[Effects of residents' care needs classification (and misclassification) in nursing homes: the example of SOSIA classification]. / Effetti della classificazione (e mis-classificazione) del case- mix nella rappresentazione dei bisogni degli ospiti delle Re- sidenze Socio-Assistenziali per Anziani non Autosufficienti (RSA): l'esempio della Scheda di OSservazione Intermedia dell'Assistenza (SOSIA).

Since 2003, the Lombardy region has introduced a case-mix reimbursement system for nursing homes based on the SOSIA form which classifies residents into eight classes of frailty. In the present study the agreement between SOSIA classification and other well documented instruments, including Barthel Index, Mini Mental State Examination and Clinical Dementia Rating Scale is evaluated in 100 nursing home residents. Only 50% of residents with severe dementia have been recognized as seriously impaired when assessed with SOSIA form; since misclassification errors underestimate residents' care needs, they determine an insufficient reimbursement limiting nursing home possibility to offer care appropriate for the case-mix.

Indicators for preventable drug-related morbidity. Practical application in home-based care.

AIM: The aim of this study is of evaluating Morris' PDRM indicator system in the Italian Health Care System, especially in the context of home-based health care assistance, so as to assess the reliability of such a system to detect preventable events of drug-related morbidity (DRM). METHODS: This is a pilot study which has been carried out on a control group of patients. The results, which have been obtained, have then been used to calculate the incidence of the preventable drug-related morbidity (PDRM) in the entire population. The sample of patients was taken from the Health District of Chivasso (Local Health Unit 7 in Piedmont). The subjects had all been inserted in the Integrated Home Healthcare Assistance programme in the period from 1st January to 31st December 2004. RESULTS: The PDRM is equal to 32, with an incidence of 15.6% in the entire population (205). Seven indicators out of 19 were able to identify PDRM. Of these, the indicator which showed the best detection rate scored 72%. CONCLUSIONS: The study revealed that this indicator system has the capability of detecting events of PDRM. In addition to this, the version of the system which has been approved by the expert panel has proved executable in the Italian healthcare system, especially in home-based healthcare.

[Managing waiting lists outpatients clinic. An experience in ASL 4--Turin]. / I tempi di attesa per le prestazioni ambulatoriali: la gestione nell'esperienza dell'ASL 4 di Torino.

Waiting lists issue is one of the main matters of every public health system. The aim of this study is to design a pathway in the Local public health authority 4 in Turin (Piedmont Region, Italy) as far as waiting lists management of outpatient service is concerned between 2004 and 2006. This study emphasizes a new approaching methodology based on: a) clearly defined criteria of clinic priorities to accessing public health facilities; b) working groups composed by a representing member of the District, one or more medical and general practitioners representing different equipe; c) monitoring priority criteria as objectives to both medical practitioners and equipe in order to assess them at the end of the year Results are encouraging because equipe correctly applied defined priority criteria so that they reached objectives improving their performance during considered period (66.3% of conformity with "U", "B" and "D" codes in 2006 and 84.2% with all codes, improving the value of 81.3% in the past year).

Drivers involved in road traffic accidents in Piedmont Region: psychoactive substances consumption.

INTRODUCTION: The role played by psychoactive substances in road safety has become object of increasing interest: these substances can reduce driving performance and increase accidents risk. Aims of the study are to establish the dimension of the problem and to describe the characteristics of people involved in accidents under psychoactive substance effects. METHODS: Target population consists of people from 18 to 60-years-old involved in accidents afferent in Emergency Rooms. Subjects were interviewed by surveyors and a urines was collected for psychoactive substances screening. RESULTS: In 18.5% of people we found substance consumption. Cocaine was the most frequently detected substance (9.5%), then benzodiazepines (7.5%), methadone, morphine and marijuana (THC) (3.5%). In 5.5% of subjects more than one substance was found. Considering only illegal substances detected, female have a higher risk to be consumers (OR = 1.36) and the young age (18-35 years) seems to be at higher prevalence and risk for substance use (OR = 1.86). DISCUSSION: Considering all psychoactive substances detected, clearly the problem about substances consumption and driving is not restricted to youngest but involves all age groups. CONCLUSIONS: In order to decrease the number of accidents due to substance use, new prevention programmes able to involve also middle age groups should be planned.

Performance and costs of a rapid syphilis test in an urban population at high risk for sexually transmitted infections.

INTRODUCTION: Rapid syphilis screening could facilitate case-identification in populations at high risk for sexually transmitted infections (STI). The aim of this study was to compare the performance and the cost-effectiveness of a rapid immunochromatography syphilis test with a traditional ELISA screening test in patients with suspected infectious syphilis or patients at high risk for STI/syphilis. METHODS: Consecutive patients attending a STI clinic cosensually underwent serological testing with two different tests. Sensitivity, specficity, Positive Predictive Values, Negative Predictive Values and effectiveness of the two tests were evaluated with respect to definitive diagnosis. RESULTS: In our population, the immunochromatography essay (Abbott Determine Syphilis TP) had a sensitivity of 95.0% (95% CI 88.7-97.8) and a specificity of 97.7% (95% CI 94.7-99.0). The ELISA test had a sensitivity of 95.0% (95% CI 88.8-97.9) and a specificity of 97.2% (95% CI 94.1-98.7). The Positive Predictive Value for ELISA was 94.1% (95% CI 87.6-97.3) and 95.0% (95% CI 88.7-97.8) for the rapid test. The Negative Predictive Value was 97.7% (95% CI 94.7-99) for both ELISA and the rapid tests. The cost-effectiveness analysis showed that the rapid test was less expensive than ELISA (EUR 26.46 vs EUR 40.57) and yielded a similar number of right diagnoses. CONCLUSIONS: The Abbott Determine Syphilis TP test is an accurate, easy and inexpensive test that could facilitate the rapid detection of syphilis in high-risk urban patients.

