Parents' and caregivers' role toward childhood vaccination in Albania: assessment of predictors of vaccine hesitancy.

Background: Vaccination has saved millions of lives through the protection of individuals and populations from communicable diseases. Vaccine hesitancy, defined as the delay in acceptance or refusal of vaccines despite the availability of vaccination services, has become a growing global concern. The objective of this study was to investigate parents'/caregivers' hesitancy toward childhood vaccination and its predictors in Albania. Study design: A cross-sectional survey was conducted. Methods: The data comes from a survey conducted on a sample of parents/caregivers (89.6% mothers) of children aged 6 months to 8 years at health care vaccination centers in seven Albanian cities from December 2020 to February 2021. Parents/caregivers (one per child) were interviewed by trained healthcare staff using a standardized questionnaire on six main content domains, including immunization behavior, beliefs about vaccine safety and efficacy, attitudes about vaccines, vaccination confidence, estimation of vaccine delay, and the intention to immunize children against SARS-CoV-2, and a self-reported hesitancy. The Albanian Ministry of Health approved the questionnaire, after it was translated, validated and adapted to the local setting. Statistical analyses included independent sample t-tests (p<0.05) and a logistic regression (OR; 95% C.I.). Results: A total of 475 parents/caregivers of children aged from 6 months to 8 years, attending childhood vaccination in public health services, were interviewed. To the question "how hesitant you are about childhood vaccination", a high number of parents/caregivers (46%) responded that they do not feel hesitant at all, and 32% were not hesitant, a small number of parents/caregivers said they are very hesitant (5%) or somewhat hesitant (12%). A binary logistic model was fitted to the data to test the hypothesis regarding the relationship between parental vaccine hesitancy and possible predictors. A lower parental attitude toward childhood vaccines (OR = 3.7; 95% C.I. 1.102-12.421), a health center with a high vaccine delay (OR = 2.878; C.I. 95% 1.735-4.773), and low confidence in health staff information (OR = 2.042; 95% C.I. 1.156-3.605) were all independent predictors of parental vaccine hesitancy. Regarding intention to vaccinate children against COVID-19, when available, nearly 75% of parents/caregivers showed hesitancy. Conclusions: Our results highlighted the role of positive parents'/caregivers' attitudes toward childhood vaccines followed by high staff confidence and good health center organization in order to deal with vaccine hesitancy, particularly for traditional and well-known childhood vaccines. Nevertheless, the hesitancy can be a critical barrier for childhood vaccination when we have to introduce a new vaccine, as is demonstrated in the recent vaccination campaign against the ongoing pandemic of SARS-CoV2.

Exploring Tdap and influenza vaccine uptake and its determinants in pregnancy: a cross-sectional study.

Background: The literature claims that an increased risk of complications from pertussis and influenza exists for pregnant women and infants. Maternal tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines seem to decrease this risk so that several countries are committed to increase vaccination uptake, but not all of them know their own vaccination coverage and factors that motivate this population to vaccination. Study Design: A cross-sectional survey was conducted. Methods: We conducted this survey to estimate among pregnant women: 1) the vaccine coverage, 2) the availability of information, 3) the knowledge about maternal Tdap and influenza vaccination, 4) the factors that could have driven unvaccinated pregnant women to have themselves vaccinated. In addition, determinants of Tdap and influenza vaccine uptake and correct knowledge about vaccine-preventable diseases and vaccination in pregnancy were assessed using univariate and multivariate analyses. Results: Of the 250 women included in the present study, only 58 (23.2%, 95% Confidence Interval (CI): 18-28.4%) and 21 (8.1%, 95% CI: 5-11.8%) reported that they had been vaccinated with Tdap and influenza vaccine, respectively, during their current pregnancy. The most common reasons cited for getting themselves vaccinated was having background knowledge of the health problems due to the diseases prevented by Tdap and influenza vaccines, awareness regarding these vaccines being recommended in pregnancy, knowledge of their effectiveness and/or side effects, and having been informed about vaccination by a healthcare professional. Conclusions: Influenza and Tdap vaccine uptake among pregnant women in Italy is low, however, the present study showed that women are available to get vaccinated during pregnancy when adequately informed about the vaccines recommended.

Who will be lost? Identifying patients at risk of loss to follow-up in Malawi. The DREAM Program Experience.

