The First Two Years of COVID-19 Hospitalization Characteristics and Costs: Results from the National Discharge Registry.

BACKGROUND: The COVID-19 pandemic has emerged as the primary global health challenge of the new millennium. Understanding its impact on health systems and learning from these experiences are crucial for improving system resilience against future health crises. This paper examines hospitalizations related to COVID-19 in Italy from 2020 to 2021, with a specific focus on the costs associated with these admissions. DESIGN AND METHODS: This is a retrospective, population-based study of Italian hospitalizations of patients diagnosed with COVID-19 during the 2020-2021 period, using data extracted from the National Hospital Discharge Registry. The outcome variables considered include hospital admissions, costs, and length of stay. RESULTS: In Italy, hospitalizations for COVID-19 totaled 357,354 in 2020 and 399,043 in 2021, with the transfer rate being three times higher than that of other patients. Hospitalizations were predominantly concentrated in the northern regions, especially during the first year. Mortality rates increased with age, while hospitalization rates peaked in the youngest and oldest age groups. The financial impact of COVID-19 hospitalizations was approximately €3.1 billion in 2020 and €3.6 billion in 2021. The cost per admission was around €8000 for standard care and €24,000 for intensive therapy in both years. CONCLUSION: Conducting a cost-benefit analysis of implementing a protective pad around the entire health system, which leverages networks of family doctors and nurses connected in real-time, could be an important step in strengthening health system resilience.

The first 2 years of COVID-19 in Italy: Incidence, lethality, and health policies.

Background: The novel coronavirus disease 2019 (COVID-19) is an ongoing pandemic that was first recognized in China in December 2019. This paper aims to provide a detailed overview of the first 2 years of the pandemic in Italy. Design and methods: Using the negative binomial distribution, the daily incidence of infections was estimated through the virus's lethality and the moving-averaged deaths. The lethality of the original strain (estimated through national sero-surveys) was adjusted daily for age of infections, hazard ratios of virus variants, and the cumulative distribution of vaccinated individuals. Results: From February 24, 2020, to February 28, 2022, there were 20,833,018 (20,728,924-20,937,375) cases distributed over five waves. The overall lethality rate was 0.73%, but daily it ranged from 2.78% (in the first wave) to 0.15% (in the last wave). The first two waves had the highest number of daily deaths (about 710) and the last wave showed the highest peak of daily infections (220,487). Restriction measures of population mobility strongly slowed the viral spread. During the 2nd year of the pandemic, vaccines prevented 10,000,000 infections and 115,000 deaths. Conclusion: Almost 40% of COVID-19 infections have gone undetected and they were mostly concentrated in the first year of the pandemic. From the second year, a massive test campaign made it possible to detect more asymptomatic cases, especially among the youngest. Mobility restriction measures were an effective suppression strategy while distance learning and smart working were effective mitigation strategies. Despite the variants of concern, vaccines strongly reduced the pandemic impact on the healthcare system avoiding strong restriction measures.

The first year of COVID-19 in Italy: incidence, lethality, and health policies.

BACKGROUND: The novel coronavirus disease is an ongoing pandemic that started in China in December 2019. This paper is aimed at estimating the first two infections waves in Italy in relation to adopted health policies. DESIGN AND METHODS: We moved deaths of the Italian COVID-19 registry from recorded to infection date by the weighted moving average. We considered two infection fatality ratios related to the effective or saturated health system, we estimated the likely incidence curve from the resulting deaths and evaluated the curve shape before and after the national health policies. RESULTS: From the 24th of February 2020 to the 7th of February 2021, we estimated 6,664,655 (4,639,221-9,325,138) cases distributed on two waves. Suitable daily infection fatality rates were 2.53% within the first wave and 1.15% within the second one. The first wave (February-July 2020) had its peak on the 14th of March 2020 (26,575). The second wave (August 2020-February 2021) was fatter with the peak on the 12th of November (60,425) and a hump in December before decreasing to 26,288 at the end. Adopted health policies were followed by changes in the curve rate. CONCLUSIONS: Tracing infection contacts and quarantining asymptomatic people reduced virus lethality in the second wave.  Restriction on population mobility is effective within a suppression strategy, distance learning reduces contacts among families. Removal of restrictions should be implemented by sequential steps for avoiding a quick rising of incident cases. A reasonable public health daily goal to control both virus spread and lethality could be to find at least 87 cases for each death.