[Healthcare profiles: similarities and differences with respect to case and disease management]. / I Profili assistenziali: una prospettiva di confronto con il case ed il disease management.

In Healthcare systems, to overcome the problem of the fragmented response to the medical needs of patients, new theoretical models and operative approaches have been proposed; the process-based approach is one of the solutions more appreciated. This approach has been adopted in different ways in different healthcare systems: typically the Case management, the Disease management and, in Italy, the Healthcare profiles. These three healthcare models that share in the logic of a process-based approach present similarities and dissimilarities. This article aims to describe the features of Healthcare profiles compared to Case and Disease management, using a comparison scheme which contains items capable to distinguish the different Healthcare models.

Which competences and what managerial training for the health professions.

The process of passage to be e-profit and loss organization following the reform of the Italian health system, especially in a context of fiscal federalism and administered competition among the public and private producers, causes implications on the competences of whom develops his/her own professional activity. The aim of the paper is to give some inputs for discussion about the training of manager: starting from the meaning of the word 'management' and using the model elaborated by Mintzberg and Simon with the purpose to identify who is involved in such training, trying to make explicit that the analysis of the organizational positions and the profile of the resource that will go to occupy it is a forced passage for building the training package and to make clear characteristics and contents of the training offer.

[Primary health care appropriateness evaluation: the general practitioner case]. / La valutazione dell'appropriatezza del sistema delle cure primarie: il caso della Medicina Generale.

Even if the importance of the primary care has been stated both by WHO and our National Health System (in the meaning of prevention, diagnosis, treatment and rehabilitation), only recently it seems to deserve a more structured evaluation. The paper aims to deeply analyse the meaning of primary health care system within the clinical governance practice, to identify - using national and international data - the role of its appropriateness in reaching the best outcomes in terms of health and economical results and to supply the readers with some operative methods for the evaluation. According to the most recent literature and the data gathered from Italian experiences, some suggestions are given in order to improve appropriateness and quality of this first and fundamental level of the national system of care.

[The role of social and demographic variables in the treatment of cardiovascular diseases. The experience of "Azienda Ospedaliera San Giovanni Battista di Torino"]. / L'influenza delle variabili socio-demografiche nel trattamento delle patologie cardiovascolari. L'esperienza dell'azienda Ospedaliera San Giovanni Battista di Torino.

Health resources rationalization needs a carefull control on appropriateness and equity safeguard. For some diseases (f.i. acute cardiovascular diseases) the delivery of effective but resources consuming treatment could be influenced by socio-demographic variables. Aim of this work is to evaluate the effects of age and gender on the course of supplying effective treatments. 386 clinical records (among the 4317 eligible) have been randomized and analized using a protocol designed ad hoc on former international experiences basis. Diagnostic interventions are not statistically related to patient's age and gender but the major use of therapeutic interventions analized (CABG, PTCA, AVR, trombolisis) in younger patients is consistent with their more healthy general conditions even if the 'conservativE behavior of physicians in oldest patients don't seem to be based on EB procedures or specific Guidelines.

Fine-tuning of Th17 Cytokines in Periodontal Disease by IL-10.

Periodontitis (PD) is a chronic disease caused by the host inflammatory response to bacteria colonizing the oral cavity. In addition to tolerance to oral microbiome, a fine-tuned balance of IL-10 levels is critical to efficiently mount antimicrobial resistance without causing immunopathology. Clinical and animal studies support that adaptive T-helper (Th) cytokines are involved in the pathogenesis of alveolar bone destruction in PD. However, it remains unclear what type of Th response is related to human PD progression and what role IL-10 has on this process. We addressed the contribution of IL-10 in limiting Th1 and Th17 inflammatory response in murine and human PD. Through a combination of basic and translational approaches involving selected cytokine-deficient mice as well as human genetic epidemiology, our results demonstrate the requirement for IL-10 in fine-tuning the levels of Th17 (IL-17A and IL-17F) cytokines in experimental and human PD. Of novelty, we found that IL-17F correlated with protection in murine and human PD and was positively regulated by IL-10. To our knowledge, this is the first demonstration of the protective role for IL-17F in PD, its positive regulation by IL-10, and the potential differential role for IL-17A and IL-17F in periodontal disease.

[Cost analysis of toxoplasma infection control in pregnancy]. / Analisi dei costi relativi al controllo dell'infezione toxoplasmica in corso di gravidanza.

