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1.
Artículo en Inglés | MEDLINE | ID: mdl-33158223

RESUMEN

Decision makers are used to consider Out-of-Pocket Expenditure (OOPE) within a health technology assessment framework in order to account for an indicator relying on the level of fairness and on the quality of care of a health system. In this paper, we provide estimates on the determinants of OOPE in Italy by using data coming from an observational cross-sectional study that enrolled a sample of 2526 patients suffering from inflammatory bowel diseases. We explore the association between OOPE and: (1) geographical location; (2) income effects; (3) performances in delivering healthcare. A regression model was used. Individuals' age were in the range of 18-88 (mean 44 ± 14.55). Forty-six percent were females, 54% were married and 19% held a bachelor degree. Ninety-six percent of respondents declared an OOPE >0 whose mean value was €960 ± €950. Individuals belonging to low-income and low-performance regions were more likely to declare an OOPE >0 (99%). Regression findings suggest that increases in OOPE could be considered as a response from patients aiming to compensate for lacks and inefficiencies in the public healthcare offers. Policymakers should consider increases in OOPE in patients with Inflammatory Bowel Diseases (IBDs) as an indicator of poor quality of care and poor fairness.

2.
Artículo en Inglés | MEDLINE | ID: mdl-33114587

RESUMEN

Aim: In this article, we aim to present a tool for the early assessment of medical technologies. This evaluation system was designed and implemented by the National Centre for HTA and the National Centre for Innovative Technologies of the Istituto Superiore di Sanita, Italy, in order to respond to an institutional commitment within the "Health Technologies Assessment Team" that was established to face the huge demand for the evaluation of Health Technologies during the pandemic event caused by COVID-19, with a smart and easy-to-use framework. Methods: Horizon scanning was conducted through a brief assessment carried out according to the multicriteria decision analysis methodology. Each HTA domain was attributed a score according to a pros/cons and opportunities/threats system, derived from evidence in the literature. Scores were weighted according to different perspectives. Scores were presented in a Cartesian graph showing the positioning according to the potential value and the perceived risk associated with the technology. Results: Two case studies regarding the early assessment were reported, concerning two specific technologies: an individual protection device and a contact tracking system.


Asunto(s)
Infecciones por Coronavirus , Técnicas de Apoyo para la Decisión , Pandemias , Neumonía Viral , Evaluación de la Tecnología Biomédica , Betacoronavirus , Humanos , Italia , Riesgo
3.
Vaccine ; 38(42): 6609-6617, 2020 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-32788138

RESUMEN

BACKGROUND: In 2017 the Italian government introduced compulsory vaccination for Italian school children for ten diseases, in response to an alarmingly decrease in coverage and measles outbreak. A hot social debate arose around the issue of the law. Studies on the opinion of Italians on this topic are rare, so we investigated the socio-cultural profile of Italians about beliefs towards vaccination. METHODS: Data were extracted from the Italian section of the European Social Survey (ESS), conducted by the Italian National Institute for Public Policies Analysis during 2017. The main outcome assessed was the opinion about the supposed harmfulness of vaccines. We analysed the association between the outcome and a selected group of socio-cultural characteristics, with a specific interest in examining the interaction between our main outcome and the perceived trust in the scientific community in regards to vaccines. A principal component analysis was then performed for determining the socio-cultural profile of respondents. RESULTS: Among the 2,626 subjects interviewed face to face, 19% believed that vaccines were harmful and 10% did not have trust in the scientific community in regards to vaccines. Out of the respondents who believed in the harmfulness of vaccines, 29% neither had trust in the scientific community. Principal Component Analysis suggested that this group (Anti-vax/science sceptic) was characterised by low participation in political and cultural life, being male, older of age and politically oriented towards the right. People agreeing about harmfulness of vaccines are mostly males, have a lower education level, poor attendance in political and cultural life and are politically oriented to the right. CONCLUSIONS: The ESS survey is unique in its capacity to deal with emerging themes of the social debates. Results paint a picture of the opinions of Italians on vaccines. This profile may be useful for policymakers to design targeted vaccination campaigns and to intervene more efficaciously in the public debate.

