RESUMO
BACKGROUND: Human papillomavirus (HPV) is a common sexually transmitted pathogen and the cause of several cancers and of anogenital warts. With this study, we estimated the trend of hospitalizations for anogenital warts (AGWs) in the Veneto region (Italy) from 2007 to 2018. METHODS: The analysis included all the hospital discharge records of public and accredited private hospitals occurred in Veneto residents in the timespan 2007-2018. The ICD9-CM code 078.11 considered were those associated with condyloma acuminatum and those associated with surgical interventions for vulval/vaginal warts, penile warts anal warts. Annual total and sex- and age-specific hospitalization rates and trends were calculated and correlated with the different HPV vaccine coverage over the study period. RESULTS: We observed an overall reduction of hospitalization rates for AGWs: from 15.0 hospitalizations every 100,000 Veneto residents in years 2007-08 to 10.9 hospitalizations every 100,000 Veneto residents in year 2017-18 (- 37.4%; p < 0.05). Reduction has been caused by a drop in hospitalizations in females - from a rate of 20.4/100,000 in 2007-2008 to a rate of 10.8/100,000 in 2017-18 (AAPC: -7.1; 95%CI: - 10.6;-3.4); while in males, we observed a slight - but not statistically significant - increase in hospitalization rates. CONCLUSION: The marked decline in hospitalization rates for AGWs in Veneto Region is probably attributable to the high coverage rates of HPV vaccination programs implemented since 2008.
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Doenças do Ânus/prevenção & controle , Condiloma Acuminado/prevenção & controle , Hospitalização/tendências , Papillomaviridae/imunologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/imunologia , Doenças do Pênis/prevenção & controle , Doenças Virais Sexualmente Transmissíveis/prevenção & controle , Vacinação , Doenças Vaginais/prevenção & controle , Doenças da Vulva/prevenção & controle , Adolescente , Adulto , Doenças do Ânus/virologia , Criança , Pré-Escolar , Estudos de Coortes , Condiloma Acuminado/epidemiologia , Condiloma Acuminado/virologia , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Doenças do Pênis/virologia , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Doenças Vaginais/virologia , Doenças da Vulva/virologia , Adulto JovemRESUMO
BACKGROUND: Legionella is a ubiquitous Gram-negative bacterium naturally found in aquatic environments. It can pose a health problem when it grows and spreads in man-made water systems. Legionella pneumophila is the most common cause of Legionnaires' disease nowadays, a community-acquired pneumonia with pulmonary symptoms and chest radiography no different from any other form of infectious pneumonia. Legionella monitoring is important for public health reasons, including the identification of unusual environmental sources of Legionella. METHODS: We report two cases of Legionnaires' disease associated with two different car wash installations in the province of Vicenza, in the Veneto region, northeastern Italy. Patients were not employees of the car wash installations, but users of the service. In both cases, Legionella antigen was detected in urine using the Alere BinaxNOW® Legionella Urinary Antigen, and Legionella antibodies were detected in serum using SERION ELISA classic Legionella pneumophila 1-7 IgG and IgM. Water samples were also analyzed as part of the surveillance program for Legionella prevention and control in compliance with the Italian guidelines. RESULTS: Both patients had clinical symptoms and chest radiography compatible with pneumonia, and only one of them had diabetes as a risk factor. Legionella urinary antigen and serological test on serum samples were positive for Legionella in both patients, even if much slighter in the case A due to the retrospective serological investigation performed a year later the episode and after the second clinical case occurred in the same district. The environmental investigations highlighted two different car wash plants as potential source of infection. A certified company using shock hyperchlorination was asked to disinfect the two plants and, subsequently, control samples resulted negative for Legionella pneumophila. CONCLUSION: Any water source producing aerosols should be considered at risk for the transmission of Legionella bacteria, including car wash installations frequently used by a large number of customers and where poor maintenance probably creates favorable conditions for Legionella overgrowth and spreading. Additional research is needed to ascertain optimal strategies for Legionella monitoring and control, but environmental surveillance, paying careful attention to possible unconventional sources, should remain an important component of any Legionnaires' disease prevention program. Additionally, all available diagnostic methods would be recommended for the confirmation of all cases even in the event of non-serogroup 1 Legionella pneumophila infection, probably underestimated at this time.