In Italy, the management of Toxoplasma infection screening in pregnant women is often unproductive and inefficient and generates a wide variability of costs. This study evaluated performance parameters in the screening management of a population of pregnant women, estimated its costs and compared them with the costs of a full application of Ministerial Documents of 1995 and 1998. We controlled until delivery 830 pregnant women who had done the first blood test between September 1st and December 31st 1997. The costs of direct and indirect testing were analysed using the Excel database and statistical software package. Of the 573 pregnant women defined 'susceptible' at the first test, only 240 (42%) did further blood tests during the II and III trimesters, 30% did no more tests and the remaining women adopted a heterogeneous behaviour. The mean cost of each screening was found to be euro 54.47/pregnancy and euro 60.05/pregnancy with a full application of the Ministerial Document of 1995. A full application of Ministerial Document of 1998, instead, would have involved a cost of euro 94.28/pregnancy for 5 tests, euro 111.40/pregnancy for 6 tests and euro 128.51 for 7 tests. The study shows that the management of toxoplasmosis screening during pregnancy needs greater attention to the prescription of tests, so that useless testing can be reduced and the efficacy of the screening improved, two important goals the Ministerial Documents were designed to achieve.

Recreational drug consumers: who seeks treatment?

BACKGROUND: Recreational drug consumption represents a complex issue, because of the lack of a shared definition, settings and patterns of consumptions, and poorness of evidence-based treatments. In spite of the great number of users, just few seek specific treatment, probably representing those at major risk of continuing and problematic use. The general objective of this study was to report the characteristics and main consumption patterns of recreational drug consumers treated in Regione Piemonte (Italy), in order to formulate hypotheses suitable for further research aimed at establishing more effective preventive intervention and treatment. METHODS: All addiction treatment services in the region were required to fill in, for each user, a questionnaire reporting: contact of the user with the service, socio-demographic data, drugs consumption and interventions/treatments. RESULTS: Among 441 users, 70.3% were new users, 85.5% were males and the average age of consumption onset was 22 years. Psychiatric and traumatics events were present in 13.3% and in 17.9% of cases, respectively. The most frequent primary substances were cocaine (76.9%) and ecstasy (13.8%). Substances taken in association with primary drug are quoted in 75% of cases. CONCLUSIONS: The users that get in touch with services are those showing greater problems, representing, therefore, the main target for preventive public health interventions. Some interesting points can be noted: among patients treated, cocaine represents the main issue; females seem to be more sensitive to recreational drug effects; social class (education), settings and use habits are similar for recreational drugs users and heroin users.

Enquiry on the antibiotic usage at Ancona Regional Hospital.

A survey of the use of antimicrobial agents in the Regional Hospital of Ancona was carried by the Infectious Disease Department in collaboration with the Hygiene Institute, Ancona, in all patients admitted in the hospital in a 15-day period, March 1--15, 1978. This study has shown an overuse of antibiotics in this series of patients. Despite the limitations of the survey it can be a useful aid to know the situation of antibiotic therapy in this Italian hospital.

[Forms and methods of tutorship in the university nursing diploma. Consensus conference in San Miniato, November 1997)]. / Figure e metodi della tutorship nel diploma universitario per l'infermiere. Consensus conference di S. Miniato (Novembre 1997).

The contribution presented is the result of a workshop with the participation of nurses, educationalists and course directors involved in the education of student nurses. The different educational experiences and organizational styles adopted in nursing schools were compared and some reflections on the role and expected competences of the nurse tutor, responsible of the theoretical and practical training of student nurses are formulated. The consensus document analyzes the implications related to the different definitions of the role of the nurse-tutor and each different role is discussed according to the theoretical model it derives from. Different educational strategies are discussed and eventually proposals on the education and educational requirements of the nurse-tutor are made.

[Obligatory anti-tetanus vaccination and the public health service]. / Vaccinazione antitetanica obbligatoria e servizi di sanità pubblica.

Tetanus antitoxin levels were measured in a non-random group of 281 subjects of pediatric age, using a passive haemagglutination technique. 94.7% of sera had protective antitoxin levels (titer greater than or equal to 1: 1024), while the other ones had levels usually considered as partly protective (titer of 1:256 or 1:512). Subjects who completed vaccination schedule had protective levels also 6 or more years after last dose. Subjects with partly protective antitoxin levels can be identified reviewing vaccination registers and recalling people who did not complete vaccination schedule. This procedure, if used as screening test, has sensitivity of 20%, specificity of 98% and a predictive value of positive tests of 37.5%. The quality of vaccination service of the study area, assessed using three indicators, resulted fairly good.

Human leptospirosis in an area of central Italy: results from a serological survey.

The results of a serosurvey for leptospiral antibodies in a random sample of healthy subjects are reported. The study was carried out in an area where a waterborne outbreak of leptospirosis, due to leptospires of serogroup Australis, had occurred a month before. Sera were tested with the microagglutination technique. Leptospiral agglutinins were found in 13.8% of tested subjects, mostly in adult females. The highest prevalence rate was observed for serovar lora belonging to serogroup Australis. The leptospires of this group have a relevant spread in the study area in keeping with other surveys carried out in Italy.