Frequent use of emergency departments: an application to the paediatric context.

Frequent users of Emergency Departments (EDs) represent a particularly interesting category of users since they account to a small percentage of patients but they affect considerably accesses, overcrowding and the overall costs of ED activities. The literature on the topic is vast and it allows to delineate a profile of frequent users identifying socio-demographic (age, gender, nationality) and clinical (chronic diseases, drugs and alcohol abuse; psychic illnesses) risk factors. However, most of the studies on the topic limit the analysis to one-year period or to a single study site and there is no consensus on the definition of frequent use. Frequent users are generally defined as those patients reporting a number of accesses per year beyond a certain threshold. The selection of the threshold is often based on previous literature or on percentiles but the definitions vary considerably and the choice tends to be subjective. In this study, the focus will be placed on paediatric patients, with reference to which the contributions in the literature are still very limited. The objective is to identify the most important drivers of ED frequent use in the 19 EDs of Liguria region (Italy) during a three-year period (2013-2015). The dataset contains 287,242 accesses referred to 144,895 under 14 patients and it includes information on patients\u2019 characteristics and on their clinical pathway. To overcome the limitations connected to previous definitions of frequent use, we exploit the availability of data on three years; this allows to define, not only frequent use, but also its duration (i.e. One-shot / Multiple shot frequent use) and intensity (Normal, High, Very high). By the use of logit and multinomial logit regressions we identify a set of risk factors associated to frequent use and to the different forms of frequent use. Results show that even if frequent users represent a small share of patients (9%) they contribute to roughly 25% of accesses. Chronic conditions are the most relevant determinants of frequent use (particularly mental disorders, diseases of the respiratory system) but also foreign nationality turns out to be an important predictor. Differences emerge in the impact of regressors on the different forms of frequent use defined according to its duration and intensity. The study represents an important tool to support policy-making and to discriminate between the potentially preventable frequent use (i.e. inapFrequent users of Emergency Departments (EDs) represent a particularly interesting category of users since they account to a small percentage of patients but they affect considerably accesses, overcrowding and the overall costs of ED activities. The literature on the topic is vast and it allows to delineate a profile of frequent users identifying socio-demographic (age, gender, nationality) and clinical (chronic diseases, drugs and alcohol abuse; psychic illnesses) risk factors. However, most of the studies on the topic limit the analysis to one-year period or to a single study site and there is no consensus on the definition of frequent use. Frequent users are generally defined as those patients reporting a number of accesses per year beyond a certain threshold. The selection of the threshold is often based on previous literature or on percentiles but the definitions vary considerably and the choice tends to be subjective. In this study, the focus will be placed on paediatric patients, with reference to which the contributions in the literature are still very limited. The objective is to identify the most important drivers of ED frequent use in the 19 EDs of Liguria region (Italy) during a three-year period (2013-2015). The dataset contains 287,242 accesses referred to 144,895 under 14 patients and it includes information on patients\u2019 characteristics and on their clinical pathway. To overcome the limitations connected to previous definitions of frequent use, we exploit the availability of data on three years; this allows to define, not only frequent use, but also its duration (i.e. One-shot / Multiple shot frequent use) and intensity (Normal, High, Very high). By the use of logit and multinomial logit regressions we identify a set of risk factors associated to frequent use and to the different forms of frequent use. Results show that even if frequent users represent a small share of patients (9%) they contribute to roughly 25% of accesses. Chronic conditions are the most relevant determinants of frequent use (particularly mental disorders, diseases of the respiratory system) but also foreign nationality turns out to be an important predictor. Differences emerge in the impact of regressors on the different forms of frequent use defined according to its duration and intensity. 150 05 March 2018, IISES Annual Conference, Sevilla ISBN ISBN 978-80-87927-45-8, IISES The study represents an important tool to support policy-making and to discriminate between the potentially preventable frequent use (i.e. inapFrequent users of Emergency Departments (EDs) represent a particularly interesting category of users since they account to a small percentage of patients but they affect considerably accesses, overcrowding and the overall costs of ED activities. The literature on the topic is vast and it allows to delineate a profile of frequent users identifying socio-demographic (age, gender, nationality) and clinical (chronic diseases, drugs and alcohol abuse; psychic illnesses) risk factors. However, most of the studies on the topic limit the analysis to one-year period or to a single study site and there is no consensus on the definition of frequent use. Frequent users are generally defined as those patients reporting a number of accesses per year beyond a certain threshold. The selection of the threshold is often based on previous literature or on percentiles but the definitions vary considerably and the choice tends to be subjective. In this study, the focus will be placed on paediatric patients, with reference to which the contributions in the literature are still very limited. The objective is to identify the most important drivers of ED frequent use in the 19 EDs of Liguria region (Italy) during a three-year period (2013-2015). The dataset contains 287,242 accesses referred to 144,895 under 14 patients and it includes information on patients\u2019 characteristics and on their clinical pathway. To overcome the limitations connected to previous definitions of frequent use, we exploit the availability of data on three years; this allows to define, not only frequent use, but also its duration (i.e. One-shot / Multiple shot frequent use) and intensity (Normal, High, Very high). By the use of logit and multinomial logit regressions we identify a set of risk factors associated to frequent use and to the different forms of frequent use. Results show that even if frequent users represent a small share of patients (9%) they contribute to roughly 25% of accesses. Chronic conditions are the most relevant determinants of frequent use (particularly mental disorders, diseases of the respiratory system) but also foreign nationality turns out to be an important predictor. Differences emerge in the impact of regressors on the different forms of frequent use defined according to its duration and intensity. 150 05 March 2018, IISES Annual Conference, Sevilla ISBN ISBN 978-80-87927-45-8, IISES The study represents an important tool to support policy-making and to discriminate between the potentially preventable frequent use (i.e. inapappropriate use) and that associated to complex medical conditions, such as chronic conditions

