Igiene e sanita pubblica

Publisher: Associazione dei medici provinciali italiani

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Website Igiene e Sanita Pubblica website
Other titles Igiene e sanitá pubblica
ISSN 0019-1639
OCLC 3048186
Material type Periodical
Document type Journal / Magazine / Newspaper

Publications in this journal

  • Igiene e sanita pubblica 01/2016;
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    ABSTRACT: Introduction: Medical malpractice and litigation have a significant impact on the Italian National Health Service. The aim of this study was to analyze the state of the art of medical errors in Italy, in particular, assessing which specialties are most affected. Methods: We performed a literature search in PubMed, Google Scholar; institutional websites (Ministry of Health, Higher Institute of Health, National Agency for Regional Health Services, National Institute of Statistics, National Research Council, Court of Auditors), gray literature and specialized magazines. Results: Results show that data regarding the frequency of medical errors and the effectiveness of prevention measures in Italy are scarce. Most papers published on this topic refer to a few specialties, including Surgery, Radiology, Cardiology, and Laboratory medicine. Surgery is the specialty most affected. Conclusions: Despite a growing attention towards patient safety and quality of healthcare, medical errors continue to occur in clinical practice. Most errors are not due to individual incompetence or negligence but they are rooted in system breakdowns. A systematic approach is therefore required, based on: an analysis of critical aspects in the system; the selection and implementation, at different levels of the system, of appropriate and evidence-based risk management interventions involving all stakeholders; a context analysis to identify barriers and facilitators for change; a performance assessment to verify results and identify actions for improvement.
    Igiene e sanita pubblica 10/2015; 71(4):405-417.
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    ABSTRACT: Only 40% of women in the territory of the Local Health Unit RMA (Rome, Italy) adhere to the local breast cancer screening programme. A questionnaire was administered to participating women, to assess their level of satisfaction with the programme. A descriptive analysis, logistic regression and reliability analysis using the Cronbach's alpha as a measure of internal consistency, were performed. Most women who adhere to mammography screening are employers, retired, and with a low education. Factors that affect adherence include receiving a letter of invitation, intent to participate, age, and low education. The questionnaire is reliable for evaluating reasons affecting participation.
    Igiene e sanita pubblica 10/2015; 71(4):433-446.
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    ABSTRACT: The "Framework for the Ethical Conduct of Public Health Initiatives", developed by Public Health Ontario, is a practical guide for assessing the ethical implications of evidence-generating public health initiatives, whether research or non-research activities, involving people, their biological materials or their personal information. The Framework is useful not only to those responsible for determining the ethical acceptability of an initiative, but also to investigators planning new public health initiatives. It is informed by a theoretical approach that draws on widely shared bioethical principles. Two considerations emerge from both the theoretical framework and its practical application: the line between practice and research is often blurred; public health ethics and biomedical research ethics are based on the same common heritage of values.
    Igiene e sanita pubblica 08/2015; 71(3):327-34.
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    ABSTRACT: Healthcare-associated infections (HAI) are the most frequent and severe complication acquired in healthcare settings and have a significant impact in terms of morbidity, mortality and costs. This document is aimed at different health professionals and focuses on the role of molecular epidemiology in the prevention and management of these infections. It describes the role of molecular characterization and of bioinformatics archives, the organizational levels of laboratories, the evidence regarding cost-effectiveness, ethical aspects related to HAI, and highlights some specific peculiarities of Italy. Molecular epidemiology is an indispensable tool and should be part of a multidisciplinary approach in the proper management of HAI.
    Igiene e sanita pubblica 08/2015; 71(3):241-325.
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    ABSTRACT: Varicella is an infectious disease still frequent in Italy, where 8 out 20 Regions have adopted universal vaccination programs starting from 2003. Accordingly to National Vaccination Plan, all Regions should introduce universal varicella vaccination in 2015. An independent multidisciplinary group of experts met to discuss some debated questions. The available evidence of varicella vaccine efficacy in the 8 Regions was evaluated and the evidence of safety of monovalent and combined varicella vaccines are presented. The strategy for introducing universal varicella vaccine in the pediatric immunization schedule is discussed. The expert group concludes that available evidence supports the active offer of varicella vaccine in all Italian Regions and that catch up programs for susceptible cohorts should be encouraged.
    Igiene e sanita pubblica 05/2015; 71(1):115-27.
