[Evaluation of the appropriateness of public hospital use using AEP, Disease Staging, and other DRG-based criteria (essential levels of care--Italian LEA): results and degree of agreement among the different methodologies]. / Valutazione dell'appropriatezza organizzativa degli ospe- dali pubblici abruzzesi tramite PRUO, Disease Staging, e mediante il calcolo dei DRG ad alto rischio di inappropria- tezza secondo i "nuovi" e "vecchi" LEA: risultati e grado di concordanza tra le diverse metodiche.

Currently, more than one instrument has been found to be reliable and valid for the assessment of hospital admission appropriateness. However; data on the level of agreement among these methodologies are extremely scarce. The study was aimed at evaluating whether the percentages of organizational (in)appropriateness resulting from some of the most diffused instruments (Italian Appropriateness Evaluation Protocol--AEP/PRUO; Disease Staging; Essential Levels of Care--LEA, version 2001 and 2008) are substantially concordant, or they largely depend upon the methodology. For each public hospital of Abruzzo, Italy, the amount of inappropriateness has been computed using six indicators: inappropriate days of care (PRUO1); totally inappropriate admissions (PRU02); early admissions DRGs according to the first Law on Italian LEA (LEA01); admissions assigned to one of the 108 potentially inappropriate DRGs according to the second Law on Italian LEA, currently inactive (LEA08). The sample was composed by all ordinary admissions made in 2006 in the Region, with the exception of PRUO indicators, which were based upon the manual revision of 2% of all admissions that could be assessed using PRUO methodology. We found a good correlation among most indicators based upon administrative discharge data (DS1, DS2 and LEA01), whereas the results obtained using PRUO and new LEA (LEA08) were discordant, and marked differences were observed also between the two PRUO indicators. Although the limitations of the study permit only preliminary conclusions, in future appropriateness evaluations it may be reasonable to use more than one indicator--allowing the creation of combined scores--and rank hospitals in large categories--avoiding excessively precise scores--as such rankings might relevantly differ depending upon the used instrument.

[Disease staging analysis of the timeliness and appropriateness of hospital admissions: no relevant improvements in the Abruzzo Region of Italy from 2001 to 2005]. / Analisi tramite Disease Staging della tempestività dei ricoveri quale indice di appropriatezza di utilizzo dell'assistenza ospedaliera: assenza di miglioramento nella Regione Abruzzo nel quinquennio 2001-2005.

The study was aimed at evaluating whether the degree of hospital admission inappropriateness and timeliness was improved in the Abruzzo Region of Italy between the year 2001 and 2005. All hospital admissions for the year 2001 (n = 286,924) and 2005 (n = 280,761) in the Region were analysed (SDO discharge data), and three diseases were in-depth reviewed: diabetes mellitus; cholecystitis/cholelithiasis; and bacterial pneumonia. Using Disease Staging methodology, the timeliness of hospitalisation was assessed by grouping admissions in three categories: premature or medically unnecessary, timely, and late. Overall, the rate of medically unnecessary admissions for diabetes mellitus was 72.3% in 2001 and 73.4% in 2005. The percentage of late hospitalizations for the same disease was still 20.2% in 2005, when the rate of late admissions for cholelithiasis/cholecystitis was 53.3% (+10.5% compared to 2001);for bacterial pneumonia 14.5%. The rate of early admissions did not improve for any disease, and any of the six local health units in Abruzzo showed an improvement in all the measures evaluated. In the period 2001 and 2005, in the Abruzzo Region there is no evidence of an improvement in the rates of inappropriate hospital admission, both early and late, which are still excessively high for all diseases examined excepted bacterial pneumonia. Interventions to address this issue are strongly needed.

The question of differences in body dimensions between children from endogamic and exogamic matings: a study in Sardinia.

The aim of this study is to investigate whether there are differences in body dimensions between children of the same sex from endogamic and exogamic matings. The cross-sectional sample consisted of 285 children, 136 males and 149 females, 6 to 10 years old, attending elementary schools in Tortolí, a town in east-central Sardinia. The children of each sex were divided into two groups: endogamic and exogamic, the first including children from parents born in the same Sardinian village, the latter children from parents born in two different places. For each sex, ANCOVA with age as covariate revealed no significant differences between the two groups of children for the 35 anthropometric variables considered. Moreover, for each sex, there were no significant differences between the two groups of children for some anthropometric variables considered to be indicators of nutritional status: sums of skinfold thicknesses, waist/hip ratio, body mass index, total upper arm area, upper muscle arm area, upper arm fat area. We conclude that when Sardinian children of endogamous and exogamous unions are in similar nutritional conditions, they do not differ in body dimensions.