4.
Ann Ist Super Sanita ; 53(4): 337-343, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29297865

RESUMEN

INTRODUCTION: Audit and feedback are recognized as part of a strategy for improving performance and supporting quality and safety in European health care systems. These considerations led the Clinical Management Staff of the "Regina Elena" Italian Cancer Institute to start a project of self-assessment of the quality of clinical records and organizational appropriateness through a retrospective review. MATERIALS AND METHODS: The evaluation about appropriateness and congruity concerned both clinical records of 2013 and of 2015. At the end of the assessment of clinical records of each Care Unit, results were shared with medical staff in scheduled audit meetings. RESULTS: One hundred and thirteen clinical records (19%) did not meet congruity criteria, while 74 (12.6%) resulted as inappropriate. Considering the economic esteem calculated from the difference between Diagnosis Related Groups (DRG) primarily identified as main diagnosis and main surgical intervention or procedure and those modified during the Local Health Unit (LHU) assessment, 2 surgical Care Units produced a high negative difference in terms of economic value with a consequent drop of hospital discharge form (named in Italian "scheda di dimissione ospedaliera", SDO) remuneration, 7 Care Units produced about the same medium difference with almost no change as SDO remuneration, and 2 Care Units had a positive difference with a profit in terms of SDO remuneration. Concerning the quality assessment of clinical records of 2015, the most critical areas were related to medical documents and hospital discharge form compilation. CONCLUSIONS: Our experience showed the effectiveness of clinical audit in assessing the quality of filling in medical records and the appropriateness of hospital admissions and the acceptability of this tool by clinicians.


Asunto(s)
Instituciones Oncológicas/normas , Auditoría Médica , Registros Médicos/normas , Neoplasias/terapia , Humanos , Italia , Neoplasias/diagnóstico , Mejoramiento de la Calidad , Estudios Retrospectivos
5.
BMJ Open ; 6(2): e010134, 2016 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-26895985

RESUMEN

OBJECTIVES: To explore the accuracy of application of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool in epidemiological studies focused on the evaluation of the role of antibiotics in selecting resistance, and to derive and test an extension of STROBE to improve the suitability of the tool in evaluating the quality of reporting in these area. METHODS: A three-step study was performed. First, a systematic review of the literature analysing the association between antimicrobial exposure and acquisition of methicillin-resistant Staphylococcus aureus and/or multidrug-resistant Acinetobacter baumannii was performed. Second, articles were reviewed according to the STROBE checklist for epidemiological studies. Third, a set of potential new items focused on antimicrobial-resistance quality indicators was derived through an expert two-round RAND-modified Delphi procedure and tested on the articles selected through the literature review. RESULTS: The literature search identified 78 studies. Overall, the quality of reporting appeared to be poor in most areas. Five STROBE items, comprising statistical analysis and study objectives, were satisfactory in <25% of the studies. Informative abstract, reporting of bias, control of confounding, generalisability and description of study size were missing in more than half the articles. A set of 21 new items was developed and tested. The new items focused particularly on the study setting, antimicrobial usage indicators, and patients epidemiological and clinical characteristics. The performance of the new items in included studies was very low (<25%). CONCLUSIONS: Our paper reveals that reporting in epidemiological papers analysing the association between antimicrobial usage and development of resistance is poor. The implementation of the newly developed STROBE for antimicrobial stewardship (AMS) tool should enhance appropriate study design and reporting, and therefore contribute to the improvement of evidence to be used for AMS programme development and assessment.


Asunto(s)
Antibacterianos/uso terapéutico , Lista de Verificación , Farmacorresistencia Bacteriana , Métodos Epidemiológicos , Mejoramiento de la Calidad , Infecciones por Acinetobacter , Acinetobacter baumannii/fisiología , Estudios Epidemiológicos , Humanos , Staphylococcus aureus Resistente a Meticilina/fisiología , Pautas de la Práctica en Medicina , Infecciones Estafilocócicas
6.
Ig Sanita Pubbl ; 72(5): 481-504, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-28068678

RESUMEN

BACKGROUND: Gender differences are evident in many common health conditions, especially respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). The aim of this review was to identify published studies describing gender differences in asthma and COPD, in particular regarding pathophysiology, diagnosis and treatment, with a focus on Italian data. METHODS: a literature review was performed from April to November 2015, using the PubMed scientific database and the following ??eywords: "gender differences" and "asthma" for the asthma review and "gender differences" and "COPD" for the COPD review. RESULTS: Gender differences in asthma are related to age groups. In the female population, asthma is generally more severe and disabling, and presents higher mortality rates with respect to same-age males. COPD prevalence is growing and is underestimated in women, because it tends to be diagnosed with difficulty and at a delayed stage. The same findings were observed when restricting the review to Italian data. CONCLUSION: Clinicians should collaborate to develop a more gender-oriented approach towards diagnosis and treatment of asthma and COPD. In Italy, this would also facilitate measures to improve compliance, particularly among women.