OBJECTIVES: Retention of subjects in HIV treatment programmes is crucial for the success of treatment. We evaluated retention/loss to follow-up (LTFU) in subjects receiving established care in Malawi. METHODS: Data for HIV-positive patients registered in Drug Resource Enhancement Against AIDS and Malnutrition centres in Malawi prior to 2014 were reviewed. Visits entailing HIV testing/counselling, laboratory evaluations, nutritional evaluation/supplementation, community support, peer education, and antiretroviral (ART) monitoring/pharmacy were noted. LTFU was defined as > 90 days without an encounter. Parameters potentially associated with LTFU were explored, with univariate/multivariate logistic regression analyses being performed. RESULTS: Fifteen thousand and ninety-nine patients registered before 2014; 202 (1.3%) were lost to follow-up (LTFU) (1.3%). Nine (0.5%) of 1744 paediatric patients were LTFU vs. 1.4% (n = 193) of 13 355 adults (P < 0.001). Subjects who were LTFU had fewer days in care than retained subjects (1338 vs. 1544, respectively; P < 0.001) and a longer duration of ART (1530 vs. 1300 days, respectively; P < 0.001). Subjects who were LTFU had higher baseline HIV viral loads (P = 0.016) and higher body mass indexes (P < 0.001), were more likely to live in urban settings (88% of patients who were LTFU lived in urban settings) with better housing [relative risk (RR) 2.3; 95% confidence interval (CI) 1.67-3.09; P < 0.001], and were more likely to be educated (RR 1.88; 95% CI 1.42-2.50; P < 0.001). Distance to the centre and cost of transportation were associated with LTFU (RR 3.4; 95% CI 2.84-5.37; P < 0.001), as was absence of a maternal figure (RR 1.57; 95% CI 1.17-2.09; P < 0.001). Viral load, distance index, education and a maternal figure were predictive of LTFU. CONCLUSIONS: Educated, urbanized HIV-infected adults living far from programme centres are at high risk of LTFU, particularly if there is no maternal figure in the household. These variables must be taken into consideration when developing retention strategies.

Trend and determinants of acute inpatient care for the elderly in Italy from 2001 to 2011.

BACKGROUND: The population over 64 years of age is the main user of acute hospital care services. The elderly admission rates represent a marker for the appropriateness of the model of care. The aim of this study was to assess trends and determinants of acute in-patient care among the elderly in Italy between 2001 and 2011. STUDY DESIGN: Retrospective analysis of data included in the Italian Hospital Discharge Form Database. METHODS: Data from the Italian Hospital Discharge Form Database, Italian Ministry of Health, for the years 2001, 2006 and 2011 were analyzed for individuals over 64 years of age. Inpatient admission (> 1 day) rates across Italian Regions were calculated and compared with demographic variables and out-of-hospital care indicators. Univariate and multivariate analysis were used to determine independent relationship among variables. RESULTS: From 2001 to 2011 the elderly hospital admission rate decreased from 302.1/1,000 in 2001, to 222.4 in 2011, accounting for an overall decrease of about 28%. The decline in admission rates was less pronounced among individuals > 74 y (26.4%) than among those 65-74 y (32.1%). Hospitalization rates decreased in all Italian administrative regions between 2001 and 2011, even if the hospitalization rates in 2011 were still very different through the different Italian regions, ranging from 180.3/1,000 in Piedmont to 278.1/1,000 in Molise for people > 64 y. The multivariate linear regression was statistically significant in explaining the variations in hospitalization rates among the different Italian administrative regions (F: 3.637; p = 0.024; adjusted R2 = 0.57) and pointed to the role played by the proportion of the elderly (as percentage of the total population, p=0.043) and the rate of variation of acute care beds from 2004 to 2011 (p=0.001). Variables related to community-based care did not show any association with the hospital admissions rate among the elderly. CONCLUSIONS: The trend toward decline in elderly inpatient admissions is still present in 2011 as it was in 2001. Determinants of elderly hospital care in Italy are related to the increased number of elderly individuals and the reduction of hospital beds. Out-of-hospital care does not correlate with the variation of in-patient care so the overall care appropriateness could be negatively affected.

Hepatitis B virus mother-to-child transmission among HIV-infected women receiving lamivudine-containing antiretroviral regimens during pregnancy and breastfeeding.