Are there differences in body dimensions among children from matings at different exogamic levels?

The aim of this study was to investigate if there are differences in body dimensions among children from matings of different levels of exogamy. The cross-sectional sample consisted of 285 children, 136 males and 149 females, 6 to 10 years old, attending elementary schools in Tortoli, a town in east-central Sardinia. The children were divided into four groups according to the level of exogamy. One of them included the children of parents born in the same Sardinian village is highly endogamous. For each sex, the Kruskal-Wallis test revealed no significant differences among the four groups of children for the 35 anthropometric variables considered, with the exception of head circumference in the male sample. In particular, there were no significant differences among the four groups of children for some anthropometric variables that are considered to be indirect indicators of nutritional status: sum of skinfolds, waist/hip ratio, body mass index, total upper arm area, upper arm muscle area, upper arm fat area. We conclude that Sardinian children from marriages of different levels of exogamy do not differ in body dimensions if they have similar nutritional conditions.

Hes genes regulate sequential stages of neurogenesis in the olfactory epithelium.

We have characterised the functions of the bHLH transcriptional repressors HES1 and HES5 in neurogenesis, using the development of the olfactory placodes in mouse embryos as a model. Hes1 and Hes5 are expressed with distinct patterns in the olfactory placodes and are subject to different regulatory mechanisms. Hes1 is expressed in a broad placodal domain, which is maintained in absence of the neural determination gene Mash1. In contrast, expression of Hes5 is restricted to clusters of neural progenitor cells and requires Mash1 function. Mutations in Hes1 and Hes5 also have distinct consequences on olfactory placode neurogenesis. Loss of Hes1 function leads both to expression of Mash1 outside of the normal domain of neurogenesis and to increased density of MASH1-positive progenitors within this domain, and results in an excess of neurons after a delay. A mutation in Hes5 does not produce any apparent defect. However, olfactory placodes that are double mutant for Hes1 and Hes5 upregulate Ngn1, a neural bHLH gene activated downstream of Mash1, and show a strong and rapid increase in neuronal density. Together, our results suggest that Hes1 regulates Mash1 transcription in the olfactory placode in two different contexts, initially as a prepattern gene defining the placodal domain undergoing neurogenesis and, subsequently, as a neurogenic gene controlling the density of neural progenitors in this domain. Hes5 synergizes with Hes1 and regulates neurogenesis at the level of Ngn1 expression. Therefore, the olfactory sensory neuron lineage is regulated at several steps by negative signals acting through different Hes genes and targeting the expression of different proneural gene homologs.

Mash1 activates a cascade of bHLH regulators in olfactory neuron progenitors.

The lineage of olfactory neurons has been relatively well characterized at the cellular level, but the genes that regulate the proliferation and differentiation of their progenitors are currently unknown. In this study, we report the isolation of a novel murine gene, Math4C/neurogenin1, which is distantly related to the Drosophila proneural gene atonal. We show that Math4C/neurogenin1 and the basic helix-loop-helix gene Mash1 are expressed in the olfactory epithelium by different dividing progenitor populations, while another basic helix-loop-helix gene, NeuroD, is expressed at the onset of neuronal differentiation. These expression patterns suggest that each gene marks a distinct stage of olfactory neuron progenitor development, in the following sequence: Mash1>Math4C/neurogenin1>NeuroD. We have previously reported that inactivation of Mash1 function leads to a severe reduction in the number of olfactory neurons. We show here that most cells in the olfactory epithelium of Mash1 mutant embryos fail to express Math4C/neurogenin1 or NeuroD. Strikingly, a subset of progenitor cells in a ventrocaudal domain of Mash1 mutant olfactory epithelium still express Math4C/neurogenin1 and NeuroD and differentiate into neurons. Cells in this domain also express Math4A/neurogenin2, another member of the Math4/neurogenin gene family, and not Mash1. Our results demonstrate that Mash1 is required at an early stage in the olfactory neuron lineage to initiate a differentiation program involving Math4C/neurogenin1 and NeuroD. Another gene activates a similar program in a separate population of olfactory neuron progenitors.