Inequality in Healthcare Utilization in Italy: How Important Are Barriers to Access?

With the ageing population, equitable access to medical care has proven to be paramount for the effective and efficient management of all diseases. Healthcare access can be hindered by cost barriers for drugs or exams, long waiting lists or difficult access to the place where the needed healthcare service is provided. The aim of this paper is to investigate whether the probability of facing one of these barriers varies among individuals with different socio-economic status and care needs, controlling for geographical variability. Methods. The sample for this study included 9629 interviews with Italian individuals, aged 15 and over, from the second wave (2015) of the European Health Interview Survey, which was conducted in all EU Member States. To model barriers to healthcare, two-level variance components of logistic regression models with a nested structure given by the four Italian macro-areas were considered. Results. Of the barriers considered in this study, only two were found to be significantly associated with healthcare utilization. Specifically, they are long waiting lists for specialist service accessibility (adjOR = 1.20, 95% CI (1.07; 1.35)) and very expensive exams for dental visit accessibility (adjOR = 0.84, 95% CI (0.73; 0.96)). Another important result was the evidence of an increasing north–south gradient for all of the considered bar-riers. Conclusion. In Italy, healthcare access is generally guaranteed for all of the services, except for specialist and dental visits that face a waiting time and financial barriers. However, barriers to healthcare were differentiated by income and sex. The north–south gradient for healthcare utilization could be explained through the existing differences in organizational characteristics of the several regional healthcare services throughout Italy

Can bayesian models play a role in dental caries epidemiology? Evidence from an application to the BELCAP data set

ObjectivesThe aim of this study was to show the potential of Bayesian analysis in statistical modelling of dental caries data. Because of the bounded nature of the dmft (DMFT) index, zero-inflated binomial (ZIB) and beta-binomial (ZIBB) models were considered. The effects of incorporating prior information available about the parameters of models were also shown. MethodsThe data set used in this study was the Belo Horizonte Caries Prevention (BELCAP) study (Bohning etal. (1999)), consisting of five variables collected among 797 Brazilian school children designed to evaluate four programmes for reducing caries. Only the eight primary molar teeth were considered in the data set. A data augmentation algorithm was used for estimation. Firstly, noninformative priors were used to express our lack of knowledge about the regression parameters. Secondly, prior information about the probability of being a structural zero dmft and the probability of being caries affected in the subpopulation of susceptible children was incorporated. ResultsWith noninformative priors, the best fitting model was the ZIBB. Education (OR=0.76, 95% CrI: 0.59, 0.99), all interventions (OR=0.46, 95% CrI: 0.35, 0.62), rinsing (OR=0.61, 95% CrI: 0.47, 0.80) and hygiene (OR=0.65, 95% CrI: 0.49, 0.86) were demonstrated to be factors protecting children from being caries affected. Being male increased the probability of being caries diseased (OR=1.19, 95% CrI: 1.01, 1.42). However, after incorporating informative priors, ZIB models' estimates were not influenced, while ZIBB models reduced deviance and confirmed the association with all interventions and rinsing only. DiscussionIn our application, Bayesian estimates showed a similar accuracy and precision than likelihood-based estimates, although they offered many computational advantages and the possibility of expressing all forms of uncertainty in terms of probability. The overdispersion parameter could expound why the introduction of prior information had significant effects on the parameters of the ZIBB model, while ZIB estimates remained unchanged. Finally, the best performance of ZIBB compared to the ZIB model was shown to catch overdispersion in data

Statistical advances in epidemiology and public health

The key role of statistical modeling in epidemiology and public health is unquestionable [...]

Adult exposures from MDCT including multiphase studies: first Italian nationwide survey.

