Interactive management control via analytic hierarchy process (AHP). An empirical study in a public university hospital.

Management control in public university hospitals is a challenging task because of continuous changes due to external pressures (e.g. economic pressures, stakeholder focuses and scientific progress) and internal complexities (top management turnover, shared leadership, technological evolution, and researcher oriented mission). Interactive budgeting contributed to improving vertical and horizontal communication between hospital and stakeholders and between different organizational levels. This paper describes an application of Analytic Hierarchy Process (AHP) to enhance interactive budgeting in one of the biggest public university hospital in Italy. AHP improved budget allocation facilitating elicitation and formalization of units’ needs. Furthermore, AHP facilitated vertical communication among manager and stakeholders, as it allowed multilevel hierarchical representation of hospital needs, and horizontal communication among staff of the same hospital, as it allowed units’ need prioritization and standardization, with a scientific multi-criteria approach, without using complex mathematics. Finally, AHP allowed traceability of a complex decision making processes (as budget allocation), this aspect being of paramount importance in public sectors, where managers are called to respond to many different stakeholders about their choices

Persistently high IgA serum levels are a marker of immunological or virological failure of combined antiretroviral therapy in children with perinatal HIV-1 infection

Non-expensive and low-complexity surrogate markers for monitoring the response to combined antiretroviral therapy (combined-ART) are needed in poor-resource settings where routine assessment of CD4+ T-lymphocyte count and viral load can not be afforded. We longitudinally evaluated Ig serum levels in 234 HIV-1 infected children receiving combined-ART with ≥ 3 drugs. Since Ig levels physiologically vary with age, differences at different age periods were evaluated as differences in z-scores calculated using the mean and standard deviation of the normal population for each age period. Data from 17 (7·3%) children with immunological failure and from 54 (23·1%) children with virological failure of combined-ART were compared with data from not-failed children. At baseline children with immunological failure showed higher IgM z-scores (P = 0·042) than children without. After 3–12 months of therapy immunologically failed children displayed higher viral loads (P < 0·0001) and IgA (P = 0·043) z-scores than not-failed children. Similarly, at the same follow-up time, children with virological failure showed lower CD4+ T-lymphocyte percentages (P = 0·005) and higher IgA z-scores (P < 0·0001) than not-failed children. No difference in IgG or IgM z-scores was evidenced between failed and not-failed children after 3–12 months of therapy. In conclusion, IgA serum level is a cheap and low-complexity marker of immunological or virological failure of combined-ART which might be adopted in poor-resource settings

Lower mother-to-child HIV-1 transmission in boys is independent of type of delivery and antiretroviral prophylaxis. The Italian register for HIV intection in children.

The relationship between infant's gender and rate of HIV-1 mother-to-child transmission (MTCT) was evaluated in a prospective cohort of 4151 children (2166 boys and 1985 girls) born to HIV-1-infected mothers enrolled in the Italian Register for HIV Infection in Children. Logistic regression models were performed to estimate crude odds ratios (ORs) and adjusted odds ratios (AORs) and 95% CIs for factors potentially influencing MTCT separately for the period 1985-1995 and the period 1996-2001. To evaluate rates of MTCT by gender in specific subgroups, separate logistic regression models by mode of delivery and antiretroviral prophylaxis were performed. Among children born in 1985-1995, 15.5% boys (95% CI: 13.6-17.7) and 17.9% girls (95% CI: 15.7-20.3) were infected (P = 0.1181). After 1995, a lower proportion of boys (3.1% [95% CI: 2.0-4.4]; AOR: 0.43 [95% CI: 0.26-0.71], P = 0.0008) than girls (AOR: 6.3%, 95% CI: 4.8-8.1) was infected. Lower AORs for boys persisted independently of elective cesarean delivery (AOR: 0.31, 95% CI: 0.14-0.71); other than elective cesarean (AOR: 0.38, 95% CI: 0.19-0.78) and antiretroviral prophylaxis (zidovudine monotherapy (AOR: 0.11, 95% CI: 0.03-0.38); none (AOR: 0.43, 95% CI: 0.21-0.90). No difference was observed when combined therapy in the mother was administered (AOR: 1.14, 95% CI: 0.30-4.32), but results were likely to be biased by the very low rate of infected children in this group. A lower proportion of HIV-1-infected boys in children born after 1995 was found. Factor(s) intrinsic to gender (rather than type of delivery or maternal antiretroviral prophylaxis) may be involved, because the risk of infection in boys was lower independent of interventions. A possible explanation is that, among infected fetuses, more girls survive up to the end of pregnancy and may take advantage of the benefits of preventive strategies