Hospitalisation costs of malignant mesothelioma: results from the Italian hospital discharge registry (2001-2018).

OBJECTIVES: This paper aims to establish hospitalisation costs of mesothelioma in Italy and to evaluate hospital-related trends associated with the 1992 asbestos ban. DESIGN: This is a retrospective population-based study of Italian hospitalisations treating pleura, peritoneum and pericardium mesothelioma in the period 2001-2018. SETTINGS: Public and private Italian hospitals reached by the Ministry of Health (coverage close to 100%). PARTICIPANTS: 157 221 admissions with primary or contributing diagnosis of pleural, peritoneal or hearth cancer discharged from 2001 to 2018.Primary and secondary outcome measures: number, length and cost of hospitalisations with related percentages. RESULTS: Each year, Italian hospitals treated a mesothelioma in 6025 admissions on average. Mean annual costs by site were €20 293 733, €3183 632 and €40 443 for pleura, peritoneum and pericardium, respectively. Pericardial mesothelioma showed the highest cost per admission (€6117), followed by peritoneal (€4549) and pleural cases (€3809). Percentage of hospitalisation costs attributable to mesothelioma was higher when it is located in pleura (53.4%) and pericardium (51.8%) with respect to peritoneum (41.2%). Overall annual hospitalisation cost, percentages of number and length of admissions showed an inverted U-shape, with maxima (of €25 850 276, 0.064% and 0.096%, respectively) reached in 2011-2013. Mean age at discharge and percentages of surgery and of urgent cases increased over time. CONCLUSIONS: The highest impact of mesothelioma on the National Health System was recorded 20 years after the asbestos ban (2011-2013). Hospitals should expect soon fewer but more severe patients needing more cares. To study the disease prevalence could help assistance planning of next decade.

Costs of asbestosis and silicosis hospitalization in Italy (2001-2018) : Costs of asbestosis and silicosis hospitalization.

BACKGROUND: Asbestosis and silicosis are preventable fibrotic forms of pneumoconiosis. Decades ago, the World Health Organization began prevention campaigns for eliminating these diseases worldwide. PURPOSE: To establish Italian hospitalization costs of asbestosis and silicosis in relation to national adopted prevention policies. METHODS: This is a retrospective population-based study of Italian hospitalizations treating asbestosis or silicosis in the period 2001-2018. We have extracted data from the National Hospital Discharge Registry and merged with national standard charges of hospitalizations through diagnosis-related group coding. We expressed costs in 2018 euros and evaluated data time-trends by linear normal and logistic regression models. RESULTS: During 2001-2018, hospitalization costs per year were 3,787,540 € for asbestosis and 10,103,215 € for silicosis. There were significant annual reductions in frequency (- 41 and - 266 hospitalizations per year for asbestosis and silicosis, respectively), length of stay (- 148 and - 2781 days per year for asbestosis and silicosis, respectively) and cost (- 43,881 and - 959,516 € per year for asbestosis and silicosis, respectively) of diseases. Length and cost of hospital stay per admission significantly increased over time for asbestosis (+ 0.2 days and + 100 €, respectively, per year). CONCLUSION: Overall hospitalizations costs were higher for silicosis than asbestosis. Over time hospitals treated fewer cases with greater severity. The decreased 2001-2018 consumption of hospital resources by patients with asbestosis or silicosis is associated with the occupational health policies instituted from the 1990s to reduce exposures to asbestos and silica. Extending existing epidemiological surveillance systems to pneumoconioses would help to control the social costs of work-related diseases.

Asbestosis and silicosis hospitalizations in Italy (2001-2015): results from the National Hospital Discharge Registry.

