Diagnostic Technology: Trends of Use and Availability in a 10-Year Period (2011–2020) among Sixteen OECD Countries

Background. Overuse of imaging results in cost increases, with little to no benefit to patients. The purpose of this study is to evaluate imaging tests and radiology equipment over a ten-year period in 16 Organisation for Economic Co-operation and Development (OECD) countries. Methods. Twelve countries were included in a time-trend analysis based on OECD indicators on diagnostic imaging (computer tomography [CT], magnetic resonance imaging [MRI], and positron emission tomography [PET]). These annual indicators included the number of exams per 1000 population, the number of devices per million population, and the number of exams per device. Average annual percent change was used to measure country-specific trends. Results. Most countries saw a rise in the exam-to-scanner ratio for CT, MRI, and PET, demonstrating a faster increase in exam volume than device volume. Italy exhibited an increase in CT, MRI, and PET equipment units during the same period, but not in exams, most likely due to a reduction in medical procedures during the pandemic. Only in Luxemburg, CT and PET examinations increased despite a reduction in scanners. Conclusions. Considering the expected increasing demand for diagnostics due to the evolving needs of the population, proper governance and resource allocation are necessary requirements for cost-efficient health systems

Determinants of COVID-19 vaccination worldwide: WORLDCOV, a retrospective observational study

Introduction: The COVID-19 pandemic has resulted in numerous deaths, great suffering, and significant changes in people's lives worldwide. The introduction of the vaccines was a light in the darkness, but after 18 months, a great disparity in vaccination coverage between countries has been observed. As disparities in vaccination coverage have become a global public health issue, this study aimed to analyze several variables to identify possible determinants of COVID-19 vaccination. Methods: An ecological study was conducted using pooled secondary data sourced from institutional sites. A total of 205 countries and territories worldwide were included. A total of 16 variables from different fields were considered to establish possible determinants of COVID-19 vaccination: sociodemographic, cultural, infrastructural, economic and political variables, and health system performance indicators. The percentage of the population vaccinated with at least one dose and the total doses administered per 100 residents on 15 June 2022 were identified as indicators of vaccine coverage and outcomes. Raw and adjusted values for delivered vaccine doses in the multivariate GLM were determined using R. The tested hypothesis (i.e., variables as determinants of COVID-19 vaccination) was formulated before data collection. The study protocol was registered with the grant number NCT05471635. Results: GDP per capita [odds = 1.401 (1.299–1.511) CI 95%], access to electricity [odds = 1.625 (1.559–1.694) CI 95%], political stability, absence of violence/terrorism [odds = 1.334 (1.284–1.387) CI 95%], and civil liberties [odds = 0.888 (0.863–0.914) CI 95%] were strong determinants of COVID-19 vaccination. Several other variables displayed a statistically significant association with outcomes, although the associations were stronger for total doses administered per 100 residents. There was a substantial overlap between raw outcomes and their adjusted counterparts. Discussion: This pioneering study is the first to analyze the association between several different categories of indicators and COVID-19 vaccination coverage in a wide complex setting, identifying strong determinants of vaccination coverage. Political decision-makers should consider these findings when organizing mass vaccination campaigns in a pandemic context to reduce inequalities between nations and to achieve a common good from a public health perspective

Impact of COVID-19 on Timing of Hip-Fracture Surgeries: An Interrupted Time-Series Analysis of the Pre/Post-Quarantine Period in Northern Italy

To assess whether the imposition of the coronavirus disease 2019 (COVID-19) national quarantine (March 10, 2020) resulted in a shift in the proportion of patients operated for hip fracture on the day of admission, the following day and two days after admission in the region of Piedmont, northern Italy

A retrospective analysis of the costs and management of genital warts in Italy

BACKGROUND: In Italy the prevalence of genital warts in women (15–64 years) is approximately 0.6% with an incidence of 0.4% per year. Treatments for GW are usually long, with moderate success and high costs. The aim of the study was to evaluate the diagnostic-therapeutic pathway, duration and setting of treatment, costs of episodes of condyloma in a population attending a regional STI clinic in Piedmont. METHODS: This was a retrospective observational study conducted using medical records of outpatients who first visited the STI Clinic of San Lazzaro Dermatological Hospital in 2008. The patients’ medical histories were analysed for episodes that occurred and were cleared in 18 months following the initial visit. Data on screening methods for STIs, type of diagnosis for condyloma, treatment type, treatment setting, and anatomic lesion site were obtained from medical records. The costs were calculated for each episode. RESULTS: A total of 450 episodes were analysed (297 men,153 women). The most frequently affected anatomic site was the genital area (74%) in both genders. With regard to treatment setting, 78.44% of patients received outpatient treatment at the STI clinic, 4% were treated at home, and 0.22% were hospitalised; 11.11% were treated in multiple settings. The mean number of treatments per episode was 2.03; although many patients received only 1 treatment (n = 207, 46%), exspecially cryotherapy or diathermy coagulation (64.73% versus 28.02% of episodes, respectively). The mean episode duration was 80.74 days. The mean cost (in 2011 euros) for an episode was €158.46 ± 257.77; the mean costswere €79.13 ± 57.40 for diagnosis and €79.33 ± 233.60 for treatment. The mean cost for treatment in a STI-Clinic setting was €111.39 ± 76.72, that for home treatment was €160.88 ± 95.69, and that for hospital care was €2825.94. CONCLUSIONS: The treatment of and associated costs for genital warts are significant. Several factors affect the cost, and internal STI clinic protocols, such as the 6 month window used to consider a recurrence or new diagnosis, create bias. Nonetheless, our findings how costs similar to those reported in the international literature and should be considered when deciding on which HPV vaccination programs should be provided by the public health system

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

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 then 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