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Doença dos Legionários/etiologia , Doenças Profissionais/microbiologia , Humanos , Legionella pneumophila/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Microbiologia da ÁguaRESUMO
BACKGROUND: In 2014, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI), in collaboration with the National Association of Medical Hospital Managers (ANMDO), conducted a survey on the availability of procedures for cleaning and disinfecting ambulances in order to assess the practices in use. METHODS: An online questionnaire was prepared through the Survey Monkey® platform and a web link access was sent to a convenience sample of ANMDO doctors working in healthcare management in public and private healthcare facilities. RESULTS: Ninety-six questionnaires were collected (26% response rate). In 73% of cases there was a procedure for cleaning and disinfecting ambulances, which had been produced at a company level (67%) and involved various professionals. In 21% of cases the procedure had been prepared in expectation of an epidemic or following an epidemic (5%). The recommendations had been presented to the staff (90%), in 28% of cases through training events with verification of the knowledge acquired. Monitoring of the implementation of the procedure is planned in the majority of cases (88%), mainly through direct observation (92%). In 67% of cases the tender specifications for ambulance services did not include a section dedicated to cleaning and disinfection and, in the absence of a procedure, this was provided by the hospital in only 51% of case. CONCLUSION: This survey represented a first step towards the development of guidelines for standardising procedures and providing indications useful for their evaluation and monitoring their implementation.
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Ambulâncias/normas , Desinfecção/normas , Guias como Assunto/normas , Zeladoria/normas , Desinfecção/métodos , Contaminação de Equipamentos/prevenção & controle , Humanos , Higiene , Itália , Sociedades Médicas , Inquéritos e Questionários/estatística & dados numéricosRESUMO
BACKGROUND: Healthcare-Associated Infections are a great concern for worldwide healthcare systems and represent a considerable threat to patient safety, leading to adverse clinical outcomes. A defined panel of indicators represents a key element to guide Healthcare Organizations towards identification of main gaps, implementation of effective actions and continuous improvements on Healthcare-Associated Infections prevention and control activities. A review on accreditation systems conducted by the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene Preventive Medicine and Public Health revealed a substantial heterogeneity of implemented standards and led to the development of a core set of indicators and requirements for Healthcare-Associated Infections' prevention and control within the hospital setting. The main aim of the study was to test the feasibility of the Healthcare-Associated Infections' prevention and control within the hospital setting tool to calculate performance scores on a sample of Italian Healthcare Organizations and to identify major critical issues. The potential benefits of the possibility of future implementation of the tool within Institutional Accreditation Programs is discussed. STUDY DESIGN: Cross sectional pilot survey. METHODS: The Healthcare-Associated Infections' prevention and control within the hospital setting included 96 criteria and 20 key areas including an area for outcomes indicators. For applicable criteria, standards fulfilment was evaluated according to a 4 point Likert scale. A composite score was calculated for each Healthcare Organization and five performance levels were identified. Data were further analysed by computing performance scores at the level of each area and requirement. RESULTS: 20 Healthcare Organizations agreed to take part in this pilot study including two rehabilitative Healthcare Organizations. Among the whole sample a mean of 12.20% of requirements resulted not fulfilled, leaving space for further improvements. Critical areas were easily identified and the instrument was able to capture substantial differences between Healthcare Organizations. Only a few number of standards resulted "Not Applicable" (Mean = 4.71%) and most of them regarded Rehabilitative Healthcare Organizations. Mean composite performance index resulted 74.06% (SD = 16.96, range 36.30 - 94.27%); area of outcome indicators obtained a mean score of 56.17. CONCLUSION: The Healthcare-Associated Infections' prevention and control within the hospital setting resulted an useful tool to assess Healthcare Organizations' performance in the field of Healthcare-Associated Infections prevention and control and to identify necessary actions for further improvements. The distribution of total scores by Healthcare Organizations showed a high heterogeneity. Implementation of the Healthcare-Associated Infections' prevention and control within the hospital setting tool as an institutional accreditation tool may help to drive the required harmonization at a national level of Healthcare-Associated Infections management and control strategies and overcome current substantial regional differences.