Comparative analysis of medicinal plants used in traditional medicine in Italy and Tunisia

<p>Abstract</p> <p>Background</p> <p>Italy and Tunisia (Africa for the Romans), facing each other on the opposite sides of the Mediterranean Sea, have been historically linked since the ancient times. Over the centuries both countries were mutually dominated so the vestiges and traces of a mutual influence are still present. The aim of the present study is to conduct a comparative analysis of the medicinal species present in the respective Floras in order to explore potential analogies and differences in popular phytotherapy that have come out from those reciprocal exchanges having taken place over the centuries</p> <p>Methods</p> <p>The comparative analysis based on the respective floras of both countries takes into consideration the bulk of medicinal species mutually present in Italy and Tunisia, but it focuses on the species growing in areas which are similar in climate. The medicinal uses of these species are considered in accordance with the ethnobotanical literature.</p> <p>Results</p> <p>A list of 153 medicinal species belonging to 60 families, present in both floras and used in traditional medicine, was drawn. A considerable convergence in therapeutic uses of many species emerged from these data.</p> <p>Conclusion</p> <p>This comparative analysis strengthens the firm belief that ethno-botanical findings represent not only an important shared heritage, developed over the centuries, but also a considerable mass of data that should be exploited in order to provide new and useful knowledge.</p

Ethnobotanical remarks on Central and Southern Italy

<p>Abstract</p> <p>Background</p> <p>The present paper is a brief survey on the ethnobotanical works published by the Authors since 1981, concerning the research carried out in some southern and central Italian regions. Before Roman domination these territories were first inhabited by local people, while the southern areas were colonized by the Greeks. These different cultural contributions left certain traces, both in the toponyms and in the vernacular names of the plants and, more generally, in the culture as a whole.</p> <p>Methods</p> <p>Field data were collected through open interviews, mainly of farmers, shepherds and elderly people, born or living in these areas for a long time. Voucher specimens of collected plants are preserved in the respective herbaria of the Authors and in the herbarium of "Roma Tre" University. Important contributions have been made by several students native to the areas under consideration. A comparative analysis with local specific ethnobotanical literature was carried out.</p> <p>Results</p> <p>The paper reports several examples concerning human and veterinary popular medicine and in addition some anti-parasitic, nutraceutic, dye and miscellaneous uses are also described. Moreover vernacular names and toponyms are cited. Eight regions of central and southern Italy (particularly Latium, Abruzzo, Marche and Basilicata) were investigated and the data obtained are presented in 32 papers. Most of the species of ethnobotanical interest have been listed in Latium (368 species), Marche (274) and Abruzzo (203). The paper also highlights particularly interesting aspects or uses not previously described in the specific ethnobotanical literature.</p> <p>Conclusion</p> <p>Phyto-therapy in central and southern Italy is nowadays practised by a few elderly people who resort to medicinal plants only for mild complaints (on the contrary food uses are still commonly practised). Nowadays therapeutic uses, unlike in the past, are less closely or not at all linked to ritual aspects. Several plants deserve to be taken into consideration not only from the anthropological or cultural point of view, but also for further phyto-chemical investigation. Our studies, as well as those of other authors, try to provide an original picture of the local ethno-biodiversity.</p

Notulae to the Italian alien vascular flora: 2

In this contribution, new data concerning the Italian distribution of alien vascular flora are presented. It includes new records, exclusions and confirmations for Italy or for Italian administrative regions for taxa in the genera Ageratum, Aster, Buddleja, Cedrus, Centranthus, Cephalotaxus, Clerodendrum, Cotoneaster, Cyperus, Honorius, Lantana, Ligustrum, Morus, Muscari, Oenothera, Opuntia, Platycladus, Plumbago, Pseudotsuga, Sedum, Sporobolus, Stachys, Ulmus and Yucca. A nomen novum, Stachys talbotii, is proposed as a replacement name for Sideritis purpurea

