Predictors and trajectories of ED visits among patients receiving palliative home care services: Findings from a time series analysis (2013-2017)

Background: Current policies recommend integrating home care and palliative care to enable patients to remain at home and avoid unnecessary hospital admission and emergency department (ED) visits. The Italian health care system had implemented integrated palliative home care (IHPC) services to guarantee a comprehensive, coordinated approach across different actors and to reduce potentially avoidable ED visits. This study aimed to analyze the trajectories of ED visit rates among patients receiving IHPC in the Italian healthcare system, as well as the association between socio-demographic, health supply, and clinical factors. Methods: A pooled, cross-sectional, time series analysis was performed in a large Italian region in the period 2013-2017. Data were taken from two databases of the official Italian National Information System: Home Care Services and ED use. A clinical record is opened at the time a patient is enrolled in IHPC and closed after the last service is provided. Every such clinical record was considered as an IHPC event, and only ED visits that occurred during IHPC events were considered. Results: The 20,611 patients enrolled in IHPC during the study period contributed 23,085 IHPC events; ≥1 ED visit occurred during 6046 of these events. Neoplasms accounted for 89% of IHPC events and for 91% of ED visits. Although there were different variations in ED visit rates during the study period, a slight decline was observed for all diseases, and this decline accelerated over time (b = - 0.18, p = 0.796, 95% confidence interval [CI] = - 1.59;1.22, b-squared = - 1.25, p < 0.001, 95% CI = -1.63;-0.86). There were no significant predictors among the socio-demographic factors (sex, age, presence of a non-family caregiver, cohabitant family members, distance from ED), health supply factors (proponent of IHPC) and clinical factors (prevalent disorder at IHPC entry, clinical symptoms). Conclusion: Our results show that use of ED continues after enrollment in IHPC, but the trend of this use declines over time. As no significant predictive factors were identified, no specific interventions can be recommended on which the avoidable ED visits depend

Emergency-department accesses in home care paediatric patients: Occurrence and risks of use in a six-year retrospective investigation in Northern Italy

Objective To assess the determinants of ED use in paediatric patients enrolled in an Integrated Paediatric Home Care (IPHC) program. Methods A retrospective study was conducted using administrative databases on a cohort of patients enrolled in an IPHC program between January 1st, 2012, and December 31st, 2017, in Northern Italy. ED visits that occurred during the IPHC program were considered. Data were collected considering sociodemographic, clinical and organizational variables. A multivariable stepwise logistic regression analysis was performed. The dependent variable to identify possible associations was ED visit. Results A total of 463 ED visits occurred in 465 children, with an incidence rate of 1. The risk of ED visits significantly increased among children involved in the IPHC program after hospital discharge (OR 1.94). Additionally, the risk of ED visits increased significantly as the duration of IPHC increased (OR 5.80 between 101 and 200 days, to OR 7.84 between 201 and 300 days, OR 12.54 between 301 and 400 days and OR 18.67 to more than 400 days). Conclusion The overall results represent a practical perspective to contribute improving both the service quality of IPHC and reducing low acuity and improper ED use

Trends in adolescent overweight prevalence in Italy according to socioeconomic position

BACKGROUND: The aim of this research is to update the trend in overweight (including obesity) prevalence among Italian adolescents, evaluating possible differences by age and gender, and analyzing their relationships with socioeconomic status, between 2002 and 2014. METHODS: The present study is based on data from the Italian HBSC study at four time points (2002, 2006, 2010 and 2014), which involved 15 035 adolescents, aged 11-13-15 (7540 boys and 7495 girls). RESULTS: Gender and age were associated with the occurrence of overweight. In all surveys, boys had a higher prevalence of excess weight compared to girls (p < 0.001), but only among girls there was a significant increasing trend (from 11.2% in 2002 to 13.3% in 2014). From 2002 to 2014, the risk of being overweight was inversely associated with the economic level of the family, for both genders and all age groups. CONCLUSIONS: Data collected between 2002 and 2014 in Italy showed a low overall increase in prevalence of obesity and overweight and an inverse association between SES and obesity in all age groups and in both genders. These findings suggest that concerted, multi-sectorial, efforts are needed in Italy, in combination with a sound political will, focused on reducing social inequality associate

Frequency of human papillomavirus infection and genotype distribution among women with known cytological diagnosis in a Southern Italian region

Introduction. In the Puglia region (South Italy) about 200 new hospitalizations for cervical cancer are registered every year. The study investigated the frequency of Human Papillomavirus (HPV) infection and the genotype distribution of HPV in a sample of women with known cytology attending the outpatient clinics of four Gynecological Departments of the University of Bari over a four-year period (2005-2008). Methods. Cervical samples from 1,168 women were analyzed for the presence of HPV-DNA through Polymerase Chain Reaction (PCR) in L1 region and reverse hybridization. The cytological results were associated with HPV positivity and type-specific prevalence. Results. Overall, HPV infection was found in 355 (30.4%) women. HPV-DNA was found in 34.4% of women with a cytological diagnosis of ASCUS, in 46.8% of women with Low-grade Squamous Intraepithelial Lesion (LSIL) and in 87.0% of women with High-grade Squamous Intraepithelial Lesion (HSIL)/carcinoma. Also 16.0% of women with normal Pap smear were found to be HPV-DNA positive. The most common HPV genotype was type 16 found in 27.3% of positives, followed by type 53 (11.5%), type 66 (9.2%) and type 31 (9.0%). HPV genotype 18 was found in 6.4% of positives. Types 16 or 18 were detected in about 34% (120/355) of all infected women, in about 33% of LSIL and in 60% of HSIL/ carcinoma HPV-positive women. Among low risk (LR) genotypes, type 61 was found in 10.7% of HPV positive women, type 62 in 8.4%, type 42 in 8.1% and type CP6108 in 7.8%. Discussion and conclusions. The findings of the study give evidence that HPV infection is frequent in the studied cohort of women. The most widespread genotypes found were 16 and 53. These data may represent a benchmark for future evaluation after the recent introduction of vaccination against HPV in 12-year-old girls

