Sustainability of paediatric radiology in Italy.

Italy is the sixth most populous country in Europe and has the second highest average life expectancy, reaching 79.4 years for men and 84.5 for women. However, Italy has one of the lowest total fertility rates in the world: in 2018 it was 1.3 births per woman, with the population older than 65 comprising more than 30%, and those younger-than-19 less than 15%. Older people are the main concern of the Italian health system. Weighted coefficients for the allocation of funds favour older adults. As confirmed by our study, paediatric radiology is expensive, and the reimbursement based on Italian adult rates is not sufficient. The negative impact on the budget discourages the diffusion of paediatric radiology both in the private practices that provide services paid for by the state government and in the public hospitals. The 501 paediatric hospital units in Italy are not homogeneously distributed throughout the national territory. Furthermore, in Italy there are 12 highly specialised children's hospitals whose competences were defined in 2005 by the Ministry of Health. Paediatric radiology is not included among the highly qualified specialties. The quality gap in paediatric radiology between children's hospitals and general hospitals, the latter often without paediatric radiologists, is evident in daily practice with misdiagnoses and investigations not carried out.

The role of artificial intelligence in healthcare: a structured literature review.

BACKGROUND/INTRODUCTION: Artificial intelligence (AI) in the healthcare sector is receiving attention from researchers and health professionals. Few previous studies have investigated this topic from a multi-disciplinary perspective, including accounting, business and management, decision sciences and health professions. METHODS: The structured literature review with its reliable and replicable research protocol allowed the researchers to extract 288 peer-reviewed papers from Scopus. The authors used qualitative and quantitative variables to analyse authors, journals, keywords, and collaboration networks among researchers. Additionally, the paper benefited from the Bibliometrix R software package. RESULTS: The investigation showed that the literature in this field is emerging. It focuses on health services management, predictive medicine, patient data and diagnostics, and clinical decision-making. The United States, China, and the United Kingdom contributed the highest number of studies. Keyword analysis revealed that AI can support physicians in making a diagnosis, predicting the spread of diseases and customising treatment paths. CONCLUSIONS: The literature reveals several AI applications for health services and a stream of research that has not fully been covered. For instance, AI projects require skills and data quality awareness for data-intensive analysis and knowledge-based management. Insights can help researchers and health professionals understand and address future research on AI in the healthcare field.

HIV screening in pregnant women: A systematic review of cost-effectiveness studies.

INTRODUCTION: Vertical transmission represents the major route of HIV infection for children. However, the preventive interventions available are extremely effective. This review summarizes evidence regarding the cost-effectiveness of mother-to-child-transmission preventive screenings, to help policy makers in choosing the optimal antenatal screening strategy. METHODS: A systematic review following PRISMA guidelines was conducted, using 3 databases: PubMed, Scopus, and Cost-Effectiveness Analysis Registry. All articles regarding HIV screening to avoid vertical transmission were included. RESULTS: The review included 21 papers. Seven studies assessed the cost-effectiveness of universal antenatal screening during early gestation. Two papers considered the integration of HIV screening with other medical interventions. Eight works estimated the cost-effectiveness of HIV screening in late pregnancy. Finally, 4 papers considered the combination of multiple strategies. The selected papers focused on both developed and developing countries, with a different HIV prevalence. The characteristics and methodology of the studies were heterogeneous. However, all studies agreed about the main findings, outlining the cost-effectiveness of both universal antenatal screening and HIV rescreening in late pregnancy. Cost-effectiveness improved when HIV burden increased. The major findings were proved to be robust across various scenarios when tested in sensitivity analysis. CONCLUSIONS: The review confirmed the cost-effectiveness not only of HIV universal antenatal screening but also of rescreening in late gestation in both developed and developing countries. Universal screening is cost-effective even in case of extremely low HIV prevalence. Therefore, to maximize screening, coverage appears as a worldwide priority. In certain settings, a targeted screening towards high-risk groups could be a valuable option.

Cost-effectiveness of HIV screening in high-income countries: A systematic review.

INTRODUCTION: Over 2 million people in high-income countries live with HIV. Early diagnosis and treatment present benefits for infected subjects and reduce secondary transmissions. Cost-effectiveness analyses are important to effectively inform policy makers and consequently implement the most cost-effective programmes. Therefore, we conducted a systematic review regarding the cost-effectiveness of HIV screening in high-income countries. METHODS: We followed PRISMA statements and included all papers evaluating the cost-effectiveness of HIV screening in the general population or in specific subgroups. RESULTS: Thirteen studies considered routine HIV testing in the general population. The most cost-effective option appeared to be associating one-time testing of the general population with annual screening of high-risk groups, such as injecting-drug users. Thirteen studies assessed the cost-effectiveness of HIV screening in specific settings, outlining the attractiveness of similar programmes in emergency departments, primary care, sexually transmitted disease clinics and substance abuse treatment programmes. DISCUSSION: Evidence regarding the health benefits and cost-effectiveness of HIV screening is growing, even in low-prevalence countries. One-time screenings offered to the adult population appear to be a valuable choice, associated with repeated testing in high-risk populations. The evidence regarding the benefits of using a rapid test, even in terms of cost-effectiveness, is growing. Finally, HIV screening seems useful in specific settings, such as emergency departments and STD clinics.