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Infecção Hospitalar/prevenção & controle , Atenção à Saúde/normas , Melhoria de Qualidade/normas , Acreditação , Infecções Relacionadas a Cateter/prevenção & controle , Estudos Transversais , Atenção à Saúde/classificação , Atenção à Saúde/estatística & dados numéricos , Estudos de Viabilidade , Humanos , Itália , Projetos Piloto , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
INTRODUCTION: Among the health professions with a long period of training, the students of the Nursing Bachelor's Degree are the most exposed to biological risk resulting from accidents, in particular with needles and cutting edges. The aim of the study was to estimate the frequency and the circumstances for the occurrence of needle stick injuries, as a knowledge base for targeted prevention interventions. METHODS: The study was carried out between May and July 2017 in 11 Universities in Italy and 1 in Albania (associated with the "Tor Vergata" University of Rome). An anonymous semi-structured questionnaire was proposed to 1st (second semester), 2nd and 3rd year students of Nursing Bachelor's Degree. RESULTS: A total of 2742 questionnaires were collected. The average age of participants was 22.9 years (median 22, range 19-60 years), 73% of whom were females. A total of 381 injuries were reported. Three hundred and sixteen students (11.8%) underwent at least 1 injury (12.7% among females, 9.7% among males); 41 students declared two or more injuries; four students did not report the number of injuries occurred. The first injury occurred, as an average, 17 days after the start of the internship (median 15 days) and, in 25% of the cases, during the first 9 days. The highest percentage of accidents occurred during the first internship (25.3% of the total) and decreased with the progress of the training path. The injuries occurred in 38% of cases during drug preparation, 24% when disposing of sharp devices, 15% while re-capping needles, 13% during blood sampling and 10% in other circumstances. In 51.2% of cases, the needle was not sterile. Among the nursing students who suffered a needle stick injury, 58.1% declared that they had performed the post-exposure prophylaxis. 96% of students stated to be vaccinated against Hepatitis B virus. Amongst the students who had their serological status checked (74%), 18% stated the antibody titre was not protective. 49.8% of students answered to have been trained in advance on the correct procedures to avoid needle stick and cutting edges injuries in each clinical ward attended, 41.2% referred that this occurred only in some wards and 10% in no ward at all. CONCLUSION: The results of this study show a high percentage of needle stick injuries in students of the Nursing Bachelor's Degree. Therefore, there is a need for careful reflection on the most effective methods of targeted training acquisition of knowledge, skills and behavioural models useful for the exercise of the profession.
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Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Escolas de Enfermagem/estatística & dados numéricos , Estudantes de Enfermagem/estatística & dados numéricos , Adulto , Albânia/epidemiologia , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Profilaxia Pós-Exposição/estatística & dados numéricos , Distribuição por Sexo , Adulto JovemRESUMO
BACKGROUND: In Italy there are no rules concerning the establishment of a hospital hygiene structure in hospitals and other healthcare settings, and the hospital organization plans vary widely. The aim of the survey, carried out by the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive medicine and Public health, was to evaluate the presence in the hospital organization plan of a structure referred to as Hospital hygiene, or including in its denomination the words "hygiene" or "hospital hygiene", the activities carried out, the relation to other areas, like patient safety, the type and quantity of professionals involved, the strengths and the critical aspects. METHODS: A semi-structured questionnaire was administered to Healthcare Trusts representing all Italian Regions through the members of the above Study Group. RESULTS: 35 Trusts, 13 in Northern, 8 in Central, 14 in Southern Italy (including Sicily and Sardinia), completed the questionnaire. In 19 Trusts (54.3%) a structure whose denomination included the words "hospital hygiene" or "hygiene" was present. The activities related to the management of infectious risk were most represented, carried out autonomously or in collaboration, but many other activities were covered. In all hospitals the activities of the Hospital Hygiene Unit inter-linked with those of the clinical risk, with different forms of collaboration. CONCLUSION: This survey, even though on a limited sample, provided a picture of hospital hygiene at a national level, showing a considerable heterogeneity and highlighting critical issues but also strengths. It is essential to share organizational and management models that enhance and promote hospital hygiene, to ensure the appropriateness of healthcare practices offered in a safe and comfortable environment to patients, operators, and visitors.
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Infecção Hospitalar/prevenção & controle , Administração Hospitalar , Higiene , Controle de Infecções/organização & administração , Inquéritos e Questionários , Hospitais , Humanos , Itália , Sociedades Médicas , Inquéritos e Questionários/estatística & dados numéricosRESUMO
BACKGROUND: The World Health Organization's Action Framework for tuberculosis elimination in low-tuberculosis incidence countries includes the screening for active and latent tuberculosis in selected high-risk groups, including health care workers. In this context, medical and health profession students, exposed to nosocomial tuberculosis transmission during training and clinical rotations, are target populations for tuberculosis screening. No updated data are available on tuberculosis screening practice and knowledge of medical and health profession students in Italy. METHODS: Within the activities Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health, we carried out a multicentre cross-sectional study to assess knowledge, attitude and practices on tuberculosis prevention and control among Medical, Dentistry, Nursing and other health professions' students. Students were enrolled in the study on a voluntary basis and were administered a previously piloted structured questionnaire. Logistic regression models were applied to explore knowledge on tuberculosis prevention by selected socio-demographic variables and University-based tuberculosis prevention practice. RESULTS: Students of seventeen Universities across Italy participated in the study, and 58.2% of them received compulsory tuberculin skin test either at enrollment or while attending clinical practice. A total of 5,209 students filled the questionnaire. 37.7% were medicine and dentistry students (Group 1), 44.9% were nursing students (Group 2) and 17.4% were other health professions' students (Group 3). Age and gender had different distributions by groups, as well as knowledge and practice on tuberculin skin test. 84.4% of the study population (95% CI = 83.3-85.3) was aware of the existence of the tuberculin skin test, 74.4% (95% CI = 73.2-75.6) knew what is the first-level screening test for latent tuberculosis and only 22.5% (95% CI = 21.4-23.6) knew how to proceed after a positive tuberculin skin test result. Overall, knowledge on tuberculosis prevention was higher in Group 2 and lower Group 3, as compared to Group 1. CONCLUSION: In Italy, the knowledge on tuberculosis screening among University students is generally good. To reduce some of the criticalities found among the different study courses, it would be appropriate to harmonize both the regulations on tuberculosis screening practices for admission to University courses, and the educational activities on the topic of tuberculosis, to be extended to all workers involved in health care setting.