BACKGROUND: This work is aimed at evaluating the quality of Italian hospitalizations data about asbestosis and silicosis, assessing the impact of these diseases on the national health system and providing advice related to public health. METHODS: Italian hospital discharge data (2001-15) with diagnosis of asbestosis or silicosis were analysed by the multiple correspondence analysis and diseases epidemics were evaluated through hospitalization rates. RESULTS: Hospitalizations were concentrated in the northwestern area, referred mainly to males and oldest people, the most treated tumors were lung cancer and mesothelioma (for asbestosis) and cares were aimed at reducing symptoms and increasing blood oxygenation. Overall adjusted Italian hospitalization rates of asbestosis and silicosis were, respectively, 25.2 and 74.9 per 1 000 000 residents. With respect to asbestosis, hospitalizations treating silicosis reported doubled mortality (10.5 vs. 5.7%), longer stays (10.4 vs. 8.6 mean days) and older patients (77 vs. 72 years on average). Diseases rates reduced over time (with a steeper slope for silicosis) and in both fibroses increased hospital mortality (92.1% in asbestoses, 59.5% in silicoses) and percentage of urgent hospitalizations (116.0% in asbestoses, 56.6% in silicoses). CONCLUSION: Hospitalizations data regarding asbestosis and silicosis are consistent. Silicosis had a higher impact than asbestosis on the Italian health system. Although data show decreasing incidence of both fibroses, multiple correspondence analysis highlights that levels of illness severity were higher in silicosis and increased over time in both diseases. Further studies investigating the effectiveness of the current health surveillance programs concerning these diseases are suggested.

The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure.

INTRODUCTION: The epidemiology of gender differences for mesothelioma incidence has been rarely discussed in national case lists. In Italy an epidemiological surveillance system (ReNaM) is working by the means of a national register. METHODS: Incident malignant mesothelioma (MM) cases in the period 1993 to 2012 were retrieved from ReNaM. Gender ratio by age class, period of diagnosis, diagnostic certainty, morphology and modalities of asbestos exposure has been analysed using exact tests for proportion. Economic activity sectors, jobs and territorial distribution of mesothelioma cases in women have been described and discussed. To perform international comparative analyses, the gender ratio of mesothelioma deaths was calculated by country from the WHO database and the correlation with the mortality rates estimated. RESULTS: In the period of study a case list of 21 463 MMs has been registered and the modalities of asbestos exposure have been investigated for 16 458 (76.7%) of them. The gender ratio (F/M) was 0.38 and 0.70 (0.14 and 0.30 for occupationally exposed subjects only) for pleural and peritoneal cases respectively. Occupational exposures for female MM cases occurred in the chemical and plastic industry, and mainly in the non-asbestos textile sector. Gender ratio proved to be inversely correlated with mortality rate among countries. CONCLUSIONS: The consistent proportion of mesothelioma cases in women in Italy is mainly due to the relevant role of non-occupational asbestos exposures and the historical presence of the female workforce in several industrial settings. Enhancing the awareness of mesothelioma aetiology in women could support the effectiveness of welfare system and prevention policies.

[National epidemiological surveillance systems of mesothelioma cases]. / I sistemi nazionali di sorveglianza dei casi di mesotelioma.

INTRODUZIONE: sebbene la relazione causale tra esposizione ad amianto e malattie neoplastiche sia ben nota, in molti Paesi il consumo del materiale è ancora rilevante e crescente. A causa della lunga latenza, nei Paesi dove è stato bandito (come in Italia) è oggi in corso un'epidemia di malattie correlate ad amianto. OBIETTIVI: descrivere i sistemi di sorveglianza dei mesoteliomi attivi nel mondo mediante un'analisi comparativa. METODI: è stata condotta una revisione bibliografica della letteratura disponibile sui sistemi di sorveglianza epidemiologica dei mesoteliomi attivi nel mondo, comparando metodi e risultati disponibili. RISULTATI: sistemi di ricerca dei casi incidenti e di analisi anamnestica dei soggetti ammalati sono attivi solo in Italia, Francia e Corea del Sud. I Paesi presso i quali sono attivi sistemi di rilevazione e controllo dei casi incidenti di mesotelioma sono quelli in cui vige il bando dell'amianto e che hanno sperimentato consumi rilevanti in passato. Non sono stati istituiti sistemi epidemiologici di sorveglianza in molti Paesi dove il consumo di amianto è ancora importante (inclusi Russia, Cina, India e Brasile). CONCLUSIONI: si conferma l'importanza dei sistemi di sorveglianza epidemiologica dei mesoteliomi per la sanità pubblica, il sostegno alle politiche di welfare e la prevenzione dei rischi. Lo sviluppo di progetti per tendere a una maggiore uniformità nei metodi di ricerca dei casi, di classificazione delle diagnosi e dell'esposizione e nelle tecniche di analisi dei dati potrebbe consentire una maggiore fruibilità dei dati aggregati. La disponibilità di dati internazionali confrontabili può essere di stimolo all'adozione di provvedimenti di bando internazionale.

