The Erice 58 Charter on 'The health of migrants. An equity challenge for the public health system'.

Abstract: The Erice 58 Charter titled "The Health of Migrants: a Challenge of Equity for the Public Health System", was unanimously approved at the conclusion of the 58th Residential Course of the School of Epidemiology and Preventive Medicine 'Giuseppe D'Alessandro' entitled "The Health of Migrants: a Challenge of Equity for the Public Health System. Epidemiological, clinical-relational, regulatory, organisational, training and public communication aspects at international, national and local level', which took place from 28 March to 2 April 2022 in Erice (Sicily, Italy), at the 'Ettore Majorana' Foundation and Centre for Scientific Culture. The Course was promoted by the Italian Society of Migration Medicine (S.I.M.M.) and the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI), with the collaboration and patronage of the Istituto Superiore di Sanità (ISS). 72 learners participated (mainly resident doctors in 'Hygiene and Preventive Medicine' but also other health service professionals), whose average age was 37 years; on the basis of territorial origin, 13 of the 20 Italian regions were represented. During the intense learning experience, which consisted of 18 frontal lessons (with 20 lecturers from the bio-medical, socio-anthropological and journalistic fields) and 7 working group sessions (supported by 4 classroom tutors in addition to the lecturers) in 'blended learning' mode, the various dimensions and critical issues related to the possibility of guaranteeing truly inclusive health policies for foreigners/migrants, throughout the country, were identified and discussed from an 'Health Equity' perspective. This enabled a small editorial group to draw up the basic document that, in the last session of the Course, was discussed and modified by all participants into the version of the 'Erice 58 Charter' presented here.

Is the mental health profile of immigrants changing? A national-level analysis based on hospital discharges in Italy.

BACKGROUND: Among asylum seekers and refugees in European countries, several studies have shown a high burden of mental disorders, including post-traumatic stress disorder, anxiety, depression and psychoses. The present study compares hospitalization for mental disorders among migrants arriving from countries typically linked to the refugee phenomenon (putative asylum seekers), migrants arriving from other countries, and natives. METHODS: The study is based on hospital discharge data collected at the national level by the Italian Ministry of Health. Age-standardized hospitalization rates for mental health diagnoses are calculated for the three groups during the period 2008-2015. Differences in type of admission (urgent or planned) and length of stay in hospital are also assessed. RESULTS: Temporal trends show a general decrease of hospitalization rates for mental disorders among both immigrants and natives; however, an increase is observed among young male putative asylum seekers (from 30.3 in 2010 to 43.6 per 10,000 in 2015), mainly due to admissions for "other nonorganic psychoses". CONCLUSION: These findings suggest that in Italy a higher burden of mental disorders might derive from the landing phenomenon, and the increase of hospitalization ascribed to "other nonorganic psychoses" (which is a general and unspecific diagnostic label) might conceal diagnostic difficulties by Italian psychiatrists to recognize atypical pictures associated with traumatic experiences.

Social inequalities in the metropolitan area of Rome. A multidisciplinary analysis of the urban segregation of the "formerly-Bastogi" compound.

BACKGROUND: This study tries to evaluate, through a multidisciplinary approach, the relationship between urban structure, isolation and distribution of social determinants of health, in the so-called "formerly-Bastogi, a compound, with more than 1,500 inhabitants, located in north-western Rome, Italy. METHODS: The architectural-urban analysis, conducted through site visits and evaluations of urban situation, showed how strongly the compound is isolated from the neighbourhoods, and structurally degraded. The socio-demographic analysis, based on the National Census data, showed significant differences in the distribution of the social determinants of health between "formerly-Bastogi" and the surrounding areas. RESULTS: The area under study appears to be isolated from the surrounding urban space, both because of social and architectural factors. This situation could have some association with inhabitants' health. CONCLUSIONS: If our preliminary investigation was useful for a diagnosis of the situation, a more complete - qualitative and quantitative - investigation of the context will be needed to plan appropriate multidisciplinary health-promoting interventions.