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Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Tuberculose Latente/prevenção & controle , Estudantes de Ciências da Saúde/psicologia , Teste Tuberculínico/psicologia , Tuberculose Pulmonar/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Itália , Tuberculose Latente/diagnóstico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Estudantes de Ciências da Saúde/estatística & dados numéricos , Inquéritos e Questionários , Tuberculose Pulmonar/diagnóstico , Adulto JovemRESUMO
BACKGROUND: Healthcare-associated infections (HAIs) are an important issue in terms of quality of care. HAIs impact patient safety by contributing to higher rates of preventable mortality and prolonged hospitalizations. In Italy, analysis of the currently available accreditation systems shows a substantial heterogeneity of approaches for the prevention and surveillance of HAIs in hospitals. The aim of the present study is to develop and propose the use of a synthetic assessment tool that could be implemented homogenously throughout the nation. METHODS: An analysis of nine international and of the 21 Italian regional accreditation systems was conducted in order to identify requirements and indicators implemented for HAI prevention and control. Two relevant reviews on this topic were further analyzed to identify additional evidence-based criteria. The project team evaluated all the requirements and indicators with consensus meeting methodology, then those applicable to the Italian context were grouped into a set of "focus areas". RESULTS: The analysis of international systems and Italian regional accreditation manuals led to the identification respectively of 19 and 14 main requirements, with relevant heterogeneity in their application. Additional evidence-based criteria were included from the reviews analysis. From the consensus among the project team members all the standards were compared and 20 different thematic areas were identified, with a total of 96 requirements and indicators for preventing and monitoring HAIs. CONCLUSIONS: The study reveals a great heterogeneity in the definition of accreditation criteria between the Italian regions. The introduction of a uniform, synthetic assessment instrument, based on the review of national and international standards, may serve as a self-assessment tool to evaluate the achievement of a minimum standards set for HAIs prevention and control in healthcare facilities. This may be used as an assessment tool by the Italian institutional accreditation system, also useful to reduce regional disparities.
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Acreditação , Infecção Hospitalar/prevenção & controle , Hospitais/normas , Avaliação de Processos em Cuidados de Saúde , Humanos , ItáliaRESUMO
In June 2009, the World Health Organization (WHO) issued a pandemic alert concerning the spread of an influenza A (H1N1) virus that showed distinctive genetic characteristics vis-à-vis both seasonal influenza strains and vaccine strains. The main mutation occurred in the gene coding for hemagglutinin (HA). Mathematical models were developed to calculate the transmissibility of the virus; the results indicated a significant overlap with the transmissibility of previous pandemic strains and seasonal strains. The remarkable feature of A/(H1N1)pdm09, compared with seasonal strains, is its high fatality rate and its higher incidence among younger people. Data provided by the WHO on the number of deaths caused by A/(H1N1)pdm09 only include laboratory-confirmed cases. Some authors suggest that these data could underestimate the magnitude of the event, as laboratory confirmation is not obtained in all cases. It is important to bear in mind that the A/(H1N1)pdm09 virus is still circulating in the population. It is therefore essential to maintain its epidemiological and virological surveillance.
