Educazione, cittadinanza, volontariato

In a complex, global, multicultural and post-modern society such as the contemporary one, the concepts of "democracy", citizenship "and" training” are undergoing a more urgent and necessary rethinking, which is tracing more and more constant new variations, contaminations and interconnections. On the one hand citizenship has become today active and participatory, as today it can be exercised. On the other hand, volunteering can be a response to the need for participation claimed by contemporary societies: the donation of blood, a particular declination of the traditional concept of gift, is seen as an opportunity to participate in community life and to exercise active and responsible citizenship. From this point of view, the subject is the main actor and protagonist of contemporary processes, and must be trained in understanding the complexity of the notion of citizenship

Community Hospital in Emilia-Romagna Region: organizational models and quality of care assessment

L’attuale frammentazione dei percorsi assistenziali rivolti ai pazienti anziani con multimorbosità e fragili, non garantisce cure efficaci, efficienti né soddisfazione dei pazienti e delle loro famiglie. Si stanno sviluppando a livello internazionale modelli di organizzazione dei servizi di “cure intermedie”, per rispondere ai bisogni emergenti rappresentati da invecchiamento, aumento di patologie croniche, multimorbosità e fragilità, per evitare ospedalizzazioni inappropriate e ritardare l’istituzionalizzazione di lungo periodo. Coerentemente con le indicazioni normative nazionali, la Regione Emilia-Romagna (RER) ha intrapreso un percorso di ridefinizione dei servizi territoriali e della rete ospedaliera con l’obiettivo di garantire la continuità delle cure e l’integrazione ospedale-territorio, in particolare per le persone con patologia cronica, potenziando i servizi assistenziali di cure intermedie e attivando strutture residenziali intermedie territoriali (Ospedali di Comunità). Il progetto di ricerca aveva l’obiettivo di definire, attraverso l’individuazione di specifici indicatori, una modalità strutturata per il monitoraggio dell’assistenza fornita ai pazienti che vengono presi in carico negli Ospedali di Comunità dal punto di vista clinico, organizzativo e del paziente. Il modello organizzativo è stato studiato confrontando tre Ospedali di Comunità della Regione Emilia-Romagna. Gli indicatori individuati sono quindi stati analizzati per descrivere la coorte di pazienti dimessa dall’Ospedale di Comunità di Castel San Pietro Terme (Ausl Imola). L’analisi condotta, con l’identificazione di sottotipi caratteristici di pazienti che accedono all’Ospedale di Comunità può costituire un valido supporto conoscitivo nel processo di miglioramento dei percorsi clinico-assistenziali. La descrizione dei percorsi di cura seguiti dai pazienti presi in carico negli Ospedali di Comunità, di cui l’analisi presentata rappresenta un primo step, può infatti contribuire a meglio definire le strategie organizzative dell’assistenza ospedaliera e territoriale, sanitaria e socio-assistenziale per potenziare quindi la capacità di risposta ai bisogni dei pazienti.The fragmentation of services for elderly with multimorbidity and frailty does guarantee neither effective and efficient care, nor the satisfaction of patients and their families. At international level, for decades, organizational models for “intermediate care” have been developing, as solution to emerging problems (aging, chronic disease, multiborbidity and frailty), to avoide inappropriate hospital admission and to delay long-term care. Consistent with national documents, Emilia-Romagna Region has been redefining community services and the acute hospital network with the aim of ensuring continuity of care and integration between hospital and community services, especially for people with chronic diseases, developing intermediate care and activating bed-based intermediate care services (Community Hospitals). The research project aimed to define – through the identification and analysis of specific indicators – a structured method for monitoring health care provided to patients in Community Hospitals in terms of clinical, organizational and patient perspective. The organizational model has been examined comparing three Community Hospital of Emilia-Romagna Region. Indicators have been analyzed to describe patients discharged from the Community Hospital of Castel San Pietro Terme (Imola Local Health Authority). The structured analysis and the identification of emerging clusters of patients admitted in Community Hospital, could provide important input for the best planning of integrated care pathways for patients. The description of clinical pathway of patients admitted in Community Hospitals may help to better define organizational strategies for both acute and community care, both health and social assistance, to enhance responses to patients' needs

Burden of multimorbidity in relation to age, gender and immigrant status: A cross-sectional study based on administrative data