Asunto(s)
Asma , Enfermedad Pulmonar Obstructiva Crónica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Asma/diagnóstico , Asma/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Factores Sexuales , Adulto Joven
7.
Ig Sanita Pubbl ; 71(4): 405-17, 2015.
Artículo en Italiano | MEDLINE | ID: mdl-26519747

RESUMEN

INTRODUCTION: Medical malpractice and litigation have a significant impact on the Italian National Health Service. The aim of this study was to analyze the state of the art of medical errors in Italy, in particular, assessing which specialties are most affected. METHODS: We performed a literature search in PubMed, Google Scholar; institutional websites (Ministry of Health, Higher Institute of Health, National Agency for Regional Health Services, National Institute of Statistics, National Research Council, Court of Auditors), gray literature and specialized magazines. RESULTS: Results show that data regarding the frequency of medical errors and the effectiveness of prevention measures in Italy are scarce. Most papers published on this topic refer to a few specialties, including Surgery, Radiology, Cardiology, and Laboratory medicine. Surgery is the specialty most affected. CONCLUSIONS: Despite a growing attention towards patient safety and quality of healthcare, medical errors continue to occur in clinical practice. Most errors are not due to individual incompetence or negligence but they are rooted in system breakdowns. A systematic approach is therefore required, based on: an analysis of critical aspects in the system; the selection and implementation, at different levels of the system, of appropriate and evidence-based risk management interventions involving all stakeholders; a context analysis to identify barriers and facilitators for change; a performance assessment to verify results and identify actions for improvement.


Asunto(s)
Cardiología , Cirugía General , Laboratorios de Hospital , Mala Praxis/estadística & datos numéricos , Errores Médicos/estadística & datos numéricos , Seguridad del Paciente , Radiología , Cardiología/estadística & datos numéricos , Medicina Basada en la Evidencia , Cirugía General/estadística & datos numéricos , Humanos , Italia/epidemiología , Laboratorios de Hospital/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Radiología/estadística & datos numéricos
8.
Value Health ; 18(4): 457-66, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26091600

RESUMEN

OBJECTIVES: To develop a comparative, cost-effectiveness, and budget impact analysis of Therakos online extracorporeal photopheresis (ECP) compared with the main alternatives used for the treatment of steroid-refractory/resistant chronic graft-versus-host disease (cGvHD) in Italy. METHODS: The current therapeutic pathway was identified by searching medical databases and from the results of a survey of practice in Italian clinical reference centers. A systematic review was performed to evaluate the efficacy and safety of second-line alternatives. Budget impact and cost-effectiveness analyses were performed from the Italian National Health Service perspective over a 7-year time horizon through the adaption of a Markov model. The following health states were considered: complete and partial response, stable disease, and progression. A discount rate of 3% was applied to costs and outcomes. RESULTS: The most common alternatives used in Italy for the management of steroid-refractory/resistant cGvHD were ECP, mycophenolate, pentostatin, and imatinib. The literature review highlighted that complete and partial responses are higher with ECP than with the alternatives while serious adverse events are less common. The economic analysis showed that Therakos online ECP represents the dominating alternative, in that it delivers greater benefit at a lower cost. In fact, according to the alternatives considered, cost saving ranged from €3237.09 to €19,903.51 per patient with 0.04 to 0.21 quality-adjusted life-year gained. CONCLUSIONS: Therakos online ECP should be considered an effective, safe, and cost-effective alternative in steroid-refractory/resistant cGvHD. There is inequality in access, and a dedicated reimbursement tariff, however, should be introduced to overcome these barriers.