The study included 309 HIV-infected pregnant women receiving a lamivudine-containing antiretroviral regimen from week 25 of gestational age until 6 months postpartum, during breastfeeding. Twenty-seven of them (8.7%) were hepatitis B virus surface antigen (HBsAg) positive; at baseline, hepatitis B virus (HBV) DNA levels >3 log(10) IU/mL (with a median level of 6.2 log(10) IU/mL) were found in 10 women, who at one, three and six months postpartum had median levels of 5.2 log(10) IU/mL, 4.5 log(10) IU/mL and 2.8 log(10) IU/mL, respectively. Twenty-four of the 30 breast milk samples evaluated had undetectable HBV DNA and the other six had values between 15 and 155 IU/mL. Median lamivudine concentrations were 1070 ng/mL in serum and 684 ng/mL in breast milk. Among the 24 HBV-exposed children with available samples, 16 always tested negative, four had a transient infection, one had an undetermined status and three (12.5%) first tested positive at Month 12 or Month 24. Among the children born to the HBV-uninfected mothers of the same cohort, the rate of HBsAg positivity at 12-24 months was 2% (4/196). Our finding of the absence of significative levels of HBV DNA in the breast milk of co-infected mothers supports the present recommendations for breastfeeding in HBV-infected women. Horizontal transmission can be hypothesized for the infections detected in children at 12-24 months. Children born to HBV-positive mothers remained at higher risk of postnatal HBV acquisition compared to those born to HBV-negative women.

Unequal access, low vaccination coverage, growth retardation rates among immigrants children in Italy exacerbated in Roma immigrants.

AIM: Currently children of immigrants are the fastest growing segment of the Italian population under the age of 18. The present study reports the challenges to health services access, the vaccination coverage, the health and nutritional status of a sample of 1310 children of immigrants attended from February 2004 to May 2012 the health center "Medicina Solidale" of the "Policlinico Tor Vergata" in the suburban area of the VIII Municipality of Rome. METHODS: The data were collected using clinical archives of the health center. We analyzed the socio-demographic conditions, health problems and nutritional status on admission to the health center. The anthropometric evaluation was carried out according to international standards of child growth WHO 2006 and the statistical analysis was performed using SPSS version 19, and including risk estimation, Mantel Haentzel statistics and t-test. RESULTS: Sixty-six percent of the children were born in Italy, 62% had never had regular health care and 3.4% of children older than six months had never received any of the immunizations. It has been estimated that being Roma the risk of not been vaccinated is equal to OR=5.4 (IC95%: 2.8-10.1). Seventy-seven percent of unvaccinated children had at least one illiterate parent. This condition was strongly associated with non-immunization (OR=15:36 [IC95%: 6.4-36.4]). Growth retardation was common in Roma children as compared to other ethnicities. CONCLUSION: Significant public health efforts are needed to improve access to health services for immigrant populations and to solve relevant inequalities.

The impact of integrating food supplementation, nutritional education and HAART (Highly Active Antiretroviral Therapy) on the nutritional status of patients living with HIV/AIDS in Mozambique: results from the DREAM Programme.

DREAM (Drug Resources Enhancement against AIDS and Malnutrition) is a multiregional health program active in Mozambique since 2002 and provides free of charge an integrating package of care consisting of peer to peer nutritional and health education, food supplementation, voluntary counseling and testing, immunological, virological, clinical assessment and HAART (Highly Active AntiRetroviral Treatment). The main goals of this paper are to describe the state of health and nutrition and the adequacy of the diet of a sample of HIV/AIDS patients in Mozambique on HAART and not. A single-arm retrospective cohort study was conducted. 106 HIV/AIDS adult patients (84 in HAART), all receiving food supplementation and peer-to-peer nutritional education, were randomly recruited in Mozambique in two public health centres where DREAM is running. The programme is characterized by: provision of HAART, clinical and laboratory monitoring, peer to peer health and nutritional education and food supplementation. We measured BMI, haemoglobin, viral load, CD4 count at baseline (T0) and after at least 1 year (T1). Dietary intake was estimated using 24h food recall and dietary diversity was assessed by using the Dietary Diversity Score (DDS) at T1. Overall, the patients'diet appeared to be quite balanced in nutrients. In the cohort not in HAART the mean BMI values showed an increases but not significant (initial value: 21.9 ± 2.9; final value: 22.5 ± 3.3 ) and the mean haemoglobin values (g/dl) showed a significant increases (initial value: 10.5+ 2.1; final value: 11.5 ± 1.7 p< 0.024) . In the cohort in HAART, both the mean of BMI value (initial value: 20.7 ± 3.9; final value: 21.9 ± 3.3 p< 0.001) and of haemoglobin (initial value: 9.9 ± 2.2; final value: 10.8 ± 1.7 p< 0.001) showed a higher significant increase. The increase in BMI was statistically associated with the DDS in HAART patients. In conclusion nutritional status improvement was observed in both cohorts. The improvement in BMI was significant and substantially higher in HAART patients because of the impact of HAART on nutritional status of AIDS patients. Subjects on HAART and with a DDS > 5, showed a substantial BMI gain. This association showed an additional expression of the synergic effect of integrating food supplementation, nutritional education and HAART on the nutritional status of African AIDS patients and also highlights the complementary role of an adequate and diversified diet in persons living with HIV/AIDS in resources limited settings.