Objectives Many studies have investigated multimorbidity, whose prevalence varies according to settings and data sources. However, few studies on this topic have been conducted in Italy, a country with universal healthcare and one of the most aged populations in the world. The aim of this study was to estimate the prevalence of multimorbidity in a Northern Italian region, to investigate its distribution by age, gender and citizenship and to analyse the correlations of diseases. Design Cross-sectional study based on administrative data. Setting Emilia-Romagna, an Italian region with-1/44.4 million inhabitants, of which almost one-fourth are aged 6565 years. Participants All adults residing in Emilia-Romagna on 31 December 2012. Hospitalisations, drug prescriptions and contacts with community mental health services from 2003 to 2012 were traced to identify the presence of 17 physical and 9 mental health disorders. Primary and secondary outcome measures Descriptive analysis of differences in the prevalence of multimorbidity in relation to age, gender and citizenship. The correlations of diseases were analysed using exploratory factor analysis. Results The study population included 622 026 men and 751 011women, with a mean age of 66.4 years. Patients with multimorbidity were 33.5% in 75 years and >60% among patients aged 6590 years; among patients aged 6565 years, the proportion of multimorbidity was 39.9%. After standardisation by age and gender, multimorbidity was significantly more frequent among Italian citizens than among immigrants. Factor analysis identified 5 multimorbidity patterns: (1) psychiatric disorders, (2) cardiovascular, renal, pulmonary and cerebrovascular diseases, (3) neurological diseases, (4) liver diseases, AIDS/HIV and substance abuse and (5) tumours. Conclusions Multimorbidity was highly prevalent in Emilia-Romagna and strongly associated with age. This finding highlights the need for healthcare providers to adopt individualised care plans and ensure continuity of care

Continuity of care in children with special healthcare needs: a qualitative study of family’s perspectives

Background : To explore parents’ experiences and perceptions on informational, management and relational continuity of care for children with special health care needs from hospitalization to the first months after discharge to the home. Methods : Semi-structured interviews and a focus group were carried out to capture parents’ experiences and perceptions. Transcripts were analyzed using a directed approach to the qualitative content analysis. Results : 16 families participated to this study: 13 were involved in interviews (10 face-to-face and 3 by phone) and 3 in a focus group, within 1–6 months after discharge from the University Hospital of Bologna (S.Orsola/Malpighi) and from hospitals of Bologna Province. To parents of children with special health care needs, the three domains of continuity of care were relevant in a whole but with different key elements during hospitalization, at discharge and after discharge. Moreover, empowerment emerged from parents’ narratives as essential to help parents cope with the transition from the hospital setting to the new responsibilities connected with the home care of their child. Parent’s perceptions about the family pediatrician concerned his/her centrality in the activation and coordination of the healthcare network. Moreover, parents exhibited different attitudes towards involvement in decision making: some wished and expected to be involved, others preferred not to be involved. Conclusions : Care coordination for children with special care needs is a complex process that need to be attended to during the hospitalization phase and after discharge to the community. The findings of this study may contribute to elucidating the perceptions and experiences of parents with children with special health care needs about the continuity of care from hospital to community care

The Contribution of Case Mix, Skill Mix and Care Processes to the Outcomes of Community Hospitals: A Population-Based Observational Study

Introduction: Community hospitals (CHs) could address the emerging complex care needs of patients. We investigated which characteristics of patients' and CHs affect patient outcomes, in order to identify who could benefit the most from CH care and the best skill mix to deliver this care.Methods: We analysed all elderly patients discharged from the CHs of Emilia-Romagna, Italy. CH skill mix and care processes were collected with an ad hoc survey. The primary outcome was improvement in the Barthel index (BI) on discharge. Hierarchical regression analysis was performed to test the associations under study.Results: 53% of the patients had a BI improvement >= 10. After adjusting for the diverse case mix of the patients, no significant association was found between CH characteristics and BI improvement. Patient characteristics explained only a portion of the variability in CH performance.Discussion: Heterogeneity in case mix reflects the nature of CHs, which play context-specific roles as integrators between primary care services and hospitals. Residual variability in BI improvement rates across CHs might be attributed to aspects of care not detected in our survey.Conclusions: More research is needed to study the impact of CH skill mix and care processes on patient outcomes

Risk adjustment models for interhospital comparison of CS rates using Robson's ten group classification system and other socio-demographic and clinical variables

BACKGROUND: Caesarean section (CS) rate is a quality of health care indicator frequently used at national and international level . The aim of this study was to assess whether adjustment for Robson's Ten Group Classification System (TGCS), and clinical and socio-demographic of the mother and the fetus is necessary for inter-hospital comparisons of CS rates. METHODS: The study population includes 64,423 deliveries in Emilia-Romagna between January 1, 2003 and December 31, 2004, classified according to theTGCS. Poisson regression was used to estimate crude and adjusted hospital relative risks of CS compared to a reference category. Analyses were carried out in the overall population and separately according to the Robson groups (groups I, II, III, IV and V-X combined). Adjusted relative risks (RR) of CS were estimated using two risk-adjustment models; the first (M1) including the TGCS group as the only adjustment factor; the second (M2) including in addition demographic and clinical confounders identified using a stepwise selection procedure. Percentage variations between crude and adjusted RRs by hospital were calculated to evaluate the confounding effect of covariates. RESULTS: The percentage variations from crude to adjusted RR proved to be similar in M1 and M2 model. However, stratified analyses by Robson's classification groups showed that residual confounding for clinical and demographic variables was present in groups I (nulliparous, single, cephalic, [greater than or equal to]37 weeks, spontaneous labour) and III (multiparous, excluding previous CS, single, cephalic, [greater than or equal to]37 weeks, spontaneous labour) and IV (multiparous, excluding previous CS, single, cephalic, [greater than or equal to]37 weeks, induced or CS before labour) and to a minor extent in groups II (nulliparous, single, cephalic, [greater than or equal to]37 weeks, induced or CS before labour) and IV (multiparous, excluding previous CS, single, cephalic, [greater than or equal to]37 weeks, induced or CS before labour). CONCLUSIONS: The TGCS classification is useful for inter-hospital comparison of CS section rates, but residual confounding is present in the TGCS strata