Early triple therapy vs mono or dual therapy for children with perinatal HIV infection.

none91The time at which antiretroviral therapy (ART) should be initiated in children with perinatal human immunodeficiency virus (HIV) infection remains controversial. In a cohort study, Berk et al1 reported clinical benefit from mono/dual ART started before 60 days of life in 10 children compared with treatment administered at 61 to 120 days of life in 16 children. The 23 children who received early triple ART were not investigated because none of them progressed to category C diagnosis by 3 years of age. We performed a similar analysis in a cohort study of a larger data set of children with a longer follow-up to evaluate the outcomes of early and very early triple ART.noneChiappini E; Galli L; Gabiano C; Tovo PA; de Martino M; P.Osimani; R. Cordiali; D. De Mattia; M. Manzionna; C. Di Bari; M. Ruggeri; M.Masi; A. Miniaci; F. Specchia; M. Ciccia; M. Lanari; F. Baldi; L. Battisti; C. Fiorino; C.Dessı`; C. Pintor; M. Dedoni; M.L. Fenu; R. Cavallini; E. Anastasio; F. Merolla; M. Sticca; G. Pomero; T. Bezzi; E. Fiumana; F. Bonsignori; P. Gervaso; E. Seini; M.T. Cecchi; D. Cosso; A. Timitilli; M.Stronati; A. Plebani; R. Pinzani; I. Bongianin; A.Vigano`; V. Giacomet; P. Erba; F. Salvini; G.V. Zuccotti; M. Giovannini; G. Ferraris; R. Lipreri; C. Moretti; M. Cellini; M.C. Cano; P. Paolucci; E. Bruzzese; G. De Marco; L. Tarallo; F. Tancredi; M. Pennazzato;O. Rampon; E.R. Dalle Nogare; A. Sanfilippo; A.Romano; M. Saitta; I. Dodi; A. Barone; A. Maccabruni; R. Consolini; A. Legitimo; C. Magnani; P. Falconieri; C. Fundaro`; O.Genovese; A. Panzanella; A.M. Casadei; A. Martino;C. Concato; G. Anzidei; G. Bove; S. Cerilli; S. Catania;C. Ajassa; A. Ganau; L. Cristiano; A. Mazza; A. Di Palma; F. Mignone; C. Riva; C. Scorfaro; V. Portelli; M. Rabusin; A. Pellegatta; M. MolesiniChiappini, E; Galli, L; Gabiano, C; Tovo, Pa; de Martino, M; P., Osimani; R., Cordiali; D., De Mattia; M., Manzionna; C., Di Bari; M., Ruggeri; M., Masi; A., Miniaci; F., Specchia; M., Ciccia; M., Lanari; F., Baldi; L., Battisti; C., Fiorino; C., Dessı`; C., Pintor; M., Dedoni; M. L., Fenu; R., Cavallini; E., Anastasio; F., Merolla; M., Sticca; G., Pomero; Bezzi, Teresa Maria; Fiumana, Elisa; F., Bonsignori; P., Gervaso; E., Seini; M. T., Cecchi; D., Cosso; A., Timitilli; M., Stronati; A., Plebani; R., Pinzani; I., Bongianin; A., Vigano`; V., Giacomet; P., Erba; F., Salvini; G. V., Zuccotti; M., Giovannini; G., Ferraris; R., Lipreri; C., Moretti; M., Cellini; M. C., Cano; P., Paolucci; E., Bruzzese; G., De Marco; L., Tarallo; F., Tancredi; M., Pennazzato; O., Rampon; E. R., Dalle Nogare; A., Sanfilippo; A., Romano; M., Saitta; I., Dodi; A., Barone; A., Maccabruni; R., Consolini; A., Legitimo; C., Magnani; P., Falconieri; C., Fundaro`; O., Genovese; A., Panzanella; A. M., Casadei; A., Martino; C., Concato; G., Anzidei; G., Bove; S., Cerilli; S., Catania; C., Ajassa; A., Ganau; L., Cristiano; A., Mazza; A., Di Palma; F., Mignone; C., Riva; C., Scorfaro; V., Portelli; M., Rabusin; A., Pellegatta; M., Molesin