[Pleural mesothelioma mortality in Italy: time series reconstruction (1970-2009) and comparison with incidence (2003-2008)]. / Mortalità per mesotelioma pleurico in Italia: ricostruzione della serie storica (1970-2009) e confronto con l'incidenza (2003-2008).

BACKGROUND: the large amount of asbestos used in many Countries (including Italy) is causing an epidemic of asbestos related diseases, which is still ongoing because of their long latency. OBJECTIVES: this study is aimed at reconstructing Italian time series of deaths for mesothelioma in the period 1970-2009 and comparing Italian incidence and mortality data. DESIGN, SETTING, AND PARTICIPANTS: deaths for pleural cancer (1970-2003,2006-2009) and mesothelioma (2003, 2006-2009) were recorded by the Italian Institute of Statistics (Istat) and provided by the Italian National Agency for New Technologies, Energy and the Environment (ENEA), incidence cases (1993-2008) were provided by the Italian mesotheliomas register (ReNaM) at the Italian National Workers' Compensation Authority (Inail). For the period before ICD-10 implementation (1970-2002) and when Istat data (2004-2005) are lacking, mesothelioma deaths were estimated through statistical models (logistic, Poisson). National incidence and mortality data were compared during the overlapping period (2003, 2006-2008). RESULTS: the mortality curve strongly rises from 1970 and seems to be smoothed in the last years. Mortality caused by mesothelioma and incident cases with certain diagnosis are overlapping, as are mortality due to pleural cancer other than mesothelioma and mesothelioma incidence with uncertain diagnosis (probable/possible). CONCLUSIONS: this epidemiological analysis of deaths encoded as pleural tumour suggests to carefully investigate space-temporal distribution before excluding they could be mesotheliomas. Some new lights have been thrown on the statistical behaviour of mesothelioma mortality.

Occupational exposure and sinonasal cancer: a systematic review and meta-analysis.

BACKGROUND: Sinonasal cancer (SNC) has been related to occupational exposures, but the relative risk associated to specific jobs and/or carcinogen exposures other than wood and leather dust is generally based on small or inadequate sample sizes and the range of observed estimates is large. This paper is aimed at investigating such relationship through a systematic review of the literature followed by a meta-analysis of studies meeting specific inclusion criteria. METHODS: Systematic search was made with PubMed, Google Scholar and Scopus engines using related keywords. Occupational exposures include wood and leather dust, formaldehyde, nickel and chromium compounds, textile industry, farming and construction. Meta-analysis of published studies after 1985 with a case-control or cohort design was performed, firstly using the fixed-effect model. Heterogeneity was assessed with the Q statistical test and quantified by the I(2) index. When the heterogeneity hypothesis appeared relevant, the random-effect model was chosen. Sources of heterogeneity were explored using subgroup analyses. RESULTS: Out of 63 reviewed articles, 28 (11 cohort, 17 case-control) were used in the meta-analysis. Heterogeneity among studies was observed and random-effects models were used. Exposure to wood dust results associated with SNC (RRpooled = 5.91, 95% CI: 4.31-8.11 for the case-control studies and 1.61, 95% CI: 1.10-2.37 for the cohort studies), as well as to leather dust (11.89, 95% CI: 7.69-18.36). The strongest associations are with adenocarcinomas (29.43, 95% CI: 16.46-52.61 and 35.26, 95% CI: 20.62-60.28 respectively). An increased risk of SNC for exposures to formaldehyde (1.68, 95% CI: 1.37-2.06 for the case control and 1.09, 95% CI: 0.66-1.79 for the cohort studies), textile industry (2.03, 95% CI: 1.47-2.8), construction (1.62, 95% CI: 1.11-2.36) and nickel and chromium compounds (18.0, 95% CI: 14.55-22.27) was found. Subset analyses identified several sources of heterogeneity and an exposure-response relationship was suggested for wood dust (p = 0.001). CONCLUSIONS: By confirming the strength of association between occupational exposure to causal carcinogens and SNC risk, our results may provide indications to the occupational etiology of SNC (not only wood and leather dusts). Future studies could be focused on specific occupational groups to confirm causative agents and to define appropriate preventive measures.

Epidemiological risk analysis of home injuries in Italy (1999-2006).