Movement cognition and narration of the emotions treatment versus standard speech therapy in the treatment of children with borderline intellectual functioning: a randomized controlled trial.

BACKGROUND: Borderline intellectual functioning (BIF) is defined as a "health meta-condition… characterized by various cognitive dysfunctions associated with an intellectual quotient (IQ) between 71 and 85 which determines a deficit in the individual's functioning both in the restriction of activities and in the limitation of social participation". It can be caused by many factors, including a disadvantaged background and prematurity. BIF affects 7-12% of primary school children that show academic difficulties due to poor executive functioning. In many children with BIF, language, movement and social abilities are also affected, making it difficult to take part in daily activities. Dropping out of school and psychological afflictions such as anxiety and depression are common in children with BIF. This study investigates whether an intensive rehabilitation program that involves all of the areas affected in children with BIF (Movement, Cognition and Narration of emotions, MCNT) is more effective than Standard Speech Therapy (SST). METHODS: This is a multicenter interventional single blind randomized controlled study. Children aged between 6 to 11 years who attend a mainstream primary school and have multiple learning difficulties, behavioral problems and an IQ ranging between 85 to 70 have been enrolled. Participants are randomly allocated to one of three groups. The first group receives individual treatment with SST for 45 min, twice a week for 9 months. The second group receives the experimental treatment MCNT for 3 h per day, 5 days/ week for 9 months and children work in small groups. The third group consists of children on a waiting list for the SST for nine months. DISCUSSION: BIF is a very frequent condition with no ad hoc treatment. Over the long term, there is a high risk to develop psychiatric disorders in adulthood. Due to its high social impact, we consider it very important to intervene during childhood so as to intercept the remarkable plasticity of the developing brain. TRIAL REGISTRATION: "Study Let them grow: A new intensive and multimodal Treatment for children with borderline intellectual functioning based on Movement, Cognition and Narration of emotions", retrospectively registered in ISRCTN Register with ISRCTN81710297 at 2017-01-09.

Assessment of the stability of exogenous gamma hydroxybutyric acid (GHB) in stored blood and urine specimens.

OBJECTIVE: The aim of this work is to test the stability of exogenous GHB in whole blood and urine samples collected from living and deceased GHB free-users, spiked with known concentrations of GHB and stored at different temperatures (-20°C, 4°C and 20°C) up to 4 weeks. MATERIALS AND METHODS: GHB was added to GHB-free ante-mortem blood and urine samples at the concentration of 5 and 10 mg/L, respectively whereas in post-mortem blood and urine specimens at 50 and 10 mg/L respectively. All samples were stored at three different temperatures: -20°C, 4°C and 20°C and extracted and analyzed at three days, 1 week, 2 weeks, 3 and 4 weeks in duplicate. No preservatives were added. GHB was quantified by GC-MS after LLE according to a previously published method. RESULTS: Post-mortem blood specimens showed a reduction of GHB levels higher than 10% only after a period of 4 weeks of storage for samples kept at +4°C and +20°C, whereas samples stored at -20°C showed a mean reduction of 8.7%. In post-mortem urine samples, there was a mean reduction of GHB levels higher than 20% at all storage temperatures, after 4 weeks of storage. Ante-mortem blood samples showed a reduction of GHB levels lower than 10% only after 3 days of storage at -20°C and at +4°C (samples stored at +20°C showed a mean reduction of 10.4%). After 4 weeks of storage, there was a mean reduction of GHB concentrations higher than 20% at all storage temperatures. Ante-mortem urine samples showed a reduction of GHB levels higher than 10% after just 3 days of storage for samples kept at all tested temperatures. After 4 weeks of storage, there was a mean reduction of GHB concentrations higher than 25% at all storage temperatures. CONCLUSIONS: According to our findings, it would be useful to perform GHB analysis both in blood and urine specimens within 3 days of sampling and the specimens should be stored at -20°C or 4°C in order to avoid instability issues.

