How appropriate is the use of rehabilitation facilities? Assessment by an evaluation tool based on the AEP protocol

Background. During the last few decades, an increasing attention has been drawn to public health expenditure and resource use. The increasing aging population has highlighted the need to deliver post-acute care and to assess its appropriateness. The ?PRUO rehab? (Protocollo di Revisione dell?Utilizzo dell?Ospedale riabilitativo) protocol was realized and validated to assess the appropriateness of use of rehabilitation units. The aims of this study were to test the validity of the PRUO-rehab tool and to analyse the causes for Inappropriate Hospital Stay (IPS) in rehabilitation units. Methods. The PRUO rehab tool was retrospectively applied to the medical records of 502 patients who stayed at least overnight in one of ten different rehabilitation units set in Northern Italy, during 2007. Results. The tool was valid and the inappropriate patient stay (IPS) score was 25.0%. Conclusion. Although reasonably low, the IPS indicates that the rehabilitation structures analysed could be used more efficiently

Knowledge about tuberculosis among undergraduate health care students in 15 Italian universities: a cross-sectional study

Background: The Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health conducted a multicentre survey aiming to evaluate undergraduate health care students’ knowledge of tuberculosis and tuberculosis control measures in Italy. Methods: In October 2012–June 2013, a sample of medical and nursing students from 15 Italian universities were enrolled on a voluntary basis and asked to complete an anonymous questionnaire investigating both general knowledge of tuberculosis (aetiology, clinical presentation, outcome, screening methods) and personal experiences and practices related to tuberculosis prevention. Data were analysed through multivariable regression using Stata software. Results: The sample consisted of 2,220 students in nursing (72.6%) and medicine (27.4%) courses. Our findings clearly showed that medical students had a better knowledge of tuberculosis than did nursing students. Although the vast majority of the sample (up to 95%) answered questions about tuberculosis aetiology correctly, only 60% of the students gave the correct responses regarding clinical aspects and vaccine details. Overall, 66.9% of the students had been screened for tuberculosis, but less than 20% of those with a negative result on the tuberculin skin test were vaccinated. Multivariable regression analysis showed that age and type of study programme (nursing vs. medical course) were determinants of answering the questions correctly. Conclusions: Although our data showed sufficient knowledge on tuberculosis, this survey underlines the considerable need for improvement in knowledge about the disease, especially among nursing students. In light of the scientific recommendations concerning tuberculosis knowledge among students, progress of current health care curricula aimed to develop students’ skills in this field is needed.</br

Payment for performance (P4P): any future in Italy?

<p>Abstract</p> <p>Background</p> <p>Pay for Performance (P4P) programs, based on provision of financial incentives for service quality, have been widely adopted to enhance quality of care and to promote a more efficient use of health care resources whilst improving patient outcomes. In Italy, as in other countries, the growing concern over the quality of health services provided and the scarcity of resources would make P4P programs a useful means of improving their performance. The aim of this paper is to evaluate whether it is possible to implement P4P programs in the Lombardy Region, in Italy, based on the existing data set.</p> <p>Methods</p> <p>Thirteen quality measures were identified regarding four clinical conditions (acute myocardial infarction (AMI), heart failure (HF), ischemic stroke and hip and knee replacement) on the basis of an international literature review. Data was collected using the database of three institutions, which included hospital discharge records (Scheda di Dimissione ospedaliera-SDO-) and letters of discharge. The study population was identified using both the Principal ICD-9-CM diagnosis codes and the discharge date. A Statistical Analysis System (SAS) program was used for the text analysis.</p> <p>Results</p> <p>It was possible to calculate almost all the parameters pertaining to the three hospitals as all the data required was available with the exception of inpatient mortality in two hospitals and smoking cessation advice/counseling in one hospital.</p> <p>Conclusions</p> <p>On the ground of this analysis, we believe that it is possible to implement a P4P program in the Lombardy Region. However, for this program to be initiated, all necessary data must be available in electronic format and uniformly collected. Moreover, several other factors must be assessed: which clinical conditions should be included, the threshold for each quality parameter, the amount of financial incentives offered and how they will be provided.</p

Formazione di giovani leader di sanità pubblica: un’esperienza sperimentale dell’Accademia Lombarda di Sanità Pubblica