Asunto(s)
Enfermedad Injerto contra Huésped/epidemiología , Enfermedad Injerto contra Huésped/terapia , Fotoféresis/métodos , Evaluación de la Tecnología Biomédica/métodos , Enfermedad Crónica , Análisis Costo-Beneficio/métodos , Análisis Costo-Beneficio/normas , Femenino , Enfermedad Injerto contra Huésped/economía , Humanos , Italia/epidemiología , Masculino , Fotoféresis/economía , Fotoféresis/normas , Evaluación de la Tecnología Biomédica/normas , Resultado del Tratamiento
9.
Ig Sanita Pubbl ; 71(1): 9-20, 2015.
Artículo en Italiano | MEDLINE | ID: mdl-25927648

RESUMEN

UNLABELLED: The need to integrate clinical and public health training of medical students is increasingly important. Future physicians need to be able to deal with new, complex and growing public health challenges. MATERIALS AND METHODS: A literature search was performed through Pubmed to identify the conceptual reference framework. Meetings were carried out to identify the most appropriate modalities and priorities required for drafting the project, to identify the skills to be acquired by students, to decide on teaching formats and methods to assess student learning, to draw up the teaching schedule, to define the statistical methods to be used to assess student satisfaction, and to perform the statistical analysis of results. Training in hospital hygiene and environmental safety was carried out through presentation of a relevant case. After being divided into groups the students attended the three units (Environmental Microbiology, Environmental Xenobiotics, Genetic Epidemiology and Molecular Biology) of the Hygiene Section of a Public Health Institute. Training in Organization and Health Programming involved presentation of a set of indicators for the definition of objectives and assessment of health systems or services. RESULTS: The literature search led to the identification of the relevant literature. With regard to student satisfaction, 96% of those who replied to the questionnaire gave an overall positive review of the training course (at least 3 on a scale from 1 to 5). CONCLUSIONS: the overall high level of student satisfaction suggests that the proposed model may be exportable. Further developments will be the assessment of trends regarding functioning of the organizational model and perceived teaching quality.


Asunto(s)
Educación Médica , Salud Pública/educación , Italia , Proyectos Piloto
10.
Eur J Public Health ; 25(2): 255-62, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25320051

RESUMEN

BACKGROUND: Obesity represents an important public health issue. An assessment of its costs would be useful to provide recommendations for policy and decision-making strategies. The aims of our study were to carry out a systematic review to assess the economic burden of adult obesity in terms of direct and indirect costs and to perform a quality appraisal of the analysed studies. METHODS: A literature search was carried out on PubMed, Scopus and Cochrane Library to retrieve cost-of-illness (COI) analyses focused on adult (aged 18 years or more) overweight or obese people and published up to 2013. COI analyses that considered direct and indirect costs were included. Each included manuscript was independently appraised by three groups of researchers on the basis of the British Medical Journal Drummond's checklist. RESULTS: Approximately 2044 articles were initially retrieved, and 17 were included in the current review. The included studies showed a medium-high-quality level. The available studies seemed to be heterogeneous both in terms of methodology and results reporting. However, as many studies have been conducted from the payer perspective, just direct medical costs can be considered exhaustive. As only three studies included considered also indirect costs, there is no strong evidence to give a comprehensive picture of this phenomenon also from the societal perspective. CONCLUSION: The review confirmed that obesity absorbs a huge amount of health-care resources. Further research is therefore needed to better understand the economic impact and to identify and promote public health strategies to tackle obesity.


Asunto(s)
Prestación de Atención de Salud/economía , Costos de la Atención en Salud/estadística & datos numéricos , Obesidad/economía , Adulto , Costo de Enfermedad , Análisis Costo-Beneficio , Humanos
11.
Ig Sanita Pubbl ; 71(6): 577-87, 2015.
Artículo en Italiano | MEDLINE | ID: mdl-26847271

RESUMEN

The Day Service was established in Italy to promote appropriateness of care and consists in the delivery of packages of complex outpatient services. A Working Group for the continuous improvement of pre-hospitalization activities of the Regina Elena Scientific Institute in Rome, Italy, established that the outpatient management of surgical patients in the hospital would occur in a Day Service, through a package of services identified at the regional level or appropriate diagnostic and therapeutic pathways. This article describes the experience of the hospital's Day Service and compares results from the last four months of 2013 with those of the first four months of 2014. The introduction of a Day Service has led to a reduction in the number of inappropriate pre-admission tests (mainly computerized tomography, magnetic resonance and Positron emission scans and scintigraphy) and this has had a positive impact not only in terms of organization, reduction of hospital stay and overall hospitalization-related activities, but also from an economic standpoint. The implementation of a Day Service has also improved the overall patient experience, from an organizational point of view, and this is an important aspect, considering that patients at the Regina Elena Scientific Institute are oncological patients, they are often elderly and most reside in other Italian regions.


