Appropriateness of admission and days of stay in pediatric hospital in Ancona, Italy

Background: In Italy, hospital admission costs account for nearly 42% of total health expenditure; in the Marche region, this share exceeds 50%. High costs of hospitalization, however, can be partly explained by inappropriate use. The aim of this research was to assess the risk factors associated with inappropriate hospital admissions and stay for acute pediatric patients. Methods: Clinical records of children from 30 days to 14 years of age admitted to the wards of orthopedics, pediatrics, pediatric isolation, pediatric surgery and pediatric oncohematology at Salesi Pediatric Hospital of Ancona throughout 2004 were reviewed. The Italian Pediatric Appropriateness Evaluation Protocol (PRUO) was used as a tool for assessing inappropriateness of admission and days of stay. Results: Overall 21.7% (95% CI = 16.1%–22.4%) of hospital admissions and 30.3% (95% CI = 26.0%–34.9%) of days of stay were judged to be inappropriate. Multiple logistic regression analysis indicated that inappropriate admission was significantly associated with type of admission, discharge ward and place of residence. Inappropriateness of stay was significantly higher if admission was to a medical ward and if admission itself was judged inappropriate. Conclusions: In a socioeconomic context in which reducing waste is necessary, ineffective health care interventions are no longer tolerable. As a tool capable of integrating each patient’s specific features with those of the health care process, the pediatric PRUO could be a valid tool in the hands of managers for monitoring the appropriateness of admission and stay

Cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of two primary care interventions aimed at improving attendance for breast screening.

OBJECTIVES: To examine the effectiveness and cost-effectiveness of two interventions based in primary care aimed at increasing uptake of breast screening. SETTING: 24 General practices with low uptake in the second round of screening (below 60%) in north west London and the West Midlands, UK. Participants were all women registered with these practices and eligible for screening in the third round. METHODS: Pragmatic factorial cluster randomised controlled trial, with practices randomised to a systematic intervention (general practitioner letter), an opportunistic intervention (flag in women's notes prompting discussion by health professionals), neither intervention, or both. Outcome measures were attendance for screening 6 months after the practices had been screened and cost-effectiveness of the interventions. RESULTS: 6,133 Women were included: 1,721 control; 1,818 letter; 1,232 flag; 1,362 both interventions. Attendance data were obtained for 5,732 (93%) women. The two interventions independently increased breast screening uptake in a logistic regression model adjusted for clustering, with the flag (odds ratio (OR) 1.43, 95% confidence interval (95% CI) 1.14 to 1.79; p=0.0019) marginally more effective than the letter (OR 1.31, 95% CI 1.05 to 1.64; p=0.015). Health service costs per additional attendance were 26 pounds (letter) and 41 pounds (flag). CONCLUSIONS: Although both interventions increased attendance for breast screening, the letter was the more cost-effective. Any decision to implement both interventions rather than just the letter will depend on whether the additional (41 pounds) costs are judged worthwhile in terms of the gains in breast screening uptake

Improving attendance for breast screening among recent non-attenders: a randomised controlled trial of two interventions in primary care.

OBJECTIVES: To examine the effectiveness and cost-effectiveness of two primary care based interventions aimed at increasing breast screening uptake for women who had recently failed to attend. SETTING: 13 General practices with low uptake in the second round of breast screening (below 60%) in north west London and the West Midlands, United Kingdom. Participants were women in these practices who were recent non-attenders for breast screening in the third round. METHODS: Pragmatic factorial randomised controlled trial, with people randomised to a systematic intervention (general practitioner letter), an opportunistic intervention (flag in women's notes prompting discussion by health professionals), neither intervention, or both. Outcome measures were attendance for screening 6 months after randomisation and cost-effectiveness of the interventions. RESULTS: 1,158 Women were individually randomised as follows: 289 control; 291 letter; 290 flag; 288 both interventions. Attendance was ascertained for 1,148 (99%) of the 1,158 women. Logistic regression adjusting for the other intervention and practice produced an odds ratio (OR) for attendance of 1.51 (95% confidence interval (95% CI 1.02 to 2.26; p=0.04) for the letter, and 1.39 (95% CI 0.93 to 2.07; p=0.10) for the flag. Health service costs/ additional attendance were 35 pounds (letter) and 65 pounds (flag). CONCLUSIONS: Among recent non-attenders, the letter was effective in increasing breast screening attendance. The flag was of equivocal effectiveness and was considerably less cost-effective than the letter

Assessment of facial profile changes in Class I biprotrusion adolescent subjects submitted to orthodontic treatment with extractions of four premolars

OBJECTIVE: To evaluate cephalometric changes in tooth and profile position in young adolescent individuals with Class I biprotrusion submitted to orthodontic treatment with extractions of four first premolars. METHODS: Pre and posttreatment lateral cephalometric radiographs from 20 patients with Class I biprotrusion malocclusion were used to evaluate the following measurements: nasolabial angle, distance from lips to E line, distance from lips, incisors, tip of the nose and soft tissue pogonion to Sy line. RESULTS: All measurements showed significant changes after treatment (p<0.05), except the distance from lips and soft tissue pogonion to Sy line. There was a positive correlation between the retraction of incisors and the change of upper and lower lips (0.803/0.925; p<0.001). CONCLUSION: The profile retrusion observed occurred more due to nose growth than to lips retraction. The response from soft tissues to incisors retraction showed a great variability

Change in intergenerational economic mobility in Norway: conventional versus joint classifications of economic origin

Economic mobility, Inequality, Intergenerational transmission, Trends, Classification of economic status,

Effects of Stimulation Rate, Mode and Level on Modulation Detection by Cochlear Implant Users

In cochlear implant (CI) patients, temporal processing is often poorest at low listening levels, making perception difficult for low-amplitude temporal cues that are important for consonant recognition and/or speech perception in noise. It remains unclear how speech processor parameters such as stimulation rate and stimulation mode may affect temporal processing, especially at low listening levels. The present study investigated the effects of these parameters on modulation detection by six CI users. Modulation detection thresholds (MDTs) were measured as functions of stimulation rate, mode, and level. Results show that for all stimulation rate and mode conditions, modulation sensitivity was poorest at quiet listening levels, consistent with results from previous studies. MDTs were better with the lower stimulation rate, especially for quiet-to-medium listening levels. Stimulation mode had no significant effect on MDTs. These results suggest that, although high stimulation rates may better encode temporal information and widen the electrode dynamic range, CI patients may not be able to access these enhanced temporal cues, especially at the lower portions of the dynamic range. Lower stimulation rates may provide better recognition of weak acoustic envelope information