medicina , Adulto , Anciano , Femenino , Humanos , Italia , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
It has been carried out a survey to evaluate the appropriateness of hospital stay in a university hospital. The aims of the study were: to determine the amount of inappropriate hospital admissions and inappropriate days of stay in relation to either wards and characteristics of admission; to analyse the reasons for inappropriate patient stay. A randomised sample stratified by ward of discharge of 224 medical records were analysed using the Italian version of the Appropriateness Evaluation Protocol. 37.9% of the hospital admissions and 18.9% of hospitalisation days were judged to be inappropriate. The main reasons for categorising an admission or a day of stay as inappropriate were a) delay in performing elective surgery procedures; b) that the patient's problem could be treated on an outpatient basis; c) delay in performing diagnostic examinations. The univariate statistical analysis showed an association between appropriateness of hospital stay and gender age, ward of discharge, length of hospital stay and DRG type (medical/surgical). The study highlights a lower level of inappropriateness compared to the results of other investigations. Hints were also identified for achieving an improved efficiency at hospital level.
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Hospitales Universitarios/estadística & datos numéricos , Tiempo de Internación , Admisión del Paciente/normas , Adolescente , Adulto , Anciano , Análisis de Varianza , Niño , Preescolar , Femenino , Encuestas Epidemiológicas , Hospitalización/estadística & datos numéricos , Hospitales Universitarios/normas , Humanos , Lactante , Recién Nacido , Italia , Masculino , Registros Médicos , Persona de Mediana Edad , Revisión de Utilización de RecursosRESUMEN
Several population-based trials have shown the efficacy of colorectal cancer mass-screening based on guaiac faecal blood testing in a generic risk population. SCCR represents a very complex and resource-demanding public health intervention and, for this reason, its planning requires actual efficacy as a main goal. Since evidence of efficacy demonstrated by population-based trials may not actually generate effectiveness, the Regional Government of Latium Region decided to implement some experimental studies before introducing a screening programme, in order to define an evidence-based organisational model of SCCR and a feasibility evaluation of the real needs for screening. The aims of the pilot studies were to define an evidence-based organisational model, to evaluate the necessary resources and the actual quality standard of clinical examination, treatment and surgery. The aim of the feasibility study is to test the organisational model for SCCR for about 300,000 citizens residing in the Latium region. The present article illustrates the scheduling path set out, which is based on the involvement of experts, GP representatives and specialists from scientific societies and it is planned by the following actions: Definition of evidence-based recommendations; identification of further investigations; realization of experimental studies; definition of an evidence-based organisational model. The main research areas have been dealt with using randomised trials, in order to evaluate the efficacy of the involvement of GPs and the kind of test for RSOF Our work has produced evidences which were sometimes in contrast with information in the literature, demonstrating that guaiac RSOF testing is less reproducible and determines lower uptake than immunochemical testing. Our work also shows that the involvement of GPs should be based on their personal skills rather than on their role. Such evidences are fundamental to the definition of the organisational model and confirm the need of basing an evidence-based planning not only on evidences found in the literature. The necessity of this approach is strengthened by the level of organisational complexity and by the amount of resources needed to put a public health intervention into practice.
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Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/prevención & control , Tamizaje Masivo/métodos , Anciano , Medicina Basada en la Evidencia , Estudios de Factibilidad , Guayaco , Humanos , Pruebas Inmunológicas/métodos , Indicadores y Reactivos/farmacología , Italia , Tamizaje Masivo/organización & administración , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Sangre Oculta , Proyectos Piloto , Ensayos Clínicos Controlados Aleatorios como Asunto , Juego de Reactivos para Diagnóstico , Sensibilidad y EspecificidadRESUMEN
The number of immigrant women in Italy has increased from 260,000 in 1991 to at least 750,000 in 2003. This article describes the health situation of these women, in particular it deals with reproductive health. Immigrant women are generally young, in good health and they go to the health services mainly for pregnancy, delivery, spontaneous and induced abortion. Forty-eight per cent of acute hospital admissions and 56 per cent of day hospital admissions in 2002 were related to reproduction. Among foreign citizens, the induced abortion rate is three times higher than that reported among Italians, while the risk of spontaneous abortion is similar (97 per thousand and 101 per thousand, respectively). In general, the data show that immigrant women in Italy live in deprived social conditions, which can influence their reproductive choices and their access to health services. In order to take account of their particular needs, it is necessary to modify the health services and plan public health interventions especially for the prevention of induced abortion.
