Emergency Department Non-Urgent Visits and Hospital Readmissions Are Associated with Different Socio-Economic Variables in Italy.

OBJECTIVE: The aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED) for non-urgent visits. METHODS: The study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use. RESULTS: Among the 416,698 sampled admissions, 6.39% (95% CI, 6.32-6.47) of re-admissions have been registered; the distribution shows a high frequency of events in the age 65-84 years group, and in the intermediate care hospitals (51.97%; 95%CI 51.37-52.57). The regression model has shown the significant role played by age, type of structure (geriatric acute care), and deprivation index of the area of residence on the readmission, however, after adjusting for the intensity of primary care, the role of deprivation was no more significant. Non-urgent ED visits accounted for the 12.10%, (95%CI 9.38-15.27) of the total number of respondents to the questionnaire (N = 504). The likelihood of performing a non-urgent ED visit was higher among patients aged <65 years (OR 3.2, 95%CI 1.3-7.8 p = 0.008), while it was lower among those perceiving as urgent their health problem (OR 0.50, 95%CI 0.30-0.90). CONCLUSIONS: In the Italian context repeated readmissions and ED utilization are linked to different trajectories, besides the increasing age and comorbidity of patients are the factors that are related to repeated admissions, the self-perceived trust in diagnostic technologies is an important risk factor in determining ED visits. Better use of public national health care service is mandatory, since its correct utilization is associated to increasing equity and better health care utilization.

Utilization patterns of cervical cancer screening in Italy.

The aim of this study is to identify the use of cervical cancer screening and sociodemographic determinants associated with proper screening, overscreening, and underscreening in the Italian target population. Cross-sectional data from the national last available survey 'Health and use of health care in Italy,' conducted between December 2004 and September 2005, were analyzed. Multiple logistic regression was used to evaluate the risk factors associated independently with Pap test utilization. Our final sample included 36,161 women aged 25-64 years. Among women who reported having a Pap smear at least once, 20,920 (81.6%) repeated the Pap smear after the first one: 15,454 (74.3%) more than once every 3 years ('OVER' screening) and 2599 (12.4%) less than once every 3 years ('UNDER' screening). Among the independent risk factors associated with 'OVER' screening were higher social class [odds ratio (OR)=1.26, 95% confidence interval (CI) 1.15-1.39], being a former smoker (OR=1.16, 95% CI 1.05-1.28), and having had two or more pregnancies in the last 5 years (OR=1.43, 95% CI 1.20-1.70), whereas 'UNDER' screening was associated with the age group of 55-64 years (OR=2.11, 95% CI 1.76-2.53) and being divorced (OR=1.32, 95% CI 1.02-1.71). Improving Pap test compliance according to the proper timing is important for future reduction in cervical cancer mortality.

Determinants of influenza vaccination uptake among Italian healthcare workers.

We analyzed seasonal influenza vaccination coverage among the Italian healthcare workers (HCW) in order to identify socio-demographic and clinical determinants of vaccination. We used data from the survey "Health and health care use in Italy," which comprised interviews of 5,336 HCWs For each respondent, information on socioeconomic, health conditions, self-perceived health and smoking status were obtained. After bivariate analysis, we used multilevel regression models to assess determinants of immunization. Overall 20.8% of HCWs (95%CI 19.7-21.9) reported being vaccinated against seasonal influenza. After controlling for potential confounders, multilevel regression revealed that older workers have a higher likelihood of vaccine uptake (OR = 6.07; 95% CI 4.72-7.79). Conversely, higher education was associated with lower vaccine uptake (OR = 0.65; 95% IC 0.50-0.83). Those suffering from diabetes (OR = 2.07; 95% CI 1.19-1.69), COPD (OR = 1.95; 95% CI 1.31-2.89) and cardiovascular diseases (OR = 1.48 95% CI 1.11-1.96) were more likely to be vaccinated. Likewise, smokers, or former smokers receive more frequently the vaccination (OR = 1.40; 95% CI 1.15-1.70; OR = 1.54; 95% CI 1.24-1.91, respectively) compared with never-smokers as well as those HCWs reporting fair or poor perceived health status (ORs of 1.68, 95% CI 1.30-2.18). Vaccine coverage among HCWs in Italy remains low, especially among those with no comorbidities and being younger than 44 y old. This behavior not only raises questions regarding healthcare organization, infection control in healthcare settings and clinical costs, but also brings up ethical issues concerning physicians who seem not to be very concerned about the impact of the flu on themselves, as well as on their patients. Influenza vaccination campaigns will only be effective if HCWs understand their role in influenza transmission and prevention, and realize the importance of vaccination as a preventive measure.

Measles among healthcare workers in a teaching hospital in central Italy.

OBJECTIVES: The aim of this report is to describe a measles cluster involving health-care workers (HWCs) that occurred in a teaching hospital in central Italy during winter 2011 and the efforts made to promptly identify all the susceptible contacts in order to stop, as soon as possible, transmission of the infection within the hospital. METHODS: An epidemiological investigation took place. The immunization status of all the exposed individuals was assessed by personal interviews (history of measles or measles vaccine). Serologie screening for personnel not immune to measles was performed. RESULTS: Four cases of measles infection in HCWs were identified; of the 72 HCWs tested for measles immunity, 50 reported a past history of measles, while 22 underwent serological screening, which showed that all were IgG positive except for one case, which was excluded from duty as recommended. Strict adherence to use of alcohol-based hand rub and rapid implementation of appropriate isolation precautions are essential but insufficient to prevent measles outbreaks in hospital settings. Vaccination is the only reliable protection against nosocomial spread of measles. Therefore, assessing the immunization status of HCW and implementing vaccination strategies are needed in order to virtually set to zero the risk of acquiring and spreading measles in healthcare settings.