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Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza , Influenza Humana/epidemiologia , Influenza Humana/virologia , Pandemias/estatística & dados numéricos , Hemaglutininas Virais/genética , Humanos , Vírus da Influenza A Subtipo H1N1/genética , Influenza Humana/transmissão , Modelos Teóricos , Mutação , Vigilância da PopulaçãoRESUMO
INTRODUCTION: Pneumonia remains a common reason for hospitalizing infants and the elderly worldwide, and streptococcal infection is often responsible. The aim of this study was to assess the burden of pneumonia in a large general population. METHODS: All pneumonia-related hospitalizations from 2004 to 2013 in north-east Italy were identified from the hospital records with a first-listed diagnosis on discharge of bacterial pneumonia, or a first-listed diagnosis on discharge of meningitis, septicemia or empyema associated with a secondary diagnosis of bacterial pneumonia. We identified major comorbidities, calculated agespecific case-fatality rates (CFR), and estimated the related cost to the health care system. RESULTS: Of the 125,722 hospitalizations identified, 96.9% were cases of pneumonia, 2.4% of septicemia, 0.4% of meningitis, and 0.3% of empyema; 75.3% of hospitalizations involved ≥ 65-yearolds. The overall CFR was 12.4%, and it increased with age, peaking in people over 80 (19.6%). The mean annual pneumonia-associated hospitalization rate was 204.6 per 100,000 population, and it peaked in 0- to 4-year-old children (325.6 per 100,000 in males, 288.9 per 100,000 in females), and adults over 65 (844.9 per 100,000 in males, 605.7 per 100,000 in females). Hospitalization rates dropped over the years for the 0-4 year-olds, and rose for people over 80. The estimated overall annual cost of these pneumonia-related hospitalizations was approximately 41 million. CONCLUSIONS: This study shows that the burden on resources for pneumonia-related hospitalization is an important public health issue. Prevention remains the most valuable tool for containing pneumonia, and vaccination strategies can help in the primary prevention of infection, possibly reducing the number of cases in all age groups.
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Vacinas Pneumocócicas/uso terapêutico , Pneumonia/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Itália , Masculino , Pessoa de Meia-Idade , Pneumonia/prevenção & controle , Estudos Retrospectivos , Vacinação , Adulto JovemRESUMO
BACKGROUND: From 2007, in the Veneto Region (Italy), a surveillance system for invasive pneumococcal diseases (IPD) was implemented to estimate the regional epidemiology of IPD and to evaluate the impact of 13-valent pneumococcal conjugate vaccine (PCV13) vaccination. METHODS: Data were collected from 2007 to 2014 and the total, annual and age-specific IPD notification rates were calculated. A Poisson regression model was used to identify the possible risk factors for developing IPD. RESULTS: A total of 713 IPD cases were notified and the overall IPD notification rate was equal to 2.0 cases per 100,000 population (95% CI: 1.7-2.1), with an increasing trend between 2007 and 2014. The pneumococcal serotypes were identified in 608 (85.3%) isolates from biological specimens, and the most distributed serotypes were those contained in PCV13. Children <5 year-old and the adults over 65 year-old showed the highest PCV13 vaccine-type IPD notification rate, equal to 2.7/100,000 and 2.8/100,000, respectively. The risk to develop IPD was greater in children aged <5 years (RR = 8.9, 95% CI: 5.1-15.9; p<0.0001) and in adults aged >65 years (RR = 4.3, 95% CI: 2.7-6.9; p<0.0001), especially in males > 65 years of age (RR = 1.7, 95% CI: 1.0-2.8; p = 0.042). The invasive pneumococcal disease was mainly caused by the PCV13 serotypes (RR = 2.9, 95%CI: 2.3-3.9; p<0.0001), principally after the PCV13 introduction (RR = 2.3, 95% CI: 1.4-3.8; p<0.001). In spite of that, a significant reduction of the overall IPD incidence is evident in the period following the PCV13 vaccine introduction (RR = 0.4, 95% CI: 0.3-0.5; p<0.0001), particularly in children aged <5 years (RR = 0.3, 95% CI: 0.2-0.7; p = 0.002), demonstrating the real efficacy of PCV13 immunization for children. CONCLUSIONS: In the Veneto Region, the surveillance system has allowed to describe the detailed epidemiological profile of invasive pneumococcal disease, pointing out that the most circulating pneumococcal serotypes were those contained in the PCV13 vaccine.
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Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Vacinação , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/imunologia , Vacinas Pneumocócicas/imunologia , Vigilância da População , Estudos Prospectivos , Fatores de Risco , Distribuição por Sexo , Vacinação/métodosRESUMO
INTRODUCTION: Geographic Information Systems (GIS) have become an innovative and somewhat crucial tool for analyzing relationships between public health data and environment. This study, though focusing on a Local Health Unit of northeastern Italy, could be taken as a benchmark for developing a standardized national data-acquiring format, providing a step-by-step instructions on the manipulation of address elements specific for Italian language and traditions. METHODS: Geocoding analysis was carried out on a health database comprising 268,517 records of the Local Health Unit of Rovigo in the Veneto region, covering a period of 10 years, starting from 2001 up to 2010. The Map Service provided by the Environmental Research System Institute (ESRI, Redlands, CA), and ArcMap 10.0 by ESRI(®) were, respectively, the reference data and the GIS software, employed in the geocoding process. RESULTS: The first attempt of geocoding produced a poor quality result, having about 40% of the addresses matched. A procedure of manual standardization was performed in order to enhance the quality of the results, consequently a set of guiding principle were expounded which should be pursued for geocoding health data. High-level geocoding detail will provide a more precise geographic representation of health related events. CONCLUSIONS: The main achievement of this study was to outline some of the difficulties encountered during the geocoding of health data and to put forward a set of guidelines, which could be useful to facilitate the process and enhance the quality of the results. Public health informatics represents an emerging specialty that highlights on the application of information science and technology to public health practice and research. Therefore, this study could draw the attention of the National Health Service to the underestimated problem of geocoding accuracy in health related data for environmental risk assessment.