Features and organization of Pain Centers in the Lazio Region, Italy, in 2011.

BACKGROUND: Evidence on pain management highlights the importance of a multidisciplinary approach in order to achieve optimal therapeutic results. Such programs can be guaranteed by the Centers for Pain Management (CPMs), in which multidisciplinary teams are able to provide advanced and specialized activities for the assessment, diagnosis and treatment of chronic benign pain. To date, information related to healthcare supply and the organizational structure of these centers in Italy is incomplete. The aim of this paper was to provide an overview of the healthcare network of the CPMs in the Lazio region. METHODS: A descriptive survey was conducted in all the 37 CPMs existing in the Lazio region in 2011 of which 28 participated. RESULTS: CPMs were located either in Universities or in public or private hospital facilities. They included a clinic, a Day Hospital service, Day surgery and day-beds. CPMs were managed by anaesthesiologists who, in most instances, did not work in a multidisciplinary team. The number of other health professionals available, such as nurses, psychologists and physiotherapists, was limited. CPMs mainly provided drug therapy, Complementary Alternative Medicine (CAM) and complex interventional treatments. The median waiting time was 30 days. The clinics were not homogeneously distributed in the region with a higher concentration in Rome (56%), followed by other provinces of the Lazio region (26%) and the province of Rome (18%). Clearly, Rome was the city which offered the greatest range of healthcare services and the highest number of consultations with patients, which significantly differed from those of the other areas (χ²=19.6 p<0.01). CONCLUSIONS: In 2011, the availability of CPMs was not equally distributed throughout the territory, and there was an over-utilization of the facilities in Rome and an under-utilization in the provincial areas. Moreover, this study showed a lack of a multi-professional approach to chronic pain management.

What is common becomes normal: the effect of obesity prevalence on maternal perception.

BACKGROUND AND AIMS: This analysis investigates the poorly-known effect of local prevalence of childhood obesity on mothers' perception of their children's weight status. METHODS AND RESULTS: In 2008, a national nutritional survey of children attending the third grade of elementary school was conducted in Italy. Children were measured and classified as underweight, normal weight, overweight and obese, using the International Obesity Task Force cut-offs for body mass index (BMI). A parental questionnaire included parental perception of their child's weight status (underweight, normal, a little overweight and a lot overweight). Regions were classified by childhood obesity prevalence (<8%, 8-12%, ≥13%). The association between incorrect maternal perception and regional obesity prevalence, and maternal and child characteristics were examined using bivariate and logistic regression analyses. Complete data were available for 37 590 children, of whom 24% were overweight and 12% obese. Mothers correctly identified the status of 84% of normal weight, 52% of overweight and 14% of obese children. Among overweight children, factors associated with underestimation of the child's weight included lower maternal education (adjusted odds ratio, aOR, 1.9; 95% confidence interval (CI) 1.6-2.4), residence in a high-obesity region (aOR 2.2; 95% CI 1.9-2.6), male gender (aOR 1.4; 95% CI 1.2-1.6) and child's BMI. CONCLUSION: Higher regional obesity prevalence is associated with lower maternal perception, suggesting that what is common has a greater likelihood of being perceived as normal. As perception is a first step to change, it may be harder to intervene in areas with high-obesity prevalence where intervention is most urgent.

[Discrimination at the workplace among immigrants in Italy]. / La discriminazione nell'ambiente di lavoro tra gli immigrati in Italia.