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    ABSTRACT: The need to integrate clinical and public health training of medical students is increasingly important. Future physicians need to be able to deal with new, complex and growing public health challenges. A literature search was performed through Pubmed to identify the conceptual reference framework. Meetings were carried out to identify the most appropriate modalities and priorities required for drafting the project, to identify the skills to be acquired by students, to decide on teaching formats and methods to assess student learning, to draw up the teaching schedule, to define the statistical methods to be used to assess student satisfaction, and to perform the statistical analysis of results. Training in hospital hygiene and environmental safety was carried out through presentation of a relevant case. After being divided into groups the students attended the three units (Environmental Microbiology, Environmental Xenobiotics, Genetic Epidemiology and Molecular Biology) of the Hygiene Section of a Public Health Institute. Training in Organization and Health Programming involved presentation of a set of indicators for the definition of objectives and assessment of health systems or services. The literature search led to the identification of the relevant literature. With regard to student satisfaction, 96% of those who replied to the questionnaire gave an overall positive review of the training course (at least 3 on a scale from 1 to 5). the overall high level of student satisfaction suggests that the proposed model may be exportable. Further developments will be the assessment of trends regarding functioning of the organizational model and perceived teaching quality.
    Igiene e sanita pubblica 05/2015; 71(1):9-20.
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    ABSTRACT: Preventing healthcare-associated infections requires a number of actions, including adequate disinfection and sterilization of medical devices. A cost analysis of hospital sterilization processes is fundamental to increase quality and safety, reduce costs and to make a decision about outsourcing. The aim of this analysis was to determine the cost of sterilization and the average cost of surgical procedures at the Rizzoli hospital in Bologna (Italy), a largesurgical hospital that performs more than 11,000 surgical procedures per year.
    Igiene e sanita pubblica 05/2015; 71(1):73-82.
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    ABSTRACT: Chronic wounds cause morbidity due to local infections, sepsis, osteomyelitis, but also increase mortality in the most severe cases and in patients with multiple comorbidities. Their increasing prevalence, associated disabilities and relevant health costs make chronic wounds a real social disease. At a time in which we hear more and more about spending reviews and reduction of health care costs, the natural evolution of Medicine and Health Care is increasingly directed towards the achievement of high quality standards while at the same time, reducing costs. It is in this framework that a hub and spoke model was used for organizing Plastic Surgery services in Ancona (Italy). In order to ensure appropriate clinical and organizational management of services, the activities of reference centres need to be widely integrated, by functional interconnections with activities of peripheral hospitals and local centres. Through a careful analysis of the Regional Reference Center for non - healing wounds in Ancona, the authors make some considerations regarding appropriate diagnostic-therapeutic-healthcare pathways and the correct use of human, material and technological resources in the area of wound healing.
    Igiene e sanita pubblica 05/2015; 71(1):51-72.
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    ABSTRACT: The magnitude of the present Ebola epidemic and the resonance in the media has led to the need to draw clear guidelines for the health personnel potentially involved, since the fears raised by the high lethality of the disease may create inefficiencies Here we present the guidelines for a medium-sized hospital, where, at present, the chance to confront a case of Ebola virus disease is rare, but not impossible. The role and activities of each professional involved and the procedures have been set out. We think that this exercise will be useful for all structureswith characteristics similar to ours.
    Igiene e sanita pubblica 05/2015; 71(1):89-113.
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    ABSTRACT: In the poor zones of sub-Saharan Africa, the conventional drinking water network is very weak. The populations use alternative groundwater sources which are wells and springs. However, because of urbanization, the groundwater sources are degrading gradually making pure, safe, healthy and odourless drinking water a matter of deep concern. There are many pollutants in groundwater due to seepage of organic and inorganic pollutants, heavy metals as well as microbiological contamination. This study was carried out in October 2012 and aimed to analyze the practices and behaviors of populations related to water supply that may constitute potential risks of microbiological contamination and emergence of waterborne diseases. This study was carried out on a sample of 285 households, distributed in twelve principal quarters of the Douala V municipality in Cameroon. After data collection through the questionnaires, the selection of vulnerable quarters was done by the tabulation of some specific results on the questionnaire. The microbiological analysis was carried out using an innovative rapid test called "Micro Biological Survey (MBS)" that has been developed and patented by MBS srl, a recent spin-off of the University of Roma Tre. We found out that 42.30% of households used water from drilled wells (forages), 33.80% from Cameroon National Water Company (CDE) distribution network, 9.50% from spring, and 9.40% used other source of water such as buying industrial mineral water. However, it should be noted that, as dangerous as it may be, wells ("puits" in French) water is used as permanent source of drinking water by 5% of households. In general, 63.2% of households affirmed not to have benefited the fitting of public water point. Moreover, among the quarters were the households affirmed to have benefited from the development of a public water point, 52.5% of these water point were no longer functional. From the obtained data we have assessed that 83% of wells analyzed are faecally contaminated and all the forages analyzed (100%) are not contaminated. The most affected people by water-related diseases are children under 5 years (43%). We highly recommend the City Council of Douala V to restrict the use of the contaminated wells and provide alternative water sources such as forages for public use and to ensure that microbiological quality of the new and already existing water sources is controlled regularly by the Technical Service.
    Igiene e sanita pubblica 05/2015; 71(1):21-37.