RESUMO
BACKGROUND: The elderly are involved in an ever-increasing proportion of Emergency Department (ED) visits, consuming a large share of the available resources. The aim of this study was to assess elderly individuals' demand for ED hospital care, in terms of the management process and outcomes by level of urgency at triage. METHODS: The design was a retrospective cohort study. Details on ED attendance were drawn from the 2010 dataset of the Local Health Agency n°18 (n=18,648) in the Veneto Region, North-East Italy and the participants were resident seniors seen at the ED aged 65 or more. RESULTS: At triage on arrival, their priority was most often (in 38.63% of cases) considered non-urgent (white triage tag - Wt). In the majority of these cases, the elderly patients were self-referred, although about 1 in 5 of them had been referred by their General Practitioners. The consumption of resources for specialist visit and routine X-rays is higher for non-urgent patients. Injuries, requests for specialist examinations and musculoskeletal disorders account for a large proportion of the reasons why elderly people classified as Wt at triage had gone to the ED. CONCLUSIONS: Our findings show that older patients have high rates of non-urgent ED attendance, especially for minor traumatic events or requests to see a specialist. This picture emphasizes the need to develop new organizational models for delivering care to meet the most common health care needs of this special frail population.
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Serviço Hospitalar de Emergência/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Índice de Gravidade de Doença , Triagem/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Atenção à Saúde/organização & administração , Feminino , Idoso Fragilizado , Necessidades e Demandas de Serviços de Saúde , Humanos , Itália , Masculino , Modelos Organizacionais , Encaminhamento e Consulta/estatística & dados numéricos , Estudos RetrospectivosRESUMO
INTRODUCTION: Body piercing (P) and tattoo (T) is a growing social phenomenon over recent years. Nowadays in Italy little is known about the prevalence, the attitude, the medical and social consequences of these activities. The purpose of this study is to examine the prevalence distribution and the attitude towards P and T and the perception of the risk for infections, in a sample of high school students living in the four Provinces of the Veneto Region (Italy). METHODS: An anonymous, self administrate multiple-choice questionnaire about piercing and tattoo practices was distributed during the 2009-2010 academic year to a sample of randomly extracted grades to obtain information about sociodemographic characteristics, family educational level, personal attitude, prevalence and perception of the importance of the sanitary, technical and artistic competence of the operator. RESULTS: The correctly compiled questionnaires were 2712 (95.4%). Males and females were respectively 46.2% and 53.8% (mean age 17 +/- 1.7 years). The 20.2% and the 6.4% of all the students had already experienced respectively P and T and resulted "very interested" the 46.7% to P and the 57.4% to T. Esthetical motivations are the main ones referred to use body art. The most part of interviewed subjects (81.6%) think that it is possible to have an infection, but only about 50% of students reported to know specific information about transmission of HIV, Viral Hepatitis and skin infections. The parents' educational levels do not influence the perception of the risk of infection. The majority of interviewed subjects (88.0%) prefers to undergo body art practices in a qualified center. Only the 30% of students recur to a medical help to solve problem of infection. DISCUSSION: The piercing and tattoo prevalence rate in our study (P: 20.2% and T:6.4%) resulted similar to other Italian ones (range reported: P: 20.3-35.1%, T: 4.8-8.6%), showing an increasing trend with age. Since a high rate of interviewed students referred a substantial ignorance about the risk of transmission of body art related infectious diseases, it is suitable to promote as soon as possible among the youth educational interventions and counseling.