BACKGROUND: Discrimination at the workplace can be considered a risk factor for immigrants' health. OBJECTIVES: In this study we compared the occurrence of episodes of arrogance or discrimination perceived at the workplace between documented immigrants coming from countries with high migration pressure and Italians, and evaluated the role of selected risk factors among immigrants. METHODS: Using data from the 2007 Labour Force Survey conducted by the Italian National Institute of Statistics, adjusted odds ratios (ORs) for socio-demographic and occupational variables were estimated among a nationally representative sample of 61,214 employed persons aged 15 years or more. RESULTS: The occurrence of perceived arrogance or discrimination was higher among immigrant compared to Italian males for all geographical areas of origin considered. Adjusted ORs were 4.6 (95% CI: 3.6-5.8) for Africans, 3.4 (95% CI: 2.5-4.6) for Asians, 2.1 (95% CI :1.6-2.8) for Eastern Europeans, and 2.0 (95% CI: 1.0-3.7) for Latin Americans. Among male immigrants a higher occurrence of arrogance or discrimination was found for construction and other industrial workers and for those residing in central-southern regions of Italy. Among female workers only Latin Americans and Africans showed a higher occurrence of perceived arrogance or discrimination compared to Italians: adjusted ORs were respectively 3.9 (95% CI: 2.6-5.7) and 2.6 (95% CI:1.5-4.5). Female immigrants with a medium-to-high level of education or a highly skilled job, and those residing in the central-southern regions of ltaly perceived the highest occurrence of arrogance or discrimination. CONCLUSIONS: The study highlighted the need for policies to protect the wellbeing of immigrants that seem to be particularly exposed to patterns of discrimination at the workplace.

[Surveillance system OKkio alla SALUTE: the role of primary school in the promotion of healthy life style--results in 2008]. / Il sistema di sorveglianza OKkio alla SALUTE: il ruolo della scuola primaria nella promozione di stili di vita salutari. Risultati 2008.

In 2007 the Italian Ministry of Health/CCM promoted and funded the project "System of surveys of behavioral risks in ages 6-17", coordinated by the National Institute of Health. One of the aims of the project is the definition and implementation of a data collection system on the weight of primary school children, their eating habits, physical activity and school initiatives favoring the healthy growth of children, called "OKkio alla SALUTE". In 2008 the first survey of OKkio was conducted in 18 Italian regions. 45,590 third grade school children in 2610 classes participated. Information was collected from 2461 schools. The responses of the head teachers showed that 64% of the schools have a canteen, used by 70% of children. Only 12% of schools include the provision of a balanced mid-morning snack. Frequently there are educational activities related to physical activity and healthy eating that, in some cases, also involve the families of the children. 29% of the schools cannot guarantee two hours of physical activity as suggested by the school curriculum because of the lack or inadequacy of the gym or the structure of the timetables. The information gathered through the cooperation of school administrators, teachers and health workers, has helped to describe the major health educational activities of the school, that is confirmed to be the ideal venue for promoting healthy lifestyles in young people.

A national survey of the prevalence of childhood overweight and obesity in Italy.

To estimate the prevalence of childhood overweight and obesity among Italian schoolchildren and to examine geographic differences and present and future implications for health care, we used data from a nationwide representative survey performed in May 2008 among third-grade students in 18 of Italy's 21 regions. Cluster sampling was used to identify classes for participation. The study population included all children aged 8-9 years whose parents agreed to opt-out consent. Parents, children and teachers completed brief questionnaires, and children were weighed and measured by trained staff using standardized equipment. Consent was obtained for 97% of 50 197 third-graders, of whom 44 676 (89%) met study inclusion criteria. Obesity levels (defined using International Obesity Task Force cut-offs) ranged from 7.5% (95% confidence intervals 6.7-8.2) in the north to 16.6% (95% confidence intervals 15.8-17.4) in the south. Behaviours known to be associated with obesity also showed geographic differences. The estimated burden of obesity-related pathologies also increased from north to south. These findings suggest the need for community as well as individual interventions in all areas of the country but with particular attention to the south.

[Interregional mobility for total knee arthroplasty]. / Mobilità interregionale e chirurgia protesica del ginocchio.

