Health burden and economic impact of measles-related hospitalizations in Italy in 2002–2003

Background: A large measles outbreak occurred in Italy in 2002 - 2003. This study evaluates the health burden and economic impact of measles- related hospitalizations in Italy during the specified period. Methods: Hospital discharge abstract data for measles hospitalizations in Italy during 2002 - 2003 were analysed to obtain information regarding number and rates of measles hospitalizations by geographical area and age group, length of hospital stay, and complications. Hospitalization costs were estimated on the basis of Diagnosis- Related Groups. Results: A total of 5,154 hospitalizations were identified, 3,478 ( 67%) of which occurred in children < 15 years of age. Most hospitalizations occurred in southern Italy ( 71 %) and children below 1 year of age presented the greatest hospitalization rates ( 46.2/ 100,000 and 19.0/ 100,000, respectively in 2002 and 2003). Pneumonia was diagnosed in 594 cases ( 11.5%) and encephalitis in 138 cases ( 2.7%). Total hospital charges were approximately (sic) 8.8 million. Conclusion: The nationwide health burden associated with measles during the 2002 - 2003 outbreak was substantial and a high cost was incurred by the Italian National Health Service for the thousands of measles- related hospitalizations which occurred. By assuming that hospital costs represent 40 - 50% of the direct costs of measles cases, direct costs of measles for the two years combined were estimated to be between (sic)17.6 - 22.0 million, which equates to the vaccination of 1.5 - 1.9 million children ( 3 - 4 birth cohorts) with one dose of MMR. The high cost of measles and the severity of its complications fully justify the commitment required to reach measles elimination

Genome-based study of a spatio-temporal cluster of invasive meningococcal disease due to Neisseria meningitidis serogroup C, clonal complex 11

SummaryObjectivesTo describe a spatio-temporal cluster of invasive meningococcal disease (IMD) due to serogroup C meningococci, occurred in a restricted area of Tuscany between January and October 2015, and the results of whole genome sequencing (WGS).MethodsSurveillance activities and public health measures were implemented in the Region. Bacterial isolates from IMD cases were characterized by the National Reference Laboratory of the Istituto Superiore di Sanità (ISS), and WGS was performed on available strains. The kSNP software was used to identify core genome SNPs.ResultsOverall, 28 IMD cases due to meningococcus C were identified up to 31st October, 2015. Of them, 26 were due to meningococcus C:P1.5-1,10-8: F3-6:ST-11 (cc11) and 2 to C:P1.5-1,10-8: F3-6:ST-2780 (cc11). WGS of 13 meningococci isolated during the outbreak occurred in Tuscany in 2015 showed higher similarity when compared with those of 47 C: P1.5-1,10-8: F3-6:ST-11 (cc11) invasive strains from sporadic cases previously detected in Italy.ConclusionsA highly aggressive meningococcal C strain was involved in the cluster of severe IMD occurred in Tuscany, a Region with high vaccine coverage among children. Whether this was due to low herd immunity related to the short duration of vaccine protection needs further investigation

The perception of healthcare quality of elderly in the city of Bari, South Italy

<p>Abstract</p> <p>Background</p> <p>In recent decades in Italy, as in all the industrialized nations, the proportion of elderly subjects in the total population is constantly on the increase. However the increased life expectancy is not always paralleled by a true improvement in the quality of life.</p> <p>In this context, it is essential to analyze elderly real health needs and the responses to these needs, especially in terms of healthcare, that the territorial services are perceived to offer.</p> <p>Methods</p> <p>In the period from June to September 2006 we selected randomly one General Practitioner (GP) for each district of the Bari Municipal Area and, form each GP, we randomly chose 25 patients over 65 years old (YO). We conducted phone interviews using a standard data collection questionnaire and, for each of the recruited subjects, the GP filled a data collection sheet.</p> <p>Results</p> <p>Although the mean age (73.6 years) of the population under study was quite high, the general state of health was judged good both by the G P- and by their elderly patients (>75%).</p> <p>Notably, the great majority of elderly patients considered the healthcare they receive to be satisfactory (>60%): in particular, the GP was the true point of reference for this slice of the population for strictly medical problems as well as for advice. On the contrary, the patients attributed little value to social services, which were poorly known and scarcely used (8.5%). Public hospital facilities played a central role in second level healthcare in more than 30% of cases; private facilities covered by public health insurance were also very important. As possible solutions to the problem of loneliness, 36.6% of the patients declared that they approved of nursing homes.</p> <p>Conclusion</p> <p>Decision makers need to create services supporting the key role played by General Practitioners, who are well aware that their assistance is not sufficient to satisfy the health needs of the elderly.</p

Network organizations of general practitioners: antecedents of formation and consequences of participation

BACKGROUND: Network forms of organization are increasingly popular in primary care. At the end of the 1990s General Practitioners (GPs) in Italy were given the opportunity to adopt network forms of organization with the aim of improving the quality of their services. However factors affecting GPs' choices to join a network and the consequences of network membership have not been evaluated. METHODS: Administrative data of a Local Health Authority in Central Italy were analyzed using statistical methods at individual and dyadic levels of analysis. RESULTS: Homophily factors seem to influence a GP's choice of network. The consequences of network membership on GP performances seem very limited. CONCLUSIONS: When considering to foster the diffusion of network organizational forms in health care creating a network structure, like that of Italian GPs, is not sufficient. Other features of the implementation phase, work organization and human resource management should also be considered