Assuntos
Atitude , Piercing Corporal/efeitos adversos , Piercing Corporal/psicologia , Transmissão de Doença Infecciosa , Tatuagem/efeitos adversos , Tatuagem/psicologia , Adolescente , Piercing Corporal/estatística & dados numéricos , Feminino , Humanos , Itália/epidemiologia , Masculino , Prevalência , Fatores de Risco , Inquéritos e Questionários , Tatuagem/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Road accidents are a major public health problem that affect all age groups but their impact is most striking among the young. The aim of this study is to quantify the burden of road traffic injuries, their mortality and direct in-patient economic costs and to identify the age classes at highest risk for severe road traffic injuries, through analysis of data collected by information systems of an Italian Local Health Authority. METHODS: The study was conducted in a Local Health Authority of Veneto Region. Injured people were selected from Emergency Department (2006-2010). Data were linked to the Hospital Information System for hospital admissions and to the Mortality Registry to check 30-day mortality. The direct costs associated to hospitalizations were estimated through Diagnosis Related Group reimbursement rates. Multivariate analysis was performed using hospitalization and mortality as the dependent variables and gender, age, day of week when accident occurred as the independent variables. Traffic injury, hospitalization and mortality incidence rates were calculated by gender and age per 100,000 residents per year. RESULTS: The road traffic injuries were 9,192, decreasing from 2,112 in 2006 to 1,980 in 2010. Among injured persons 55.3% were male (68.1% among 15-19 age class); 41.7% young people aged 15-34 years (43.9% among male, 39.0% among female). Total hospitalisation rate was 5.9%. Overall mortality rate was 0.3% (0.9% among aged 65 or older). The cost of hospital admission was euro 2,742,505 (hospitalization mean cost euro 5,097). Risk of hospitalization and death was higher in male, in elderly and during week end. Young people aged 15-19 had the highest incidence of visits (2,258.4 per 100,000) and high hospitalisation weekend and mortality rates (respectively 101.5 and 8.5). CONCLUSIONS: Analysis at local level, using current data sources, permits to estimate the burden of injuries caused by road-traffic, to describe the characteristics of injured persons and finally to estimate costs of care. All this information could be used to make the population aware of its own risk for road accidents. Linkage of these data with police and transport data is required to focus prevention on higher risk groups and to adopt effective local road safety strategies.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Acidentes de Trânsito/economia , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Serviço Hospitalar de Emergência , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Itália/epidemiologia , Tempo de Internação , Masculino , Sistemas Computadorizados de Registros Médicos , Pessoa de Meia-Idade , Sistema de RegistrosRESUMO
OBJECTIVE: Sub-Saharan African countries have the highest perinatal mortality rates. Although HIV is a risk factor for perinatal death, antioretroviral therapy (ART) programs have been associated with better outcomes. We aimed to investigate how maternal HIV affects perinatal mortality. METHODS: The authors performed a nested case-control study at Saint Luke Hospital, Wolisso, Ethiopia. Data on sociodemographic characteristics, current maternal conditions, obstetric history, and antenatal care (ANC) services utilization were collected. The association between perinatal mortality and HIV was assessed with logistic regression adjusting for potential confounders. RESULTS: A total of 3525 birthing women were enrolled, including 1175 cases and 2350 controls. Perinatal mortality was lower among HIV-positive women (18.3% vs. 33.6%, P = 0.007). Crude analysis showed a protective effect of HIV (odds ratio, 0.442 [95% confidence interval, 0.241-0.810]), which remained after adjustment (adjusted odds ratio, 0.483 [95% confidence interval, 0.246-0.947]). Among HIV-negative women, access to ANC for women from rural areas was almost half (18.8% vs. 36.2%; P < 0.001), whereas in HIV-positive women, no differences were noted (P = 0.795). CONCLUSION: Among HIV-positive mothers, perinatal mortality was halved and differences in access to ANC services by area were eliminated. These data highlight the benefits of integrating ANC and HIV services in promoting access to the health care system, reducing inequalities and improving neonatal mortality.
Assuntos
Infecções por HIV , Morte Perinatal , Recém-Nascido , Gravidez , Feminino , Humanos , Mortalidade Perinatal , Mães , Etiópia/epidemiologia , Estudos de Casos e Controles , Cuidado Pré-Natal , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologiaRESUMO
The goal of this study was to describe and comment the experience of the Veneto Region in the bacterial invasive disease. Vaccination coverage was 93% against pneumococcus and 95% against haemophilus influenzae type B. Regard to meningococcus C the coverage rate was 90.1% In children, 81% at 6 years of age and 78.2% at 15 years. The preliminary data of an active surveillance of invasive bacterial diseases show that the Streptoccoccus pneumoniae was the main agent involved and that its consequences were particularly serious in elderly subjects. With regard to Neisseria meningitidis, we observed a substantial reduction in the number of cases due to serogroup C and a concomitant rise in the percentage of cases due to serogroup B. The suspension of mandatory vaccination should be maintained, the monitoring of vaccination coverage and the active surveillance proved to be a very good assessment tools.