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    ABSTRACT: A program concerning the care management of chronic conditions has been carried out in the primary care setting, starting from previous projects based on delivering integrated care and on promoting patient empowerment. The chronicity practice, which is based on common facilities and time of work, is aimed to improve communication about individual care plan of patients, to improve adherence to the treatment and to the follow-up. The expected outcome are: the increasing adherence to healthy lifestyle and doctor's recommendations, improved clinical outcome, satisfaction of patients and health professionals.
    Igiene e sanita pubblica 03/2015; 71(2):195-204.
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    ABSTRACT: In the actual economic context, with increasing health needs, efficiency and efficacy represents fundamental keyword to ensure a successful use of the resources and the best health outcomes. Together, the medical record, completely and correctly compiled, is an essential tool in the patient diagnostic and therapeutic path, but it's becoming more and more essential for the administrative reporting and legal claims. Nevertheless, even if the improvement of medical records quality and of hospital stay appropriateness represent priorities for every health organization, they could be difficult to realize. This study aims to present the methodology and the preliminary results of a training and improvement process: it was carried out from the Hospital Management of a third level Italian teaching hospital through audit cycles to actively involve their health professionals. A self assessment process of medical records quality and hospital stay appropriateness (inpatients admission and Day Hospital) was conducted through a retrospective evaluation of medical records. It started in 2012 and a random sample of 2295 medical records was examined: the quality assessment was performed using a 48-item evaluation grid modified from the Lombardy Region manual of the medical record, while the appropriateness of each days was assessed using the Italian version of Appropriateness Evaluation Protocol (AEP) - 2002ed. The overall assessment was presented through departmental audit: the audit were designed according to the indication given by the Italian and English Ministry of Health to share the methodology and the results with all the involved professionals (doctors and nurses) and to implement improvement strategies that are synthesized in this paper. Results from quality and appropriateness assessment show several deficiencies, due to 40% of minimum level of acceptability not completely satisfied and to 30% of inappropriateness between days of hospitalization. Furthermore, there are great discrepancies among departments and among Care Units: the higher problems are centered in DHs, which are generally lacking on both profiles. Finally, our audit model, that could be considered a good project according the NHS (score of 20/25), has allowed to involve in 34 editions 480 professionals of different care Unit which are satisfied and stimulated to keep going in continuous improvement of the quality and appropriateness with these arrangements. The tools used in the project have proven their value for measuring the minimum quality of healthcare documentation and organizational appropriateness: furthermore, the audit has been shown as an effective methodology for their introduction because it ensures their acceptability among the staff and creates the basis for a rapid and quantifiable improvement that, through the promotion of accountability and transparency, could support the risk management activities and ensure greater efficiency in hospitalization.
    Igiene e sanita pubblica 03/2015; 71(2):139-156.
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    ABSTRACT: the International economic crisis has challenged the sustainability of health care systems imposing reforms aimed to reduce costs and increase production efficiency. At the international level, waste reduction is considered to be the basis to ensure the heath care systems sustainability. To reduce waste and increase production efficiency is required to document the types, the extent and the level were they occur. The purpose of this paper is to document the experience of waste in nurses clinical practice. a descriptive phenomenological study was conducted. Clinical nursing operating in different care settings of the National Heath Care Service were recruited adopting a maximum variation purposeful sampling. Data saturation was considered as the finish line for the participants recruitment. thirty nurses participated in the study. They were mainly female (n = 28, 93.3%) and with an average age of 41.4 ± 7.3 years. For nurses waste means inadequate allocation of resources. Wastes are caused by individual and organizational choices determining improper, inefficient or ineffective use of material, human or virtual heath care resources and time as well as the incorrect application of clinical pathways, the inadequate use of electricity, food, and the improper disposal of the hospital waste. Wastes generates negative emotional impact on nurses such as frustration, anger and sense of impotence. Avoidable wastes were identified. They were mainly related to the expiration date, the use and the type of drugs and materials. Also unavoidable wastes were identified and they were related to established practices to ensure patients safety and changes in treatment choices due to the clinical instability of the patients. within the limits of the qualitative approach, in this study have been identified different types of waste present in clinical practice as perceived by nurses. National Health Service policies could focus on this evidences to improve production efficiency. To involve health care professionals in the choices and their awareness to the conscious and responsible use of public resources available, would avoid linear cuts and enhancing such operators.
    Igiene e sanita pubblica 03/2015; 71(2):205-224.
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    ABSTRACT: This study included 304 women, 128 Screen Detected (SD) e 176 non Screen Detected (NSD), aged 50-69, living in the ex-local health authorities (LHAs) 13 and 14, hospitalized for breast cancer or related chemotherapy or radiation treatments in 2003-2004. Some variables were detected from medical records in order to evaluate the local screening program. The results confirm that a prevention activity allows a rapid identification of cancer and less invasive surgery procedures.
    Igiene e sanita pubblica 03/2015; 71(2):179-194.