PROGETTO E-PROs: COSTRUZIONE DI UNA PIATTAFORMA DIGITALE PER LA GESTIONE DI STRUMENTI CENTRATI SUL PAZIENTE NELLA PRATICA CLINICA (The E-PROs Project: creation of a digital platform to manage patient-oriented tools in clinical practice).

The need to use PROs in both research and clinical practice is now widely shared. The PROs (Patient-Reported Outcomes) allow a complete and more reliable assessment of the health status of a patient through information provided by the patient himself and not detectable through clinical examinations. In clinical practice, PROs can play a central role in improving the management of chronic or disabling conditions. The application of PROs in clinical practice, however, seems to be complex, given the need to guarantee the patient adequate levels of comfort to correctly use the PROs tools (questionnaires). The E-PROs Project is a pilot study aiming to fill these gaps through the digital technology. A web platform was therefore created. By using common devices (smartphones, tablets, PC) in total privacy, patients were able to complete the "ISS-HIV-Symptoms-Scale", a PROs tool selected to test the website platform

Validation of a self-reported HIV symptoms list: the ISS-HIV symptoms scale.

Background: To describe the development and the psychometric properties of the Istituto Superiore di Sanità-HIV symptoms scale (lSS-HIV symptoms scale). Methods: The ISS-HIV symptom scale was developed by an Italian working team including researchers, physicians and people living with HIV. The development process went through the following steps: (1) review of HIV/AIDS literature; (2) focus group; (3) pre-test analysis; (4) scale validation. Results: The 22 symptoms of HIV-ISS symptoms scale were clustered in five factors: pain/general discomfort (7 items); depression/anxiety (4 items); emotional reaction/psychological distress (5 items); gastrointestinal discomfort (4 items); sexual discomfort (2 items). The internal consistence reliability was for all factors within the minimum accepted standard of 0.70. Conclusions: The results of this study provide a preliminary evidence of the reliability and validity of the ISS-HIV symptoms scale. In the new era where HIV infection has been transformed into a chronic diseases and patients are experiencing a complex range of symptoms, the ISS-HIV symptoms scale may represent an useful tool for a comprehensive symptom assessment with the advantage of being easy to fill out by patients and potentially attractive to physicians mainly because it is easy to understand and requires short time to interpret the results

Retention in Care of Adult HIV Patients Initiating Antiretroviral Therapy in Tigray, Ethiopia: A Prospective Observational Cohort Study

<div><p>Introduction</p><p>Although Ethiopia has been scaling up the antiretroviral therapy (ART) services, low retention in care of patients remains one of the main obstacles to treatment success. We report data on retention in care and its associated determinants in Tigray, Ethiopia.</p><p>Methods</p><p>We used data from the CASA project, a prospective observational and multi-site study of a cohort of HIV-infected patients who initiated ART for the first time in Tigray. Four participating health facilities (HFs) located in the South of Tigray were considered for this study. Patients were followed for one year after ART initiation. The main outcome measure was represented by the current retention in care, defined as the proportion of patients who were alive and receiving ART at the same HF one year after ART initiation. Patients who started ART between January 1, 2013 and December 31, 2013 were included in this analysis. Patients were followed for one year after ART initiation. The determinants of retention were analysed using univariate and multivariate Cox Proportional Hazards model with robust sandwich estimates to account for within HF correlation.</p><p>Results</p><p>The four participating HFs in Tigray were able to retain overall 85.1% of their patients after one year from starting ART. Loss to follow-up (5.5%) and transfers to other HF (6.6) were the main determinant of attrition. A multivariate analysis shows that the factors significantly associated with retention were the type of HF, gender and active TB. Alamata health center was the HF with the highest attrition rate (HR 2.99, 95% CI: 2.77–3.23). Active TB (HR 1.72, 95% CI: 1.23–2.41) and gender (HR 1.64, 95% CI: 1.10–2.56) were also significantly associated with attrition.</p><p>Conclusions</p><p>Although Ethiopia has significantly improved access to the ART program, achieving and maintaining a satisfactory long-term retention rate is a future goal. This is difficult because of different retention rates among HFs. Moreover specific interventions should be directed to people of different sex to improve retention in care in male population.</p></div

Treatment outcomes of HIV+ patients one year after ART initiation, year 2013/2014

<p>Treatment outcomes of HIV+ patients one year after ART initiation, year 2013/2014</p

Cox proportional hazards model of association between baseline characteristics and retention in care

<p>Cox proportional hazards model of association between baseline characteristics and retention in care</p

Baseline characteristics.

<p>Baseline characteristics.</p

Razionalizzazione periodica delle partecipazioni pubbliche

L’art. 20 del d.lgs. n. 175/2016 prevede un regime ordinario di ricognizione e riassetto delle partecipazioni societarie, direttamente o indirettamente detenute dalle amministrazioni pubbliche, che si sostanzia nell’obbligo in capo alle stesse di adottare, con cadenza annuale, una serie di atti vòlti alla razionalizzazione di tali partecipazioni. Il contributo si presenta quale commento sistematico all'articolo di legge e offre un'analisi degli incombenti che devono affrontare le amministrazioni nella redazione dei piani di riassetto, esaminando anche i rapporti con le norme previste nel 2014 in materia di spending review; si individuano, inoltre, le criticità sollevate dalla norma soprattutto in materia di sanzioni per la mancata redazione dei piani di riassetto o la mancata implementazione degli obiettivi di razionalizzazione posti