OBJECTIVES: To evaluate the radiation dose in routine multidetector computed tomography (MDCT) examinations in Italian population. METHODS: This was a retrospective multicentre study included 5,668 patients from 65 radiology departments who had undergone common CT protocols: head, chest, abdomen, chest–abdomen–pelvis (CAP), spine and cardiac. Data included patient characteristics, CT parameters, volumetric CT dose index (CTDIvol) and dose length product (DLP) for each CT acquisition phase. Descriptive statistics were calculated, and a multi-regression analysis was used to outline the main factors affecting exposure. RESULTS: The 75th percentiles of CTDIvol (mGy) and DLP (mGy cm) for whole head were 69 mGy and 1,312 mGy cm, respectively; for chest, 15 mGy and 569 mGy cm; spine, 42 mGy and 888 mGy cm; cardiac, 7 mGy and 131 mGy cm for calcium score, and 61 mGy and 1,208 mGy cm for angiographic CT studies. High variability was present in the DLP of abdomen and CAP protocols, where multiphase examinations dominated (71 % and 73 % respectively): for abdomen, 18 mGy, with 555 and 920 mGy cm in abdomen and abdomen–pelvis acquisitions respectively; for CAP, 17 mGy, with 508, 850 and 1,200 mGy cm in abdomen, abdomen–pelvis and CAP acquisitions respectively. CONCLUSION: The results of this survey could help in the definition of updated diagnostic reference levels (DRL)

Radiation dose from multidetector CT studies in children: results from the first Italian nationwide survey

Background Multidetector CT (MDCT) scanners have con- tributed to the widespread use of CT in paediatric imaging. However, concerns are raised for the associated radiation exposure. Very few surveys on radiation exposure from MDCT studies in children are available. Objective The aim of this study was to outline the status of radiation exposure in children from MDCT practice in Italy. Materials and methods In this retrospective multicentre study we asked Italian radiology units with an MDCT scanner with at least 16 slices to provide dosimetric and acquisition param- eters of CT examinations in three age groups (1–5, 6–10, 11– 15 years) for studies of head, chest and abdomen. The dosi- metric results were reported in terms of third-quartile volu- metric CT dose index (CTDIvol) (mGy), size-specific dose estimate (SSDE) (mGy), dose length product (DLP) (mGy cm), and total DLP for multiphase studies. These results were compared with paediatric European and adult Italian published data. A multivariate analysis assessed the association of CTDIvol with patient characteristics and scanning modalities. Results We collected data from 993 MDCT examinations performed at 25 centres. For age groups 1–5 years, 6–10 years and 11–15 years, the CTDIvol, DLP and total DLP values were statistically significantly below the values observed in our analogous national survey in adults, although the difference decreased with increasing age. CTDIvol variability among centres was statistically significant (variance = 0.07; 95% confidence interval = 0.03–0.16; P < 0.001). Conclusions This study reviewed practice in Italian centres performing paediatric imaging with MDCT scanners. The variability of doses among centres suggests that the use of standardised CT protocols should be encourage

A preliminary study on cranio-facial characteristics associated with minor neurological dysfunctions (Mnds) in children with autism spectrum disorders (asd)

Background. Craniofacial anomalies and minor neurological dysfunction (MNDs) have been identified, in literature, as risk factors for neurodevelopmental disorders. They represent physical indicators of embryonic development suggesting a possible contributory role of complications during early, even pre-conceptional, phases of ontogeny in autism spectrum disorders (ASD). Limited research has been conducted about the co-occurrence of the two biomarkers in children with ASD. This study investigates the associative patterns of cranio-facial anomalies and MNDs in ASD children, and whether these neurodevelopmental markers correlate with intensity of ASD symptoms and overall functioning. Methods. Caucasian children with ASD (n = 33) were examined. Measures were based on five anthropometric cranio-facial indexes and a standardized and detailed neurological examination according to Touwen. Relationships between anthropometric z-scores, MNDs and participant characteristics (i.e., age, cognitive abilities, severity of autistic symptoms measured using the Childhood Autism Rating Scale (CARS) checklist) were assessed. Results. With respect to specific MNDs, significant positive correlations were found between Cephalic Index and Sensory deficits (p-value < 0.001), which did not correlate with CARS score. Importantly, CARS score was positively linked with Intercanthal Index (p-value < 0.001), and negatively associated with posture and muscle tone (p-value = 0.027) and Facial Index (p-value = 0.004). Conclusion. Our data show a link between a specific facial phenotype and anomalies in motor responses, suggesting early brain dysmaturation involving subcortical structures in cerebro-craniofacial development of autistic children. This research supports the concept of a “social brain functional morphology” in autism spectrum disorders