45.049 primary total knee replacements were performed in Italy in 2005, with large distribution all over the country. However referral to centers of excellence far from the area of residency is still common with massive interregional mobility. Aim of this study is to define this issue both in quantitative and qualitative terms. For the timeframe 2001-2005 the SDO database was used to calculate the number of discharges of both residents and non residents for each Region and for each year and the ability of each region to attract patients from other regions or the tendency of the resident population to migrate. Only 8 Regions present an attraction index better than the escape index. Among those 4 are located in the North of Italy, 2 in the Center and 2 in the South. Migration from the North or Center to the South was never observed. Interregional mobility for knee replacement is noteworthy. Such phenomenon is comparable to migration for other major procedures, especially the steady tendency of a south to north mobility. An accurate analysis of potential causes of migration as well as the empowering of southern and central centers is needed.

[Promotion of healthy life style and growth in primary school children (OKkio alla SALUTE)]. / OKkIO alla SALUTE: promozione della salute e crescita sana nei bambini della scuola primaria.

In October 2007, the Italian Ministry of Health, the Centre for Disease Control and the Regions entrusted the National Institute of Health with the coordination of the initiative "Okkio alla Salute"--Promotion of healthy lifestyle and growth in primary school children. This programme is linked to the European programme "Gaining health" and the National Plan for Prevention. The objective of the project was to develop and maintain a monitoring system for both the health services and the schools that could also be used to better target public health interventions. The first national survey to estimate the prevalence of overweight and obesity in children and to collect information on diet and physical activity has been conducted in close collaboration with the individual regions. In the first nine months of the project, 1025 health workers and approximately 1500 school teachers have received training, and, using standardised methods, they have collected data and weighed and measured nearly 45000 third grade students (median age 8.8 years) in 2000 schools throughout the country. Participation rates have exceeded 95%. The results obtained to date indicate that the methodology is sustainable using existing health and educational resources and can be adopted as a national surveillance system.

[Injuries in immigrants from non-industrialized countries: analysis of emergency admissions in Lazio, Italy, in the year 2000]. / I traumi negli immigrati da paesi non industrializzati: analisi degli accessi in pronto soccorso nel Lazio nell'anno 2000.

Aim of the study is to describe the characteristics of road, home and work-related traumas among adult immigrants born in non-industrialised Countries, and to compare the consequent probability of hospitalisation with Italian adults in Lazio Region, year 2000. Source of data is the Emergency-based Surveillance System, which collects all the emergency ward visits in Lazio region. Accident incidence has been estimated using alternatively the residence permits and the roman resident population born in non-industrialised Countries. The 7.7% of all the emergency visits of immigrants are trauma-related. Road traffic accident visits are more appropriate and urgent. Immigrants have a higher risk of hospitalisation both for road and home accidents compared to the Italians (OR = 1.59 and OR = 1.37 respectively). Immigrants use emergency wards for severe and urgent trauma-related accidents, they have higher probability of hospitalisation compared to the Italians. Our analysis highlights the necessity to improve tools to study immigrant health.

[Torture survivor asylum seekers in Italy: the experience of the humanitarian association "Doctors Against Torture"]. / Vittime di tortura richiedenti asilo in Italia: l'esperienza dell'associazione umanitaria "Medici Contro la Tortura".

In recent years, the arrival in Italy of people who suffered torture in their countries led a group of volunteer doctors to set up a humanitarian association, "Doctors Against Torture", to provide care and treatment for torture survivors present in Rome. The paper describes the characteristics of 354 persons having at least one access from 1-1-1999 to 31-12-2001. About 51% of the victims came from the Middle East, 43% from Africa. Mean age was 29.6 (SD 7.0). The victims have suffered beatings and other forms of blunt trauma (64%), suspension and other positional torture (14%), psychological violence (28%), inhuman conditions of detention (10%), burns/electric shock (21%), wet asphyxiation and water jets (11%), sexual violence (15%), amputation/penetrating injuries (22%), dental torture and traumatic removal of nails (6%) and 58% suffered more than one type of torture. The types of violence observed require a thorough analysis of our knowledge in the field, in order to help victims on their way to rehabilitation, which is long and uncertain; at the same time, it is fundamental that public health begins to make itself responsible for these persons.