The DREAM model's effectiveness in health promotion of AIDS patients in Africa.

This study evaluates the effectiveness of a holistic model for treating people living with AIDS in Africa; the model aims to improve knowledge about AIDS prevention and care, increase trust in the health centre, impact behaviour, and promote a high level of adherence to HAART. The study took place in the context of the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) programme in Mozambique, designed by the Community of Sant'Egidio to treat HIV patients in Africa. It provides patients with free anti-retroviral drugs, laboratory tests (including viral load), home care and nutritional support. This is a prospective study involving 531 patients over a 12-month period. The patients, predominantly poor and with a low level of education, demonstrated a good level of knowledge about AIDS (more than 90% know how it is transmitted) and trust in the treatment, with a relatively small percentage turning to traditional healers. Overall the patients had a low level of engaging in risky sexual behaviour and a very good level of adherence to HAART (69.5% of the 531 subjects had a pill count higher than 95%). The positive results of the programme's educational initiatives were confirmed with the patients' good clinical results.

Seroprevalence of HHV8 in a cohort of HIV-negative and HIV-positive patients in Mozambique.

Kaposi Sarcoma shows several different clinical and epidemiological patterns. In Sub-Saharan Africa, where the HIV achieves an high prevalence of infection, the KS can be found both in HIV positive than in HIV negative patients, and the diffusion of the HHV8 virus is endemic. The aim of the work is to evaluate the HHV8 seroprevalence in Mozambique. Moreover the relationship of some main indicators, as CD4 and CD8 cells count, HIV viral load, Body Mass Index and haemoglobin values have been calculated in a part of the DREAM Cohort, (HIV positive patients enrolled in the Community of Sant'Egidio program to fight AIDS in the Sub-Saharan Africa). In the HIV positive cohort HHV8 negative and HHV8 positive groups show statistical significance (p < 0.05) in CD4 cells count, a strong significance (p = 0.01) in CD8 cells count and a significance also in Haemoglobin levels (p = 0.35). The difference in Haemoglobin levels (0.5 g/dl) is related more to a statistical than a clinical significance. The study confirms the free circulation of the HHV8 virus in the Mozambican population, with a prevalence rate of 51.1%, similar than that measured in bordering countries. Considering the CD8 value within the HIV positive sub-cohort a strong correlation with the positivity for HHV8 and the immunological status is suggested.

[A child health promotion intervention in Albania: results and lessons learned]. / Promozione e cura della salute infantile in Albania: risultati e lezioni apprese da un intervento di sanità pubblica.

Albania is a Balkan country in South-Eastern Europe which, in recent years, has undergone complex demographic, political and economical changes. A notable drop in infant and maternal mortality rates and a significant rise in economic indicators have been observed in recent years. Despite this, over 15% of the population living in the northern and north-eastern areas of the country lives in extreme poverty conditions. In recent years various healthcare system reforms have been introduced, including the introduction of private healthcare and improvement of the main hospital infrastructures but not much has been done to increase the provision of essential healthcare services especially in rural and poor areas. Inequalities in health care are therefore widespread and these particularly affect children living in critical areas. In this paper we describe a paediatric healthcare intervention programme conducted in Albania from 2002 to 2004, aimed at improving the health and nutrition status of children and tackling healthcare system inequalities. The intervention consisted in offering free healthcare services and assistance, delivered through the Albanian healthcare system, to 5280 children. It also involved a health education programme for the mothers. The impact of the programme on the prevalence of infant malnutrition was evaluated by examining the medical records of 1745 infants followed for at least 6 months. Prevalence of malnutrition significantly decreased, from 13.4% to 4.2% during the study period. Mortality in children aged 0-5 years also showed a considerable drop. These results confirm that an efficient and sustainable model of paediatric healthcare assistance in Albania is possible.

Iron deficiency anemia and feeding practices in Albanian children.