Asunto(s)
Centros de Día/estadística & datos numéricos , Mal Uso de los Servicios de Salud/prevención & control , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Hospitalización , Hospitales , Humanos , Registros , Roma
12.
Biomed Res Int ; 2014: 704207, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25243173

RESUMEN

OBJECTIVE: Systemic lupus erythematosus (SLE) is treated with anti-inflammatory and immunosuppressive drugs and off-label biologics. Belimumab is the first biologic approved after 50 years as an add-on therapy for active disease. This paper summarizes a health technology assessment performed in Italy. METHODS: SLE epidemiology and burden were assessed using the best published international and national evidences and efficacy and safety of belimumab were synthesized using clinical data. A cost-effectiveness analysis was performed by a lifetime microsimulation model comparing belimumab to standard of care (SoC). Organizational and ethical implications were discussed. RESULTS: Literature review showed that SLE affects 47 per 100,000 people for a total of 28,500 patients in Italy, 50% of whom are affected by active form of the disease despite SoC. These patients, if autoantibodies and anti-dsDNA positive with low complement, are eligible for belimumab. SLE determines work disability and a 2-5-fold increase in mortality. Belimumab with SoC may prevent 4,742 flares in three years being cost-effective with an incremental cost-effectiveness ratio of €32,859 per quality adjusted life year gained. From the organizational perspective, the development of clear and comprehensive clinical pathways is crucial. CONCLUSIONS: The assessment supports the use of belimumab into the SLE treatment paradigm in Italy.


Asunto(s)
Anticuerpos Monoclonales Humanizados , Inmunosupresores , Lupus Eritematoso Sistémico , Adulto , Anticuerpos Monoclonales Humanizados/efectos adversos , Anticuerpos Monoclonales Humanizados/economía , Anticuerpos Monoclonales Humanizados/uso terapéutico , Análisis Costo-Beneficio , Femenino , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/economía , Inmunosupresores/uso terapéutico , Italia/epidemiología , Lupus Eritematoso Sistémico/tratamiento farmacológico , Lupus Eritematoso Sistémico/economía , Lupus Eritematoso Sistémico/epidemiología , Masculino , Calidad de Vida
13.
Biomed Res Int ; 2014: 418416, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25050348

RESUMEN

OBJECTIVES: The aim of the study was to assess knowledge and attitudes of medical residents working in Università Cattolica del Sacro Cuore, Rome, Italy, on genetic tests for breast and colorectal cancer. METHODS: We distributed self-administered questionnaire to the residents. Logistic regression models were used to evaluate the determinants of knowledge and attitudes towards the tests. RESULTS: Of 754 residents, 364 filled in questionnaire. Around 70% and 20% answered correctly >80% of questions on breast and colorectal cancer tests, respectively. Knowledge on tests for breast cancer was higher among residents who attended course on cancer genetic testing during graduate training (odds ratio (OR): 1.72; 95% confidence interval (CI): 1.05-2.82) and inversely associated with male gender (OR: 0.55; 95% CI: 0.35-0.87). As for colorectal cancer, residents were more knowledgeable if they attended courses on cancer genetic testing (OR: 2.08; 95% CI: 1.07-4.03) or postgraduate training courses in epidemiology and evidence-based medicine (OR: 1.95; 95% CI: 1.03-3.69). More than 70% asked for the additional training on the genetic tests for cancer during the specialization school. CONCLUSION: The knowledge of Italian residents on genetic tests for colorectal cancer appears to be insufficient. There is a need for additional training in this field.