Introduzione L’Accademia Lombarda di Sanità Pubblica (ALSP), Associazione no-profit fondata nel 2017, ha come obiettivo quello di promuovere il progresso in Sanità Pubblica (SP) attraverso il coinvolgimento di studiosi impegnati a vario titolo nei molteplici ambiti della SP come quello dell’igiene, dell’epidemiologia, della prevenzione, dell’ambiente, della direzione sanitarie, dell’edilizia sanitaria, del management, del diritto e dell’economia sanitaria. A tale scopo l’Accademia ha promosso, all’inizio del 2019, l’iniziativa Academy of Young Leader in Public Health (AYLPH). Si tratta di un percorso didattico-scientifico di un anno rivolto a 10 giovani con background formativo differente, fortemente motivati a sviluppare competenze di leadership in SP e già avviati a carriere professionali e di ricerca. Metodi Questo percorso formativo per i 10 giovani, selezionati con bando competitivo aperto ai soci, basa il suo metodo didattico-formativo su incontri con riconosciuti leader nazionali e internazionali di SP; visite a istituzioni; collaborazione a progetti di ricerca; training specifico sulla scrittura di lavori scientifici; opportunità di partecipare a convegni nazionali internazionali e a corsi brevi ad hoc. Risultati A metà programma, le attività condotte sono state: esperienza di team building in località montana; incontro con alcune importanti figure impegnate, a vari livelli, nella sanità pubblica come l’ex Ministro della salute Beatrice Lorenzin, l’Editor-in-chief della rivista European Journal of Public Health Peter Allebeck, il Presidente EUPHA Natasha Azzopardi-Muscat oltre ai past-Presidenti EUPHA Walter Ricciardi e Martin Mc Kee. Ha fatto seguito un corso intensivo sulle revisioni sistematiche che ha visto l’attivazione di 6 gruppi di ricerca coinvolti in altrettanti progetti di revisione sistematica della letteratura. Ulteriori attività sono state: la partecipazione all’Assemblea Generale dell’Organizzazione Mondiale della Sanità, la partecipazione al Deans’ and Directos’ Retreat dell’ASPHER e al Congresso Americano di Sanità Pubblica (APHA). Sono in programma anche un corso di Public speaking, presso l’Università di Pisa ed alcuni incontri ad hoc. Conclusioni Nel contesto attuale, in cui la salute delle persone è minata da un senso di sfiducia nei confronti delle Istituzioni, dalla mancata equità nell’accesso alle cure e da stili di vita scorretti, la SP ha necessità di formare nuovi leaders in grado di promuovere valori e guidare al cambiamento individuale, organizzativo e politico. La AYLPH rappresenta un’occasione formativa di alto livello per giovani professionisti interessati a conoscere e attuare strategie di leadership in SP

Knowledge about tuberculosis among undergraduate health care students in 15 Italian universities: a cross-sectional study

Background: The Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health conducted a multicentre survey aiming to evaluate undergraduate health care students' knowledge of tuberculosis and tuberculosis control measures in Italy. Methods. In October 2012-June 2013, a sample of medical and nursing students from 15 Italian universities were enrolled on a voluntary basis and asked to complete an anonymous questionnaire investigating both general knowledge of tuberculosis (aetiology, clinical presentation, outcome, screening methods) and personal experiences and practices related to tuberculosis prevention. Data were analysed through multivariable regression using Stata software. Results: The sample consisted of 2,220 students in nursing (72.6%) and medicine (27.4%) courses. Our findings clearly showed that medical students had a better knowledge of tuberculosis than did nursing students.Although the vast majority of the sample (up to 95%) answered questions about tuberculosis aetiology correctly, only 60% of the students gave the correct responses regarding clinical aspects and vaccine details. Overall, 66.9% of the students had been screened for tuberculosis, but less than 20% of those with a negative result on the tuberculin skin test were vaccinated. Multivariable regression analysis showed that age and type of study programme (nursing vs. medical course) were determinants of answering the questions correctly. Conclusions: Although our data showed sufficient knowledge on tuberculosis, this survey underlines the considerable need for improvement in knowledge about the disease, especially among nursing students. In light of the scientific recommendations concerning tuberculosis knowledge among students, progress of current health care curricula aimed to develop students' skills in this field is needed