Tiny events: tales of urban domesticity from Lingotto, a former working-class neighborhood in Turin

Article published by 12 authors, coordinated by Filippo De Pieri and Gaia Caramellino, as "The Housing History Collective

Dendritic cells infiltrate the cardiac muscle fibers during myocardial infarction

Myocardial infarction (MI) consists in myocardial cell death due to prolonged ischemia. Partial ischemia at the periphery at the necrotic area may lead to “hibernating” myocardium, which may eventually recover. Upon necrosis an inflammatory a process starts [1], leading to healing through formation of a fibrous scar. Dendritic cells (DC) are involved in the regulation of immune responses and in the organization of inflammatory cell infiltrates in vascular wall, even independent of immune reactions. Another cell type involved in acute reaction to tissue injury are mast cells. The behaviour of DC and mast cells in myocardial infarction is still to be studied. To address this issue myocardial samples were taken at autopsy from the left ventricle of subjects respectively affected by (1) coronarosclerosis, (2) acute MI, (3) previous MI, and (4) traumatic lesions assumed as controls. Cryosections were stained with haematoxilin heosin and by immunohistochemistry. Fiber alterations consisting in loss of acidophilia and disappearance of nuclei and intercalar disks were found only in acute MI, while a cell infiltrate was found both in acute and previous MI. Massive infiltration of DC was found only in acute MI, while mast cells were similar to controls. These preliminary results suggest that DC react early to myocardial injury and therefore may be candidate regulators of the inflammatory and scarring response in this tissue and markers of acute myocardial infarction

The Development of a European and Mediterranean Chickpea Association Panel (EMCAP)

Association panels represent a useful tool for quantitative trait loci (QTL) mapping and pre-breeding. In this study, we report on the development of a European and Mediterranean chickpea association panel as a useful tool for gene discovery and breeding. Chickpea (Cicer arietinum L.) is one of the most important food legumes worldwide and a key crop in the Mediterranean environments. The selection of genotypes followed criteria aimed to build a set of materials representative of the genetic diversity of chickpea germplasm focusing on the European and Mediterranean environments, which have largely been ignored to date. This tool can help breeders to develop novel varieties adapted to European and Mediterranean agro-ecosystems. Initially, 1931 chickpea accessions were phenotypically evaluated in a field trial in central Italy. From these, an association panel composed by 480 genotypes derived from single-seed descent was identified and phenotypically evaluated. Current and future phenotypic data combined with the genotypic characterization of the association panel will allow to dissect the genetic architecture of important adaptive and quality traits and accelerate breeding. This information can be used to predict phenotypes of unexploited chickpea genetic resources available in genebanks for breeding

Characteristics and outcome of anti-hepatitis D virus positive patients with hepatocellular carcinoma

Background & aims: Chronic hepatitis D virus (HDV) often leads to end-stage liver disease and hepatocellular carcinoma (HCC). Comprehensive data pertaining to large populations with HDV and HCC are missing, therefore we sought to assess the characteristics, management, and outcome of these patients, comparing them to patients with hepatitis B virus (HBV) infection. Methods: We analysed the Italian Liver Cancer database focusing on patients with positivity for HBV surface antigen and anti-HDV antibodies (HBV/HDV, n = 107) and patients with HBV infection alone (n = 588). Clinical and oncological characteristics, treatment, and survival were compared in the two groups. Results: Patients with HBV/HDV had worse liver function [Model for End-stage Liver Disease score: 11 vs. 9, p < .0001; Child-Turcotte-Pugh score: 7 vs. 5, p < .0001] than patients with HBV. HCC was more frequently diagnosed during surveillance (72.9% vs. 52.4%, p = .0002), and the oncological stage was more frequently Milan-in (67.3% vs. 52.7%, p = .005) in patients with HBV/HDV. Liver transplantation was more frequently performed in HBV/HDV than in HBV patients (36.4% vs. 9.5%), while the opposite was observed for resection (8.4% vs. 20.1%, p < .0001), and in a competing risk analysis, HBV/HDV patients had a higher probability of receiving transplantation, independently of liver function and oncological stage. A trend towards longer survival was observed in patients with HBV/HDV (50.4 vs. 44.4 months, p = .106). Conclusions: In patients with HBV/HDV, HCC is diagnosed more frequently during surveillance, resulting in a less advanced cancer stage in patients with more deranged liver function than HBV alone. Patients with HBV/HDV have a heightened benefit from liver transplantation, positively influencing survival