Asunto(s)
Neoplasias de la Mama/genética , Neoplasias Colorrectales/genética , Pruebas Genéticas/estadística & datos numéricos , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud , Internado y Residencia/estadística & datos numéricos , Adulto , Neoplasias de la Mama/diagnóstico , Neoplasias Colorrectales/diagnóstico , Demografía , Femenino , Humanos , Italia , Masculino
14.
Food Environ Virol ; 6(2): 67-74, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24838574

RESUMEN

Noroviruses are recognized as the leading cause of human acute viral gastroenteritis worldwide. The rate of outbreaks on cruise ships has grown significantly in recent years. Given the potentially harmful consequences of outbreaks for passengers and crewmembers and the subsequently high costs for cruise companies, disease outbreaks on cruise ships represent a serious public health issue. The aim of our study was to systematically review published studies related to Norovirus outbreaks on commercial cruise ships. We searched the PubMed and Scopus scientific databases. We included eligible studies published from January 1990 to July 2013 that were written in English and described infectious episodes involving at least two passengers and/or crewmembers on a commercial cruise ship. As a result, 15 studies and seven reviews met the inclusion criteria, describing a total of 127 outbreaks. The majority of the cases were reported in Europe and the USA, affecting <1 to 74% of the embarked passengers. In the majority of the studies, stool samples and/or serum specimens from ill passengers were collected and tested for laboratory confirmation. Twelve studies reported that an ad-hoc questionnaire was administered. Fifteen studies investigated the possible source of infection which was contaminated food in the majority of cases. Our findings suggest a strong need for the monitoring and implementation of preventive measures in semi-closed communities, such as cruise ships. It would be advisable to strengthen all relevant initiatives in order to improve the detection of, response to and control of Norovirus outbreaks on cruise ships.


Asunto(s)
Infecciones por Caliciviridae/epidemiología , Alimentos/virología , Norovirus/fisiología , Viaje , Infecciones por Caliciviridae/prevención & control , Infecciones por Caliciviridae/virología , Brotes de Enfermedades , Europa (Continente)/epidemiología , Contaminación de Alimentos/análisis , Humanos , Norovirus/aislamiento & purificación , Salud Pública , Navíos/estadística & datos numéricos , Viaje/economía , Viaje/estadística & datos numéricos , Estados Unidos/epidemiología
15.
Biomed Res Int ; 2014: 975927, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24689066

RESUMEN

OBJECTIVE: The Health Technology Assessment (HTA) approach was applied to denosumab in the prevention of osteoporotic fractures in postmenopausal women. METHOD: Epidemiological, clinical, technical, economic, organizational, and ethical aspects were considered. Medical electronic databases were accessed to evaluate osteoporosis epidemiology and therapeutical approaches. A budget impact and a cost-effectiveness analyses were performed to assess economic implications. Clinical benefits and patient needs were considered with respect to organizational and ethical evaluation. RESULTS: In Italy around four millions women are affected by osteoporosis and have a higher risk for fractures with 70,000 women being hospitalized every year. Bisphosphonates and strontium ranelate are recommended as first line treatment for the prevention of osteoporotic fractures. Denosumab is effective in reducing vertebral, nonvertebral, and hip/femoral fractures with an advantage of being administered subcutaneously every six months. The budget impact analysis estimated a reduction in costs for the National Health Service with the introduction of denosumab. Furthermore, the economic analysis demonstrated that denosumab is cost-effective in comparison to oral bisphosphonates and strontium ranelate. Denosumab can be administered in outpatients by involving General Practitioners in the management. Ethical evaluation is positive because of its efficacy and compliance. CONCLUSION: Denosumab could add value in the prevention of osteoporotic fractures.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Conservadores de la Densidad Ósea/uso terapéutico , Fracturas Osteoporóticas/tratamiento farmacológico , Fracturas Osteoporóticas/prevención & control , Posmenopausia , Evaluación de la Tecnología Biomédica , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados/economía , Conservadores de la Densidad Ósea/economía , Presupuestos , Análisis Costo-Beneficio , Denosumab , Femenino , Hospitalización/economía , Humanos , Italia/epidemiología , Cadenas de Markov , Persona de Mediana Edad , Fracturas Osteoporóticas/economía , Fracturas Osteoporóticas/epidemiología , Posmenopausia/efectos de los fármacos , Evaluación de la Tecnología Biomédica/economía , Evaluación de la Tecnología Biomédica/ética , Evaluación de la Tecnología Biomédica/organización & administración , Resultado del Tratamiento
16.
Hum Vaccin Immunother ; 10(5): 1204-10, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24603089

RESUMEN

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011-2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P<0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011-2012 season (P<0.001). "To avoid spreading influenza among patients" was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future.