Assuntos
Infecções por Haemophilus/prevenção & controle , Vacinas Anti-Haemophilus/administração & dosagem , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Feminino , Infecções por Haemophilus/epidemiologia , Humanos , Esquemas de Imunização , Itália/epidemiologia , Masculino , Infecções Meningocócicas/epidemiologia , Infecções Pneumocócicas/epidemiologia , Vigilância da PopulaçãoRESUMO
Retrospective study in a toxicological unit care (TUC) performed to know the epidemiology of acute intoxication (AI) in Verona (Italy) during years 2008-2009. All data regarding patients with a diagnosis of certain/suspected AI were collected and evaluated: some demographic information, the characteristics of the agent involved, the pattern of exposure, the triage at the admission to TUC and the outcome. 244 cases were analyzed: 45.9% males and 54.9% females, mean age respectively 45.1 and 43.9 years. The monthly distribution of admitted patients resulted fairly constant, except from a light rising prevalence in autumn, with a majority of yellow (45.9%) and green (43.4%) triage code. The pattern of exposure resulted: ingestion (82.7% of cases; age peaks: 18-34 and 35-51 years old; mostly due to food (as mushrooms), drinks, detergents, soap, pharmaceutical, drugs of abuse, caustics substances), contact (10.2% of cases; age peak 18-51) and inhalation (6.9% of cases). In 17.2% of cases the poisoning exposure was intentional. In 63.5% the patients were sent to their general practitioners (45.5% of the yellow and 81.1% of the green coded patients) and in 22.1% of cases they were admitted to clinical rooms (44.6% of the yellow coded patients). In most cases the triage code assigned to the studied patients resulted yellow and green. Considering that the seriousness of the symptoms can appear after several hours from the exposure to toxic substances, a quick and specific intervention to obtain the best therapeutical effectiveness is suitable, in order to save lives or to avoid irremediable health damages.
Assuntos
Cuidados Críticos/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Intoxicação/epidemiologia , Doença Aguda , Adulto , Distribuição por Idade , Cáusticos/intoxicação , Etanol/intoxicação , Feminino , Humanos , Itália/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Praguicidas/intoxicação , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Distribuição por Sexo , Tentativa de Suicídio/estatística & dados numéricos , Toxicologia/estatística & dados numéricos , Adulto JovemRESUMO
Alcohol consumption among young people is a major public health problem and the Italian National Health Institute considers it the leading cause of death for people under 24 years old, mainly due to road accidents. This study summarizes the evidence emerging from three Cochrane Collaboration reviews, aiming to orient the choice of alcohol prevention programs for young people. The first review considered schemes implemented at school to prevent alcohol consumption under 18 years of age; the second concerned studies on programs to reduce alcohol abuse by means of social norms; the third examined 56 trials on schemes for preventing young people from drinking. In the first review, 6 of 11 alcohol prevention schemes showed some signs of efficacy, and 14 of 39 schemes to combat substance abuse generally induced a significantly alcohol use reduction. The second review included three specific programs for alcohol-related problems with a > 17-month follow-up and they were effective. In the third review, 15 of 39 schemes proved effective in the short-term, 9 of 12 with medium follow-up were no longer effective (and alcohol consumption even increased in 2), while 3 long-term trials and 2 of 3 community schemes proved effective. These Cochrane reviews did not assess all strategies for preventing alcohol abuse in the young which have been implemented in different countries, because many interventions has been conducted spontaneously without any evaluation of their efficacy. An international registry on substance abuse prevention measures is warranted, with shared criteria for assessing their effects, to orient public health policies.
Assuntos
Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/prevenção & controle , Consumo de Bebidas Alcoólicas/prevenção & controle , Alcoolismo/prevenção & controle , Prevenção Primária/métodos , Medicina Baseada em Evidências , Educação em Saúde , Humanos , Itália/epidemiologia , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Psicoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Adulto JovemRESUMO
The airborne transmission of SARS-CoV-2, the etiologic agent of the current COVID-19 pandemic, has been hypothesized as one of the primary routes of transmission. Current data suggest a low probability of airborne transmission of the virus in open environments and a higher probability in closed ones, particularly in hospitals or quarantine facilities. However, the potential diffusion of the virus in open environments, especially using particulate matter (PM) as a transport carrier, generated concern in the exposed populations. Several authors found a correlation between the exceeding of the PM10 concentration limits in some Italian cities and the prevalence of Covid-19 cases detected in those areas. This study investigated the potential presence of SARS-COV-2 RNA on a representative series of PM samples collected in the province of Padua in Northeastern Italy during the first wave of COVID pandemic. Forty-four samples of PM2.5 and PM10 were collected between February 24 and March 9, 2020 and analyzed with RT-qPCR for SARS-CoV-2 RNA. The experimental results did not indicate the presence of SARS-CoV-2 RNA in the outdoor PMs, thus confirming the low probability of virus airborne transmission through PM.