Iron deficiency is the most prevalent nutritional problem of humans. In northern Albania, nutritional deficiencies are widespread among children but there is a lack of biochemical data. The aim of this study was to assess the prevalence rate of the iron deficiency anemia in a sample of northern Albanian children. A group of 112 children aged 6-60 months, recruited during the routine vaccinations, was enrolled in a cross-sectional health examination survey that included venou blood measurements of iron status. The survey was conducted during 2000 in Lezha District. The mean age was 17.1 +/- 10 months, the majority of the children were living in rural areas (61%), 47.8% were female. The mean level of hemoglobin was lower than the reference value (10.3 +/- 1.1). Iron deficiency Anemia occurred in 47 children (47%) and more likely during the first year of the life (51%). Fifty seven children were fed with whole cow's milk, among them 44 were IDA. The risk value to be anemic or iron deficient for infants aged 6 to 12 months that were fed with whole cow's milk before the fourth months of life was high (OR = 6.2 (C.L.1.0-38)). In conclusion, the high prevalence of IDA and the relationship with early feeding of whole cow's milk suggest to consider iron deficiency in infancy and childhood in Albania as an important nutritional public health problem and to implement strategies for his detection, treatment and prevention.

Blood pressure and anthropometry in parents and children of a southern Italian village.

In an investigation on hypertension risk factors, the entire school population was examined in Trecchina, a southern Italian village. The reported findings refer to those children examined together with at least one parent, for a total of 134 mother-child pairs and 128 father-child pairs. For these groups of children, fathers and mothers, systolic (SBP) and diastolic (DBP) blood pressure, weight (W), height (H) and triceps skinfold (TS) were detected and body mass index (BMI) was calculated in order to evaluate the prevalence of high blood pressure (BP) values and if overweight. Of 19.3% children, 26.9% fathers and 15.8% mothers showed high BP values; 28.9% of children, 14.0% of fathers and 19.3% of mothers were overweight. In children, the analysis of correlations, after adjustment for height, showed a significant association between BP and W, BMI and TS. Using multiple regression analysis, with BP as the dependent variable, SBP was significantly associated with BMI and age in mother and fathers. For DBP the only variable entered in the model was BMI for mothers and fathers. When controlling for the children's age, H, W and BMI of children were significantly related to H, W and BMI of mothers and fathers. These results confirm that overweight and a parental history of obesity are predictive and possibly causal factors for essential hypertension.

Family history of cardiovascular diseases and risk factors in children.

A sample of 861 Roman children, aged 7 to 14 years, was investigated in order to evaluate the association between some cardiovascular risk factors such as high systolic (SBP) and diastolic (DBP) blood pressure levels, body mass index (BMI), arm fat area (AFA) and a history of diabetes, stroke, angina pectoris, myocardial infarction, hypertension and overweight in their parents. The sample investigated was subdivided into three subgroups, based on whether the children had just one parent, both parents or no parent with a positive history. For all the variables considered, the highest values were found in the group of children with a positive history for both parents and the lowest ones in children with a negative history for both parents. The analysis of significance, based on the mean values for the three groups, revealed statistically significant differences for SBP, DBP, BMI and AFA between the group of children with a positive history for both parents and that of children with a negative history for both parents. Significant differences also emerged for DBP, BMI and AFA between the mean values of children positive for one parent and those negative for both parents and for BMI and AFA between the means of children positive for one parent and those positive for both parents. The odds ratio of high systolic and/or diastolic BP, BMI and AFA levels was consistently higher in children with one or two parents with a positive history compared to children with both parents with a negative history, and even higher considering only children with both parents with a positive history vs children with both parents with a negative history.

Vitamin C and nutritional status of institutionalized and noninstitutionalized elderly women in Rome.

A cross-sectional study on 64 institutionalized and 65 noninstitutionalized elderly women has been undertaken. The age range was 60 through 90 years. Vitamin C status was assessed by serum ascorbic acid measurement and the nutritional status was evaluated by a three-day dietary record and main anthropometric measurements. Mean concentration of ascorbic acid was 1.03 mg/dl in the noninstitutionalized and 0.67 mg/dl in the institutionalized group (p less than 0.001). A serum ascorbic acid level less than 0.2 mg/dl was found in one (1.5%) and seven (10.9%) subjects respectively (p less than 0.03). Mean intake of vitamin C was 104.1 mg/d in the former and 87.3 mg/d in the latter group (p = NS), being less than 45 mg/d in 16 living at home and 11 institutionalized women. Serum ascorbic acid level did not correlate significantly to dietary nutrient intake but correlated to activity of daily living level (r = 0.29), vitamin C intake (r = 0.23), ideal body weight (r = -0.15), relative body weight (r = 0.15) and body mass index (r = 0.14). Suggestions are made concerning a higher intake of vitamin C and a more careful catering to improve the health status of the elderly people living in large institutions. The authors also suggest to include the serum ascorbic level determination in the assessment of the general health status of the elderly.