Home injuries are an important public health issue in both developed and developing countries. This study focused on the Italian epidemiological framework between 1999 and 2006, using a nation-representative sample provided by the National Institute of Statistics. Every year, about 3,000,000 Italian residents reported at least one home injury, with an overall annual rate of 5.2/100 (95% CI 5.1-5.4); 3.2/100 (3.0-3.4) for males and 7.2/100 (6.9-7.4) for females. Poisson regression models were used for different age-specific populations (children, young/adults and older people), to evaluate the effects of socio-demographic, health/income satisfaction and housing variables. For children, non-applicable variables (including smoking and health satisfaction) were taken as those of the head of family, while housework time was taken the family mean time. Evidence of decreasing time trend in risk of home injury was found only among young/adults (p < 0.01). The following were risk factors: female gender (adjusted relative risk--RR 2.0 for older people and RR 1.9 for young/adults, p < 0.01); one additional hour of work at home (RR 1.009, p < 0.01 for young/adults and RR 1.016, p = 0.01 for children); smoking (RR 1.3, p < 0.01 for young/adults and p = 0.02 for children); health dissatisfaction (RR 1.3, p = 0.05 for children, RR 1.6 for young/adults and RR 1.7 for older people, p < 0.01); income dissatisfaction (RR 1.2, p < 0.01 for young/adults ); living alone (RR 1.5, p < 0.01 for young/adults and RR 1.2, p < 0.02 for the older people); having a garden (RR 1.1, p < 0.01 for young/adults ). Awareness of the need for safety at home could be boosted by information campaigns on the risk, and its social cost could be reduced by specific prevention schemes. Developing tools for assessing the risk at home and for removing the main hazards would be useful for both informative and prevention interventions.

The relevance of socio-demographic and occupational variables for the assessment of work-related stress risk.

BACKGROUND: Work-related stress is widely recognized as one of the major challenges to occupational health and safety. The correlation between work-related stress risk factors and physical health outcomes is widely acknowledged. This study investigated socio-demographic and occupational variables involved in perceived risk of work-related stress. METHODS: The Italian version of the Health and Safety Executive Management Standards Indicator Tool was used in a large survey to examine the relationship between work-related stress risks and workers' demographic and occupational characteristics. Out of 8,527 questionnaires distributed among workers (from 75 organizations) 6,378 were returned compiled (74.8%); a set of mixed effects models were adopted to test single and combined effects of the variables on work-related stress risk. RESULTS: Female workers reported lower scores on control and peer support and more negative perceptions of relationships and change at work than male workers, most of them with full-time contracts. Age, job seniority, and educational level appeared positively correlated with control at work, but negatively with job demands. Fixed-term workers had positive perceptions regarding job demands and relationships, but more difficulties about their role at work than permanent workers. A commuting time longer than one hour and shift work appeared to be associated with higher levels of risk factors for work-related stress (except for role), the latter having more negative effects, increasing with age. CONCLUSIONS: The findings suggest that the assessment and management of work-related stress risk should consider specific socio-demographic and occupational risk factors such as gender, age, educational level, job status, shift work, commuting time, job contracts.

Pain management policies and practices in pediatric emergency care: a nationwide survey of Italian hospitals.

BACKGROUND: Pain experienced by children in emergency departments (EDs) is often poorly assessed and treated. Although local protocols and strategies are important to ensure appropriate staff behaviours, few studies have focussed on pain management policies at hospital or department level. This study aimed at describing the policies and reported practices of pain assessment and treatment in a national sample of Italian pediatric EDs, and identifying the assocoated structural and organisational factors. METHODS: A structured questionnaire was mailed to all the 14 Italian pediatric and maternal and child hospitals and to 5 general hospitals with separate pediatric emergency room. There were no refusals. Information collected included the frequency and mode of pain assessment, presence of written pain management protocols, use of local anaesthetic (EMLA cream) before venipuncture, and role of parents. General data on the hospital and ED were also recorded. Multiple Correspondence Analysis was used to explore the multivariable associations between the characteristics of hospitals and EDs and their pain management policies and practices. RESULTS: Routine pain assessment both at triage and in the emergency room was carried out only by 26% of surveyed EDs. About one third did not use algometric scales, and almost half (47.4%) did not have local protocols for pain treatment. Only 3 routinely reassessed pain after treatment, and only 2 used EMLA. All EDs allowed parents' presence and most (17, 89.9%) allowed them to stay when painful procedures were carried out. Eleven hospitals (57.9%) allowed parents to hold their child during blood sampling. Pediatric and maternal and child hospitals, those located in the North of Italy, equipped with medico-surgical-traumatological ED and short stay observation, and providing full assessment triage over 24 hours were more likely to report appropriate policies for pain management both at triage and in ER. A nurses to admissions ratio ≥ median was associated with better pain management at triage. CONCLUSIONS: Despite availability of national and international guidelines, pediatric pain management is still sub-optimal in Italian emergency departments. Multifaceted strategies including development of local policies, staff educational programs, and parental involvement in pain assessment should be carried out and periodically reinforced.