Notulae to the Italian alien vascular flora: 2

In this contribution, new data concerning the Italian distribution of alien vascular flora are presented. It includes new records, exclusions and confirmations for Italy or for Italian administrative regions for taxa in the genera Ageratum, Aster, Buddleja, Cedrus, Centranthus, Cephalotaxus, Clerodendrum, Cotoneaster, Cyperus, Honorius, Lantana, Ligustrum, Morus, Muscari, Oenothera, Opuntia, Platycladus, Plumbago, Pseudotsuga, Sedum, Sporobolus, Stachys, Ulmus and Yucca. A nomen novum, Stachys talbotii, is proposed as a replacement name for Sideritis purpurea

Traditional knowledge of wild edible plants used in the northwest of the Iberian Peninsula (Spain and Portugal): a comparative study

<p>Abstract</p> <p>Background</p> <p>We compare traditional knowledge and use of wild edible plants in six rural regions of the northwest of the Iberian Peninsula as follows: Campoo, Picos de Europa, Piloña, Sanabria and Caurel in Spain and Parque Natural de Montesinho in Portugal.</p> <p>Methods</p> <p>Data on the use of 97 species were collected through informed consent semi-structured interviews with local informants. A semi-quantitative approach was used to document the relative importance of each species and to indicate differences in selection criteria for consuming wild food species in the regions studied.</p> <p>Results and discussion</p> <p>The most significant species include many wild berries and nuts (e.g. <it>Castanea sativa, Rubus ulmifolius, Fragaria vesca</it>) and the most popular species in each food-category (e.g. fruits or herbs used to prepare liqueurs such as <it>Prunus spinosa</it>, vegetables such as <it>Rumex acetosa</it>, condiments such as <it>Origanum vulgare</it>, or plants used to prepare herbal teas such as <it>Chamaemelum nobile</it>). The most important species in the study area as a whole are consumed at five or all six of the survey sites.</p> <p>Conclusion</p> <p>Social, economic and cultural factors, such as poor communications, fads and direct contact with nature in everyday life should be taken into account in determining why some wild foods and traditional vegetables have been consumed, but others not. They may be even more important than biological factors such as richness and abundance of wild edible flora. Although most are no longer consumed, demand is growing for those regarded as local specialties that reflect regional identity.</p

Wild food plants of popular use in Sicily

In the present work the authors report the result of their food ethnobotanical researches, which have been carried out in Sicily during the last thirty years. Data concerning 188 wild species used in the traditional Sicilian cuisine are reported. The authors underline those species that are partially or completely unknown for their culinary use and they illustrate other species that local inhabitants suggested in the prevention or treatment of symptomatologies caused by a refined diet, poor in vegetables. These data want to contribute to avoid the loss of traditional knowledge on uses and recipes concerning wild food botanicals, and to encourage further studies for those species that have not yet been sufficiently researched in their food chemical and nutritional profile. These studies may also suggest new applications for a few botanicals in medico-nutritional fields. The work includes also a short review of the seaweeds and mushrooms traditionally gathered and consumed in Sicily

Beyond price: the effects of non-financial barriers on access to drugs and health outcomes

Objectives: We study the impact of the pharmacy dispensing channel (as a proxy for access to drugs) on the drug purchases, health outcomes, and health care utilization (emergency room visits or hospitalizations) of chronically ill patients in Liguria, Italy, in 2017. Methods: We use the coarsened exact matching algorithm to compare the health outcomes for a treated group of patients living in a local health authority (LHA) where drug distribution through community pharmacies was restricted. These patients were matched to a control group of patients living in other LHAs, where drugs were also dispensed through a broad network of community pharmacies. We exploit a unique administrative dataset with information on the socio-demographic characteristics and health care services utilization of Ligurian patients with chronic cardiovascular and respiratory ailments. We restrict our analysis to patients 65&nbsp;years of age or older who were admitted to hospitals from 2013 to 2016 with either a principal or secondary diagnosis connected to chronic cardiovascular and respiratory diseases. Results: Reduced access to drugs leads to lowered drug consumption, a higher probability of adverse health outcomes including mortality, and a higher consumption of medical services in terms of hospitalizations and emergency room visits. These effects increase with patients' age. Conclusion: The pharmacy dispensing channel significantly affects drug consumption and acts as a proxy for adherence among chronically ill patients. Thus, health outcomes and health care utilization should be carefully evaluated when comparing the costs of alternative dispensing channels