Trends in adolescent overweight prevalence in Italy according to socioeconomic position

Background: The aim of this research is to update the trend in overweight (including obesity) prevalence among Italian adolescents, evaluating possible differences by age and gender, and analyzing their relationships with socioeconomic status, between 2002 and 2014. Methods: The present study is based on data from the Italian HBSC study at four time points (2002, 2006, 2010 and 2014), which involved 15035 adolescents, aged 11-13-15 (7540 boys and 7495 girls)Results: Gender and age were associated with the occurrence of overweight. In all surveys, boys had a higher prevalence of excess weight compared to girls (p<0.001), but only among girls there was a significant increasing trend (from 11.2% in 2002 to 13.3% in 2014). From 2002 to 2014, the risk of being overweight was inversely associated with the economic level of the family, for both genders and all age groups. Conclusions: Data collected between 2002 and 2014 in Italy showed a low overall increase in prevalence of obesity and overweight and an inverse association between SES and obesity in all age groups and in both genders. These findings suggest that concerted, multi-sectorial, efforts are needed in Italy, in combination with a sound political will, focused on reducing social inequality associate

Predicting needlestick and sharps injuries in nursing students: Development of the SNNIP scale

Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students

Risposte morfofisiologiche di espianti di Lilium 'Helvetia?a differenti livelli di salinità, durante la proliferazione ‘in vitro’

l’elevata concentrazione di sali nel terreno, dovuta anche a irrigazioni con acque salmastre, rappresenta per le coltivazioni causa di stress che può essere tollerato in modo diverso a seconda della specie. diversi sono i meccanismi coinvolti nelle risposte allo stress salino fra cui l’accumulo di soluti compatibili, come zuccheri e amminoacidi, in vari compartimenti cellulari (haSegawa et al., 2000; munnS, 2002; BaRtelS, SunkaR, 2005). in letteratura esistono numerosi dati relativi alla tolleranza allo stress salino soprattutto in piante di interesse agro-alimentare (RouSSoS et al., 2007). Pochi studi hanno affrontato specificatamente il problema per le piante ornamentali (foRneS et al., 2007) e in particolare per il genere Lilium, benchè la sua coltivazione abbia notevole interesse economico. in un precedente lavoro è stato messo a punto un protocollo di micropropagazione in vitro di piante di Lilium ‘helvetia’, varietà da fiore reciso molto apprezzata e commercializzata (d’aniello et al., 2006). in questo studio è stata saggiata la capacità rigenerativa di scaglie di bulbo di Lilium ‘helvetia’ su terreno addizionato di nacl, al fine di valutare le risposte di tale varietà allo stress salino e ottenere informazioni utili alla selezione di piante pre-condizionate a terreni irrigati con acque salmastre (fRanco et al., 2006). Scaglie provenienti da bulbilli coltivati su murashighe e Skoog (mS), sono state trasferite su mS addizionato di iaa 3,3 μm, Ba 2,2 μm e saccarosio al 3%, secondo il protocollo precedentemente messo a punto (d’aniello et al., 2006). lo stress salino è stato indotto aggiungendo al mezzo di coltura nacl 10, 30 e 60 mm. dopo 3 mesi, in camera di crescita a 24±2°c con fotoperiodo di 16 ore di luce d’intensità pari a 70 μm × m-2 × s-1, sono stati valutati parametri di crescita e morfologici relativi alla numerosità, peso e dimensioni dei bulbilli nati da ogni scaglia e parametri fisiologici come il contenuto in clorofilla, acido ascorbico, zuccheri solubili ed amido. la proliferazione degli espianti si è verificata in tutte le condizioni di salinità e in presenza di terreno con nacl 60 mm si sono formati numerosissimi bulbilli se pur di dimensioni ridotte. lo stato redox dell’ascorbico, come rapporto aa/aa+dha, mostra un incremento all’aumentare della salinità del terreno e ciò suggerisce un potenziamento dei sistemi antiossidanti che controllano le specie reattive dell’ossigeno prodotte in maggior quantità in conseguenza dello stress salino. il contenuto degli zuccheri solubili rimane invariato all’aumentare della salinità mentre l’amido, di cui i bulbilli - essendo strutture di riserva - sono particolarmente ricchi, diminuisce soprattutto in presenza di nacl 60 mm. tali dati suggeriscono che la varietà tollera elevate concentrazioni di sale e che il protocollo di micropropagazione risulta essere efficace anche alle massime concentrazioni di nacl, producendo bulbilli di minori dimensioni, ma in numero elevato. ulteriori studi saranno condotti per meglio caratterizzare i cambiamenti fisiologici e metabolici in risposta allo stress salino valutando, inoltre, la capacità di sviluppo di piantine ottenute dalle subcolture in terreni a differente salinità