Cause-specific mortality of very preterm infants and antenatal events.

OBJECTIVE: To assess the relationship between antenatal factors and cause-specific risk of death in a large area-based cohort of very preterm infants. STUDY DESIGN: The ACTION (Accesso alle Cure e Terapie Intensive Ostetriche e Neonatali) study recruited during an 18-month period all infants 22-31 weeks' gestational age admitted to neonatal care in 6 Italian regions (n=3040). We analyzed the data of 2974 babies without lethal or acutely life-threatening malformations. Cause-specific risks of death adjusted for competing causes were calculated, and region-stratified multiple Cox regression analyses were used to study the association between cause-specific mortality and infants' characteristics, pregnancy complications, antenatal steroids, and place of birth. RESULTS: Deaths attributable to respiratory problems and intraventricular hemorrhage prevailed in the first 2 weeks of life, and those attributable to infections and gastrointestinal diseases afterwards. Antepartum hemorrhage was associated with respiratory deaths (hazard ratio [HR] 1.6, 95% CI 1.1-2.4), and maternal infection with deaths attributable to asphyxia (HR 32.5, 95% CI 4.1-259.4) and to respiratory problems (HR 2.8, 95% CI 1.6-5.2). Preterm premature rupture of membranes increased the likelihood of deaths due to neonatal infection (HR 1.8, 95% CI 1.0-3.1), and preterm labor/contractions of those due to respiratory (HR 1.5, 95% CI 1.1-2.0) and gastrointestinal diseases (HR 5.8, 95% CI 2.1-16.3). In addition, a birth weight z-score<-1 was associated with increasing hazards of death resulting from asphyxia, late infections, respiratory, and gastrointestinal diseases. CONCLUSIONS: Different complications of pregnancy lead to different cause-specific mortality patterns in very preterm infants.

Effects of combined therapies on the survival of pleural mesothelioma patients treated in Brescia, 1982-2006.

AIMS AND BACKGROUND: During the 1990's, the traditional unimodal treatments (surgery, radiotherapy, chemotherapy, immunotherapy) for malignant pleural mesothelioma started to be combined in bimodal or multimodal strategies. However, recent population-based analyses of the survival of patients with malignant pleural mesothelioma indicate that even these treatments have not led to significant improvements in prognosis, which remains very poor. The present study assessed the survival of patients given combined treatments and multimodal therapies in a specialized hospital department. METHODS: The study population comprised 530 patients diagnosed with malignant pleural mesothelioma from 1982 to 2006: 343 of them were residents in the province of Brescia (Lombardy, Northern Italy) and 187 were residents outside the province, with a follow-up to 31 December 2009. Kaplan-Meier survival analyses and Cox proportional risks model were used to test sex, age at diagnosis, histological type and treatments, as prognostic factors. RESULTS: The estimated median survival for the whole group of patients was 317 days (257 for residents and 398 for non-residents), and respectively 310 and 340 days in the groups diagnosed in the periods 1982-2000 and 2001-2006. Multivariate analysis confirmed that the prognosis was better for younger patients and cases of epithelioid type malignant pleural mesothelioma, whereas for patients receiving any single treatment the prognosis was not significantly better than for those given palliative care alone. However, patients receiving combined treatments or the multimodality approach had significantly longer median survival and the relative risk of death was respectively 0.57 and 0.61 compared to untreated patients (or those only given symptomatic therapy). CONCLUSIONS: This is the first study in Italy to assess the effectiveness of different treatment approaches in a significant number of patients treated in one hospital. Further studies are needed to confirm the improvement in prognosis - even if modest--on larger numbers of patients and taking into account the different stages of the disease.

Cognitive assessment of very preterm infants at 2-year corrected age: performance of the Italian version of the PARCA-R parent questionnaire.