[A vaccination campaign for gypsy children in Rome]. / Una campagna vaccinale in favore dei bambini Rom e Sinti a Roma.

Several studies conducted in Rome have shown low levels of vaccination coverage in gypsy communities. Thus a vaccination campaign targeting to 2400 gypsy children aged 0-13 years, present in 32 settlements in Rome, was conducted in 2002. The campaign was related to vaccinations required and recommended in Italy: diphtheria, tetanus, hepatitis B, pertussis (whooping cough), haemophilus influenzae and measles. In the majority of cases it was decided to carry out the vaccinations directly in the gypsy settlements, in accordance with the methods of pulse immunisation. In the case of small settlements a strategy for reorienting the population to vaccination centres was adopted. Around 2000 children were vaccinated, equivalent to 80% of the paediatric population present during the period. The number of children who have never been vaccinated has decreased from 40% prior to the campaign to 9% after the third week. Vaccination coverage in medium- and small-sized settlements (<200 inhabitants) after the campaign shows values of over 70%; in the large settlements, more modest increases have been recorded and coverage has rarely exceeded 50%. This experience has highlighted the importance of networking between public healthcare institutions and non-profit organisations. The mobilisation of a wide range of competences has thus enabled the attainment of a high level of effectiveness.

[Health conditions of immigrant women in Italy]. / Condizioni di salute della donna immigrata in Italia.

The number of immigrant women in Italy has increased from 260,000 in 1991 to at least 750,000 in 2003. This article describes the health situation of these women, in particular it deals with reproductive health. Immigrant women are generally young, in good health and they go to the health services mainly for pregnancy, delivery, spontaneous and induced abortion. Forty-eight per cent of acute hospital admissions and 56 per cent of day hospital admissions in 2002 were related to reproduction. Among foreign citizens, the induced abortion rate is three times higher than that reported among Italians, while the risk of spontaneous abortion is similar (97 per thousand and 101 per thousand, respectively). In general, the data show that immigrant women in Italy live in deprived social conditions, which can influence their reproductive choices and their access to health services. In order to take account of their particular needs, it is necessary to modify the health services and plan public health interventions especially for the prevention of induced abortion.

[Mini Nutritional Assessment (MNA) and nutritional risk in elderly. A proposal of nutritional surveillance system for the Department of Public Health]. / Il Mini Nutritional Assessment (MNA) e la valutazione del rischio nutrizionale in età geriatrica. Proposta di un modello operativo di sorveglianza nutrizionale all'interno del Dipartimento di Prevenzione.

Objective of the study is to present an intervention model to evaluate nutritional risk of institutionalised elderly, suitably with the aims and resources of the Hygiene of Nutrition Services, and to individuate predictive variables of nutritional vulnerability. 237 subjects from the residential homes of ASL RMB were involved in the study; to each subject was administered: a) the Mini Nutritional Assessment (MNA); b) a questionnaire for the analysis of the risk factors. Multivariate logistic regression analysis was performed to evaluate the influence of the risk factors on nutritional status. On the basis of BMI the prevalence of malnutrition is 6.5% and the prevalence of overweight and obesity is respectively 41.6% and 22.9%; on the basis of MNA, 5.1% of the subjects is malnourished and 60.3% at risk for malnutrition. The absence of chewing difficulties (OR 2.94; I.C. 1.46-5.91) and the habit to eat all foods served at meals (OR 2.83; I.C. 1.46-5.91) are associated with a good nutritional status. The age > or = 90 years is a risk factor for malnutrition at the limit of statistical significance (OR 0.44; I.C. 0.14-1.00). Carrying out the MNA resulted easy and quick, confirming the hypothesis for feasibility of this protocol in the Hygiene of Nutrition Services. The results highlight an high nutritional risk of the elderly nursing home residents and the importance of planning programs of nutritional surveillance with particular attention on masticatory function impairments, meal intake and on the oldest subjects among the elderly as a group greatly vulnerable. We believe that these areas are very important in defining public health intervention programs.