Ontologia e filosofia della volontà nel pensiero di Paul Ricoeur

Queste ricerche si prefiggono di risalire alle origini degli sviluppi ontologici più recenti della riflessione di Paul Ricoeur, in cui la nozione di «essere» giunge a designare il «fondo potente ed efficace» sotteso alle varie forme dell’esistenza, del linguaggio, del sapere e dell’agire umani, nonché l'«alterità» rispetto a cui il singolo costituisce la propria identità. Secondo la tesi che intendiamo proporre, le basi di questa visione sarebbero state gettate da un cambiamento intervenuto nel pensiero ricoeuriano verso la metà degli anni ’50, che identificheremmo con una «rimodulazione» del progetto della «filosofia della volontà», definito nei primi anni del Dopoguerra. Il nostro lavoro sarà quindi suddiviso in tre parti. Nel primo capitolo ricostruiremo la prima elaborazione della filosofia della volontà a partire dagli studi di Ricoeur su Jaspers, Gabriel Marcel e Husserl, soffermandoci poi su alcuni snodi de "Il volontario e l’involontario" (1950). Nel secondo capitolo ripercorreremo invece alcuni saggi della raccolta "Histoire et vérité" (1955), il confronto di Ricoeur con il “Saggio sul male” (1955) di Jean Nabert e “Finitudine e colpa”, in cui proveremo a cogliere rispettivamente l’inizio della «rimodulazione» della filosofia della volontà, le sue radici e i suoi primi frutti. Nel capitolo conclusivo ci concentreremo infine su "La semantica dell’azione" (1977) e "Il male. Una sfida alla filosofia e alla teologia" (1986), allo scopo di verificare l'influsso della rimodulazione della filosofia della volontà sul pensiero ricoeuriano costituitosi tra gli anni ’70 e ’90. Prima di avviare questo lavoro analitico, ci confronteremo in premessa con alcune ricostruzioni e interpretazioni dell’ontologia ricoeuriana proposte in ambito filosofico e teologico. These researches try to go back to the origins of the latest ontological developments in Paul Ricoeur’s philosophical reflection, where the notion of «being» is conceived as the «powerful and effective ground» that lies below the various forms of human existence, language, knowledge and action, but also as the «alterity» in respect to which the individual constitutes his own identity. According to the thesis we would like to advance, the foundations of this theory have been laid by a change that Ricoeur’s thought has undergone approximately in the middle of the 50s and that we would define as a «remodulation» of the project of the «philosophy of will» which had been formulated short after the Second World War. Our work is divided into three parts. In the first chapter we are going to reconstruct the first version of the philosophy of will, starting from Ricoeur’s researches on Jaspers, Gabriel Marcel and Husserl and coming to “Le volontaire et l’involontaire” (1950). Then, in the second chapter we are going to examine some articles collected in “Histoire et vérité” (1955), the research on Jean Nabert’s “Essai sur le mal” (1955) and “Finitude et culpabilité” (1960), where we will try to recognize respectively the beginning of the «remodulation» of the philosophy of will, its origins and its first results. Finally, in the third chapter we are going to concentrate on “La sémantique de l’action” (1977) and “Le mal. Un défi à la philosophie et à la théologie”(1986), in order to check the influence exerted by the remodulation of the philosophy of will on Ricoeur’s thought between the 70s and the 90s. Before starting with these analysis, we will face preliminarily the interpretations and reconstructions of Ricoeur’s ontology proposed by some philosophers and theologians

Air pollution and respiratory drug use in the city of Como, Italy.

UNLABELLED: STUDY OBJECTIVE AND SETTING: Particulate air pollution has a known negative effect on human respiratory health, often studied with hospital admissions, emergency room access, or mortality as health indicators. We evaluate respiratory drug dispensing data as health indicators for the effects of total suspended particles (TSP) air pollution in the city of Como (84,713 inhabitants). DESIGN: Weekly count of individual patients with respiratory drug dispensed (Cases) and weekly dispensed daily defined doses (DDD) of drugs were modelled with weekly air mean concentrations of TSP using a Poisson regression model adjusted for long-term trends, seasonal variations, calendar variations due to holidays, and weather. MAIN RESULT: Relative risks (RR) were expressed for a variation from 10th to 90th percentile of TSP (29-92 microg/m3). Weekly aggregation was used in consideration of the complexity of drug dispensing data and potential biases of daily aggregation. For weekly mean concentrations of TSP, RR = 1.082 (95% Confidence level (CI) 1.002-1.169) for Cases and RR = 1.137 (95% CI 1.044-1.238) for DDD. CONCLUSION: Our study concludes that both Cases and DDD of dispensed respiratory drugs could be useful for epidemiological surveillance of air pollutant health effects. Further investigation may routinely allow health and economics considerations, producing a stimulating new tool for health policy makers