[Evaluation of the work environment in a local healthcare organisation in Italy: practical aspects and public health relevance]. / Studio del clima aziendale di un'Azienda Sanitaria Locale: aspetti pratici e ricadute di Sanità Pubblica.

The aim of this study was to evaluate a model of analysis of the work environment in a healthcare setting in Italy and its potential utility as tool for improving the quality of care and safeguarding the health of users. The experimental model was generated in a publicly funded hospital and in a healthcare district of a local healthcare organisation. A questionnaire was used to evaluate the work environment and its constituents. Sixty-eight percent of those interviewed were aware of the objectives of the organisation, and 74% of the organisational structure. Only 34% however admitted feeling satisfied with the organisation's communication strategies and integration processes. Overall, most workers (84%) reported being highly satisfied with their work even though only half (52%) reported feeling part of the organisation, 34% of being satisfied with the organisation's current career advancement opportunities and 29% of being satisfied with the professional training opportunities offered. Nurses reported the lowest level of satisfaction, especially those working in healthcare districts. The results of this study show that healthcare workers' perception of the work environment are varied in both hospitals and healthcare districts. They also show that the proposed model is useful for evaluating the work environment in a healthcare setting.

[Quality, success, and appropriateness of using home care through the Local Health Station No. 13 in Novara]. / Studio della qualità, degli esiti e dell'appropriatezza di utilizzo delle cure domiciliari nell'Azienda Sanitaria Locale no 13 di Novara.

The research is aimed at evaluating the quality, appropriateness and outcomes of home-care services in the District of Novara of ASL 13, by experimenting a multidimensional model of analysis based on the current clinical records. In this study, we analysed 102 cases of admittance to Integrated Home-care Services (IHS) (50 women and 52 men; average age 72.5). The analysis of the levels of activity highlighted a widespread under-use of the service and an insufficient quality of the clinical records. The management of patients was appropriate in 43.14% of the cases, in terms of intensity and complexity of the received care. 50% of the subjects did not present such characteristics as to need IHS, while 7.86% of the patients evidenced dubious appropriateness, according to an adequate healthcare intensity unaccompanied by a sufficient complexity of the interventions. As far as outcomes are concerned, we were able to highlight how relatively few subjects actually reached the objective of the healthcare plan (26.47%). On the whole, the experimented model of analysis allowed us to trace an effective picture of the quality of the service, by highlighting its critical elements and helping in finding specific actions of improvement.

[Epidemiologic study on the performance of a smoking prevention program in an adolescent population]. / Studio epidemiologico per la realizzazione di un programma di prevenzione del tabagismo in una popolazione di adolescenti.

In the last few years, the relative number of adolescent smokers has increased, which indicates the need to boost the adoption of new preventive strategies aimed at this part of the population. In order to be effective, preventive actions should be put in the local setting thoroughly knowing the target population and any specific-predictive factors of the insurgence of smoking addiction. To this purpose, we conducted a study aimed at describing the prevalence of smoking addiction in a population of 2472 adolescents and at identifying any predisposing factors. From the analysis of the results, both predisposing and protective factors emerged, together with many formative requests from the adolescents. On the basis of such results, we were able to create ad hoc preventive interventions. The proposed strategy seems to be potentially valid; however, we will be able to express a more precise judgment only at the end of the implementation phase.

[Autopsy today: an obsolete practice or an instrument for improving the quality of health care?]. / L'autopsia oggi: una pratica superata o uno strumento per migliorare la qualità delle prestazioni sanitarie?

INTRODUCTION: Autopsies are a fundamental moment of clinical audit that have been progressively decaying. MATERIALS AND METHODS: The autoptic rates of 6 hospitals of Piedmont Region (1639 autopsies, years 1995-97) were calculated. The Positive Predictive Value and Sensitivity (indicators of concordance between clinical and autoptic diagnosis) were calculated for each diagnosis; all discrepancies were classified as type I (adverse impact on patient's survival) and type II (uncertain impact) clinical errors. The diagnostic performance of medical, surgical and emergency staffs were compared with one another. RESULTS: Autopsies are rarely performed on the patients who died in hospital (7.13%). Independently from the diagnosis, the global concordance expresses a Positive Predictive Value of 37.22% and a Sensitivity of 47.71%. 401 type I errors and 307 type II errors were found. The best performance is reached by emergency staff. AIM: To evaluate the use and the meaning of autopsies in today's Italian healthcare organisations.