[Factors correlated with arterial blood pressure. Follow-up of a young population in Rome]. / I fattori correlati alla pressione arteriosa. Follow-up in una popolazione giovanile di Roma.

In order to find out whether there is any relationship between blood pressure, body mass index, weight, heart rate in youth and arterial hypertension later on in life, 212 subjects (16-26 years of age) were re-examined 2 years later. Previous blood pressure level were very significantly associated with present blood pressure levels A relationship was also discovered with the other parameters measured 2 years earlier: weight, body mass index and heart rate. These findings confirm the fact that it is possible to detect future hypertensives early in life and to take effective preventive measures.

Disability and the need for rehabilitative facilities in the young Albanian population of the Lezha district.

In order to implement a community-based rehabilitation programme in the rural district of Lezha (Albania), a systematic survey to assess disabilities and related care needs of people under 18 years of age was carried out. The aim of the survey was to evaluate the prevalence rates and severity of disabilities, detected by means of a questionnaire issued by the WHO Community-Based Rehabilitation Programme. The prevalence of disabled people under 18 years of age was 5.86 per 1000 (180 subjects out of the estimated population of 30,712). The most frequent diagnosis was sequelae of infantile cerebral palsy (1.8 per 1000), followed by mental retardation and deafness. The results of the survey stress that the severe non-self sufficiency of these subjects could be improved by means of an appropriate programme to increase their autonomy, including rehabilitation treatment and early school attendance.

Tirane, Albania: survey on drinking water quality and facilities.

To develop a realistic model of the situation, a study was carried out in four different socioeconomic and hygienic areas of Tirane, namely in the modern and historical centre as well as in the intermediate and peripheral areas. In each area interviewers from the city's Public Health Directorate, contacted randomly, door-to-door, the residents, submitting a questionnaire and collecting water samples at the same time. Our data show relevant differences regarding distribution and quality of drinking water between the centre and peripheral areas. One third of water samples revealed the presence of microorganisms, whereas one fifth had no residual chlorine. Altogether more than 200,000 people in the peripheral areas of Tirane live under low level hygienic conditions. The recent outbreaks of cholera, poliomyelitis and the hyperendemic hepatitis A disease are the dramatic results of the low quality drinking water.

A sentinel network of general practitioners for epidemiologic surveillance in Italy.

A Computer Network of General Practitioners (GP's) has been established connecting 110 general practitioners representing a statistically selected national sample, homogeneously distributed all over Italy. The purpose of the network is to increase the epidemiologic surveillance on the health status of the Italian community, to collect useful data on the routine activity of the GP's, to promote computer use among them, and to organize some "ad hoc" investigations on specific subjects (case-control studies). To this purpose, a specific software was developed both to meet the requirements of epidemiological research and to manage general practitioners' clinical files. A working prototype of health card using micro-computer technology is also being experimented on a subset of the GP's.

[The general practitioner faced with the choice of hospitalization: an analysis of the data from the Follow-Up System computerized network]. / Il medico di medicina generale di fronte alla scelta del ricovero: analisi dei dati della Rete informatizzata "Follow-Up System".

The Project "Informatization of the General Practitioner" aimed at networking the work stations of a randomized set of 150 general practitioners equipped with the "Follow-Up System" software, for the collection of information related to the activity carried out, to be electronically transferred to a central unit was developed in the frame of the finalized Project of the National Research Council: "Prevention and Control of the Disease Factors". During the project activity, a study on prescribed hospitalizations was carried out. The contents of items regarding hospitalization diagnosis show that diagnoses concerning diseases included in chapter ICD-9: "Symptoms, signs and morbid conditions not well defined" represent 30.3% of the total; most of these undefined syndromes can be identified under the item "abdominal pain" with 18.2% of cases. Obviously in the case of appendicitis (12.1% of hospitalizations) the hospitalization carried out by the physician resulted to be necessary, in the case of biliary lithiasis (8 cases, 7.4%), the physician could have treated the patient without hospitalization. The interest of such data is to induce a sort of provocation in order to observe, within 8% of hospitalizations following abdominal pain, what rate of hospitalization could be avoided, giving the adequate support to the general practitioner in order to decide the behaviour to have.