The clinical and organisational appropriateness of tonsillectomy and adenoidectomy-an Italian perspective.

The objective of the document is to define the most appropriate indications and health-care procedures for tonsillectomy and adenoidectomy and is intended for use by paediatricians, general practitioners, and otolaryngologists involved in the treatment of adenotonsillar pathologies. After a systematic review and grading of evidences from the literature, the document was drafted by a multidisciplinary panel with identified key clinical questions related to indications for surgery, surgical and anaesthesiology procedures, clinical management and organizational issues. It should be stressed that the document was not aimed at providing graded recommendations per se, but to offer suggestions and advices. The document will be updated within December 2006.

[Evaluating hospital appropriateness with different tools: administrative data versus analytic review]. / La valutazione dell'appropriatezza organizzativa con differenti metodi: APPRO e PRUO.

PRUO, a modified version of AEP, is a widely used clinical-based tool to evaluate hospital appropriateness in Italy. We developed the APPRO method for assessing organizational appropriateness using administrative data. APPRO estimates the amount of inappropriate hospitalisation, giving consideration to severity of illness through APR-DRG classification system. The aims of the study were to: measure the agreement between evaluators using PRUO; investigate the relation between APR-DRG severity subgroups and PRUO assessment; asses the validity of APPRO method comparing its performance to PRUO results. We selected 361 hospital episodes assigned to DRG 39 ("lens procedures with or without vitrectomy") and 242 hospital episodes assigned to DRG 183 ("miscellaneous of digestive disorders, age > 17") from three hospitals in 2000. Clinical records were independently evaluated by two pairs of physicians using PRUO. Proportions of inappropriate episodes by hospital and DRG were also estimated through APPRO using data from Lazio regional hospital information system. The agreement between the two pairs of evaluators was high (k=0.93; p<0.0001). We observed no statistically significant association between APR-DRG severity subgroups and inappropriate hospitalisation found by PRUO. APPRO underestimates rates of inappropriate hospitalisation compared to PRUO. It depends on the different characteristics of the tools and particularly on the caution of APPRO in performing the evaluation using routine data.

[Factors related to in-hospital mortality after stroke in Lazio region, Italy]. / Determinanti della mortalità intra-ospedaliera in seguito a ictus cerebrale nel Lazio.

The use of hospital discharge abstracts in estimating the outcome of hospital care represents an ongoing interest in public health. However standardized methodologies are still not available. We carried out a retrospective study to estimate the association between demographic and clinical characteristics and in-hospital mortality after stroke by using administrative data from the Hospital Information System in Lazio Region. We also assessed the relationship between the presence of neurology services and the outcome. We found 12,781 incident episodes of stroke (main diagnosis ICD-9: 430-431-434-436) (49.3% male, mean age = 74 years) admitted in 126 hospitals in the Lazio region for the period 1999-2000. From the hospital discharge abstracts we collected patient demographic and clinical data. The hospitals were classified in centres with and without neurology services. Admissions to hospitals with neurology services were evaluated as predictors of in-hospital mortality after adjustment for gender, age, residence, education, source of admission, type of stroke, heart disease, kidney disease and history of atrial fibrillation. In-hospital mortality (within 30 day) was 25.1%. Female gender, advanced age, residence in Rome, urgent transport, kidney disease and history of atrial fibrillation were associated with an increased risk. Hemorrhagic stroke (ICD-9 = 430-431) had a worse outcome than ischemic stroke (ICD-9 = 434) and acute undefined cerebrovascular disease (ICD-9 = 436). Patients admitted to hospitals with neurology services showed a significantly decreased risk (OR = 0.88, IC95% = 0.79-0.98), particularly in occlusion of cerebral artery (ICD-9 = 434) and in undefined cerebrovascular disease (ICD-9 = 436). Demographic and clinical variables are associated with the outcome of hospitalised stroke patients. Admissions of acute stroke patients in specialized hospitals seem to play a role in reducing the risk of in-hospital mortality.