Asunto(s)
Actitud del Personal de Salud , Recolección de Datos , Vacunas contra la Influenza/uso terapéutico , Internado y Residencia , Médicos , Vacunación/estadística & datos numéricos , Adulto , Recolección de Datos/métodos , Femenino , Humanos , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Internado y Residencia/tendencias , Italia/epidemiología , Masculino , Médicos/tendencias , Vacunación/tendencias
17.
Ig Sanita Pubbl ; 70(6): 591-606, 2014.
Artículo en Italiano | MEDLINE | ID: mdl-25715895

RESUMEN

Childhood obesity is one of the most important issues in Public Health so that the adoption of innovative preventive integrated approaches is increasingly needed. The presence of coordinated and integrated programmes, aimed at preventing childhood obesity and based on innovative large-scale approaches, was ascertained by means of a literature search. In Europe three programmes, with activities and staff characterized by common aims and active participation of different stakeholders, use such a community-based approach, which allowed changes in physical and social environment, resulting in new and innovative elements for lifestyle modifications.

18.
Ig Sanita Pubbl ; 69(4): 427-44, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24091844

RESUMEN

Public Health (PH) and Primary Health Care (PHC) need to be better integrated, at different levels of the healthcare system, in order to improve health and social outcomes. The aim of this study was to review international models and approaches supporting the integration of PH and PHC and to classify these according to their main focus. A literature search was performed using the main scientific databases, to identify national and international journal publications regarding models to support integration between PH and PHC. The final set of the documents provided a broad coverage of the topic. Four models of integration were identified: general integration, chronic disease prevention, targeted prevention or care delivery and infection control. Models differed in their levels of implementation, stages of development and focus. This review, by classifying the main characteristics and results of the experiences retrieved, indicates a relatively scarce use of integration models in the global health care landscape, with the exception of Canada. In fact, Canada has been a leader in developing models of integrated health systems that combine tailored approaches to influence personal health behaviour and community-oriented approaches to influence the health of the population. The review also revealed a general lack of experience in evaluating the sustainability of integration between PH and PHC, not only in terms of cost-effectiveness, but also in terms of better health and work conditions and self-perceived quality of care in the population. Collaboration between PH and PHC seems to be an important strategy for achieving principles of equity and access in health care and for ensuring a more equal distribution of health care services.


Asunto(s)
Conducta Cooperativa , Atención Primaria de Salud , Salud Pública , Enfermedad Crónica/prevención & control , Prestación Integrada de Atención de Salud , Países Desarrollados , Países en Desarrollo , Salud Global , Humanos , Control de Infecciones , Evaluación de Resultado en la Atención de Salud
20.
Clin Nucl Med ; 38(6): 432-6, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23603586

RESUMEN

OBJECTIVE: The objective of this study was to compare 2 diuretic renography procedures: F-15 versus F+10(sp) for diagnosis of obstructive uropathy in adults. METHODS: Thirty-six patients with unilateral or bilateral hydronephrosis had 2 consecutive Tc-MAG3 diuretic renograms within 7 days, using the widely used procedure F-15 in supine position, and a new seated-position procedure whereby the patient drinks 400 to 500 mL of water at 5 minutes and receives an injection of 20 mg of furosemide at 10 minutes [F+10 (sp)]. RESULTS: F-15 showed nonobstructive results in 63.9% of kidneys, obstruction in 26.4%, and equivocal findings in 6.9% and was not applicable in 2.8%. F+10(sp) showed nonobstructive results in 70.9%, obstruction in 27.8%, and equivocal result in 1.4% of kidneys. Nephroptosis was observed by F+10(sp) in 22.2% of kidneys. Adverse effects reported for the F-15 were hypotension in 2 patients, renal colic in 3 patients, and interruption due to voiding in 5 patients. No adverse effects were reported for F+10(sp). CONCLUSIONS: This study shows that the F+10(sp) procedure reduces the equivocal findings of F-15 procedure in 36 patients. It can improve the accuracy and compliance, avoiding adverse effects and reducing bladder filling-related problems.


Asunto(s)
Diuréticos , Furosemida , Hidronefrosis/diagnóstico por imagen , Postura , Tecnecio Tc 99m Mertiatida , Adolescente , Adulto , Anciano , Demografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Renografía por Radioisótopo , Adulto Joven
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