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Emigración e Inmigración , Estado de Salud , Salud de la Mujer , Aborto Inducido/estadística & datos numéricos , Adulto , África/etnología , Asia/etnología , Femenino , Humanos , Italia/epidemiología , América Latina/etnología , Admisión del Paciente/estadística & datos numéricos , Embarazo , PrevalenciaRESUMEN
Aim of the study is to describe the characteristics of road, home and work-related traumas among adult immigrants born in non-industrialised Countries, and to compare the consequent probability of hospitalisation with Italian adults in Lazio Region, year 2000. Source of data is the Emergency-based Surveillance System, which collects all the emergency ward visits in Lazio region. Accident incidence has been estimated using alternatively the residence permits and the roman resident population born in non-industrialised Countries. The 7.7% of all the emergency visits of immigrants are trauma-related. Road traffic accident visits are more appropriate and urgent. Immigrants have a higher risk of hospitalisation both for road and home accidents compared to the Italians (OR = 1.59 and OR = 1.37 respectively). Immigrants use emergency wards for severe and urgent trauma-related accidents, they have higher probability of hospitalisation compared to the Italians. Our analysis highlights the necessity to improve tools to study immigrant health.
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Accidentes/estadística & datos numéricos , Países en Desarrollo , Servicio de Urgencia en Hospital/estadística & datos numéricos , Emigración e Inmigración/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Italia , Masculino , Registros Médicos/estadística & datos numéricosRESUMEN
Several studies conducted in Rome have shown low levels of vaccination coverage in gypsy communities. Thus a vaccination campaign targeting to 2400 gypsy children aged 0-13 years, present in 32 settlements in Rome, was conducted in 2002. The campaign was related to vaccinations required and recommended in Italy: diphtheria, tetanus, hepatitis B, pertussis (whooping cough), haemophilus influenzae and measles. In the majority of cases it was decided to carry out the vaccinations directly in the gypsy settlements, in accordance with the methods of pulse immunisation. In the case of small settlements a strategy for reorienting the population to vaccination centres was adopted. Around 2000 children were vaccinated, equivalent to 80% of the paediatric population present during the period. The number of children who have never been vaccinated has decreased from 40% prior to the campaign to 9% after the third week. Vaccination coverage in medium- and small-sized settlements (<200 inhabitants) after the campaign shows values of over 70%; in the large settlements, more modest increases have been recorded and coverage has rarely exceeded 50%. This experience has highlighted the importance of networking between public healthcare institutions and non-profit organisations. The mobilisation of a wide range of competences has thus enabled the attainment of a high level of effectiveness.
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Programas de Inmunización , Romaní/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adolescente , Áreas de Influencia de Salud , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Italia/epidemiología , MasculinoRESUMEN
The study aimed at searching whether antibiotic prophylaxis was practised after animal bites, and, in this case, what were the criteria adopted. It was performed by considering 162 outpatients requiring assistance after animal bites at the Antirabies Centre of Rome, Italy. In this circumstances, prevention of bacterial and viral infections is performed by wound detersion, by administering anti-tetanus and anti-rabid prophylaxis where required by italian policy, according to the patient's history. Infectious complications are described in literature as a common consequence of animal bites and include cellulitis, septic arthritis, osteomyelitis and even fatal sepsis. Microorganisms related to these infections are frequently typical of animal oral flora and include aerobic and anaerobic species, such as Pasteurella multocida, DF-2, and Leptospira. It was noted that 58 (35.8%) out of 162 were treated with antibiotic prophylaxis; the most common drug used was amoxicillin, given in 18 cases (31%). The overall results do not show any particular reason for practising or not this prophylaxis. The need of standardising the behaviour of Emergency Services, where a different and unjustified attitude to treat or not patients with antibiotic prophylaxis in order to prevent infectious complications following animal bites was observed, emerges from this study.
Asunto(s)
Antibacterianos/uso terapéutico , Mordeduras y Picaduras/tratamiento farmacológico , Infección de Heridas/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Centros Comunitarios de Salud , Humanos , Persona de Mediana Edad , Ciudad de Roma , Infección de Heridas/etiologíaRESUMEN
As the bacteria found more frequently in hospital infections are the same found in the linen, it is speculated that hospital linens can contribute to the spread of nosocomial patologies. Nevertheless this consideration does not prove that linen constitutes a significant source for transmission of hospital infections, although some studies have strengthened this possibility. The hygienic problems of hospital linens washing have a great importance and in this contest the possibility of contagion throught infected sheets or overalls constitutes only a part of the question. The problem of the spreading of nosocomial infections has to be divided into (1) collection and arlage of the linens; and (2) their disinfection and washing. Collection and carriage need precautions to prevent the hospital staff and the patients from the direct contagion, while during the washing the infected, or potentially infected, linen are to be regarded as a potential risk, which can be avoided through a disinfection before the standard washing cycle. During the washing the processes of cleansing, the dilution and the effect of temperature could be sufficient to obtain the final results. The last consideration is linked to gestational aspects, that's to say the consumptions, the costs, the traditional organizing procedures and the alternative ones, such as the possibility of substituting disposable material to linens or to refer to central laundries placed outside the hospital building and independently operated.