BACKGROUND: Serial assessments of cognitive and language development are recommended for very preterm children, but standardized neuropsychological testing is time-consuming and expensive, as well as tiring for the child. AIMS: To validate the Italian version of the PARCA-R parent questionnaire and test its clinical effectiveness in assessing cognitive development of very preterm children at 2 years of corrected age. METHODS: 120 consecutive Italian very preterm children (mean gestational age 28.8 weeks, standard deviation 2.1) were assessed in four hospitals through the Mental Development Index (MDI) of the Bayley Scales of Infant Development (BSID-II). Parents completed the PARCA-R questionnaire, designed to measure children's non-verbal and verbal (vocabulary and sentence complexity) cognitive level. The correlation between the MDI and the PARCA-R Parent Report Composite (PRC) was tested through the Pearson correlation coefficient, and the receiver operating characteristic (ROC) curve was used to identify optimal PRC cut-offs. RESULTS: Significant correlation between the PRC score and MDI (r=0.60, p<0.001) indicated good concurrent validity. The area under the ROC curve was 0.83, and the cut-off of 46 lead to 72.7% sensitivity and 77.1% specificity in identifying children with moderate/severe cognitive delay (MDI<70). Negative predictive value was 96.6 (90.3-99.3). Screening through PARCA-R would reduce the number of children with MDI≥70 undergoing BSID-II or equivalent standardized tool from 109 to 25. CONCLUSIONS: The Italian version of PARCA-R retains good discriminative power for identifying cognitive delay in 2-year very preterm children. It is well accepted by parents, and represents a valid and efficient alternative for developmental screening and outcome measurement.

Work-related stress risk assessment in Italy: the validation study of health safety and executive indicator tool.

INTRODUCTION: In compliance with the Italian occupational health and safety regulatory framework, as provided by the Lgs. Decree 81/2008, the "work-related stress" risk assessment should follow the same principles as other risk assessments, in accordance with the European Agreement of 8 October 2004; therefore, validated and scientifically proven methodological tools are needed to conduct an adequate work-related stress risk assessment. The UK's Health Safety and Executive (HSE) Indicator Tool (IT) is used for assessing the risk of work-related stress. The aim of this study is to test the factor structure of IT as a measure of work-related stress in a sample of Italian workers. METHODS: Data collected from 65 Italian organizations (6378 workers) was used for a Confirmatory Factor Analysis (CFA) on the 35-item seven-factor model. RESULTS: The results showed acceptable fit to the data (CFI .90; TLI .89, RMSEA .045). A second CFA was done to test a 35-item six-factor model (CFI .89, TLI .87, RMSEA .047). Both models were tested after removing six items (factor loadings less than .50.), resulting in a 29-item model. Here again, there was an acceptable fit to the data (29-item seven-factor model: CFI .93, TLI .91, RMSEA .044; 29-item six-factor model: CFI .92, TLI .90, RMSEA .046). DISCUSSIONS: These findings show that the HSE model satisfactorily adapts to use in a sample of Italian workers. One of the most important innovations introduced in the assessment of work-related stress with the HSE IT is the global approach for identifying work-related stress risk factors, aimed at establishing the best strategy from the viewpoints of prevention officers and also of workers.

Analysis of latency time and its determinants in asbestos related malignant mesothelioma cases of the Italian register.

Italy was an important producer of raw asbestos until 1992 (when it was banned) and it is now experiencing severe public health consequences due to large-scale industrial use of asbestos in shipbuilding and repair, asbestos-cement production, railways, buildings, chemicals and many other industrial sectors. Latency of malignant mesothelioma generally shows a large variability and the relationship with the modality of asbestos exposure is still not fully clarified. We present an analysis of latency period among the case list collected by the Italian mesothelioma register (ReNaM) in the period of diagnosis 1993-2001 (2544 malignant mesothelioma (MM) cases with asbestos exposure history). Exposure is assessed retrospectively by interview. Statistical univariate analyses were performed to estimate median and variability measures of latency time by anatomical site, gender and diagnosis period. The role of diagnostic confidence level, the morphology of the tumour and the modalities of asbestos exposure were verified in a regression multivariate model. We found a median latency period of 44.6 years increasing in recent years with a linear trend. Anatomical site, gender and morphology were not relevant for MM latency time whereas a shorter latency period was documented among occupationally exposed subjects (43 years) with respect to environmentally and household exposed ones (48 years).