An XMM-Newton and INTEGRAL view on the hard state of EXO 1745-248 during its 2015 outburst

CONTEXT - Transient low-mass X-ray binaries (LMXBs) often show outbursts lasting typically a few-weeks and characterized by a high X-ray luminosity ($L_{x} \approx 10^{36}-10^{38}$ erg/sec), while for most of the time they are found in X-ray quiescence ($L_X\approx10^{31} -10^{33}$ erg/sec). EXO 1745-248 is one of them. AIMS - The broad-band coverage, and the sensitivity of instrument on board of {\xmm} and {\igr}, offers the opportunity to characterize the hard X-ray spectrum during {\exo} outburst. METHODS - In this paper we report on quasi-simultaneous {\xmm} and {\igr} observations of the X-ray transient {\exo} located in the globular cluster Terzan 5, performed ten days after the beginning of the outburst (on 2015 March 16th) shown by the source between March and June 2015. The source was caught in a hard state, emitting a 0.8-100 keV luminosity of $\simeq10^{37}$~{\lumcgs}. RESULTS - The spectral continuum was dominated by thermal Comptonization of seed photons with temperature $kT_{in}\simeq1.3$ keV, by a cloud with moderate optical depth $\tau\simeq2$ and electron temperature $kT_e\simeq 40$ keV. A weaker soft thermal component at temperature $kT_{th}\simeq0.6$--0.7 keV and compatible with a fraction of the neutron star radius was also detected. A rich emission line spectrum was observed by the EPIC-pn on-board {\xmm}; features at energies compatible with K-$\alpha$ transitions of ionized sulfur, argon, calcium and iron were detected, with a broadness compatible with either thermal Compton broadening or Doppler broadening in the inner parts of an accretion disk truncated at $20\pm6$ gravitational radii from the neutron star. Strikingly, at least one narrow emission line ascribed to neutral or mildly ionized iron is needed to model the prominent emission complex detected between 5.5 and 7.5 keV. (Abridged)Comment: 14 pages, 6 figure, 2 tables. Accepted for publication on A&A (21/03/2017

Imaging findings of hepatic focal nodular hyperplasia in men and women: are they really different?

Purpose This study was undertaken to compare the imaging findings of focal nodular hyperplasia (FNH) in men and women, as seen on multidetector computed tomography (MDCT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS). Materials and methods Two radiologists reviewed 195 imaging studies (17 MDCT, 81 MRI and 97 CEUS examinations) pertaining to 111 FNHs (mean size 3 cm) in 91 patients (mean age 39 years). For each lesion, the readers assessed size, location, echogenicity, attenuation, or signal intensity in comparison with adjacent liver parenchyma on both unenhanced and postcontrast images. Results Eighty-nine FNHs (mean size 3.1 cm) were observed in 73 women (mean age 37.9 years) and 22 FNHs (mean size 2.7 cm) in 18 men (mean age 41.2 years). No statistically significant differences were found between men and women in terms of age, FNH lesions per patient (1.22 and 1.21, respectively), size, baseline and enhancement pattern on MRI, CEUS and MDCT (p < 0.05). A central scar in FNHs was depicted in 4/18 (22.2 %) men and 16/63 (25.4 %) women on MRI (p < 0.05), and in 1/2 (50 %) men and 7/15 (46.7 %) women on MDCT (p < 0.05), whereas a spoke-wheel pattern, central scar, and/or feeding vessel were seen in 5/17 (29.4 %) men and 22/80 (27.5 %) women on CEUS (p < 0.05). Conclusions Our results did not show any differences in imaging features, age of occurrence and size of FNH between men and women