-
[show abstract]
[hide abstract]
ABSTRACT: To try to understand the causative role of epilepsy PER SE in the developmental deterioration of brain injured infants, twenty-eight infants affected with early acquired, pre- and perinatal brain injuries were enrolled and divided into three groups, a) those with West syndrome, b) those with other non-West epilepsies, and c) those without epilepsy. Developmental monitoring consisted of a full clinical assessment, including examination of visual function, Griffiths developmental scales, standard EEG, long-term monitoring when necessary, and MRI, from the seizure onset or the first observation to the end of follow-up. Patients with epilepsy showed at study onset abnormal clinical features (neurological and developmental) distinct from those of non-epileptic patients, partially due to the varying severity of their brain injuries. A definite differentiation between groups was observed in the clinical evolution that showed among the epileptic patients, mostly in West syndrome, a significant deterioration. Moreover, impaired visual function at seizure onset was possibly associated with a bad developmental evolution. A developmental deterioration, mostly in West syndrome, accounts for a causative role of the epileptic disorder PER SE, but in few cases it was also observed in infants with only a brain injury, suggesting other aetiopathogenic mechanisms. The predictive value of early visual function seems to be confirmed.
Neuropediatrics 10/2009; 40(5):218-23. · 0.94 Impact Factor
-
G La Torre,
M De Giusti,
A Mannocci, C De Waure,
A Agostinelli,
S Schena,
G Capelli,
W Ricciardi,
A Boccia,
G Damiani,
M von Pinoci,
C Fanton,
B Federico
[show abstract]
[hide abstract]
ABSTRACT: Disability Management can be defined as a practice to improve workers' health and to reduce the impact and costs of disability. The aim of the study was to estimate the diffusion of DM in Italian companies.
A survey was conducted using a questionnaire, the Worksite Disability Management Audit. The questionnaire was structured into five parts addressing the following domains: 1) characteristics of the company; 2) health promotion activities; 3) preventive measures; 4) case management; 5) disability management. We selected public and private companies and collected information by direct interview.
Twenty companies entered the survey. Twelve Companies (60%) indicated that health promotion programs and sensibilisation campaigns are usually carried out. The presence of an individual who provided workplace safety indications and materials was stated by 19 companies (95%). Periodical medical examinations are carried out by 19 companies (95%); 16 (80%) have an evaluation process for ergonomics concerns. Risk assessment and analysis are performed by all companies and the security procedures and policies are updated at least once in a year in 40% of cases. Health status monitoring of injured workers is performed in eight (40%) of the companies, while Disability Management is present as a whole in only three companies.
This survey highlights that Disability Management is not undertaken in most companies and that, where applied, there is still confusion and disorganization about ways to promote health and manage workers' illness and disability. Hence, there is still the need to promote an all-inclusive evaluation and management of workers' safety, illness and disabilities.
Journal of preventive medicine and hygiene 03/2009; 50(1):37-45.
-
[show abstract]
[hide abstract]
ABSTRACT: We performed a pooled analysis of randomised clinical trials (RCT) on HPV vaccine efficacy in preventing cervical persistent infection.
We carried out a bibliographic search on electronic databases and we selected RCT to perform the meta-analyses.
We selected five studies. The first meta-analysis, including all studies, showed an important reduction of the risk of infection from HPV 16 in vaccinated cohort [RR 0.10 (95% CI: 0.07-0.15)]. The second and third meta-analyses, including only studies on bivalent and tetravalent vaccines, showed a RR of 0.13 (95% CI: 0.09-0.20) for HPV 16 infections and a RR of 0.22 (95% CI: 0.13-0.38) for HPV 18 ones.
HPV vaccine efficacy in preventing persistent infection is high but there is the need for further studies on the duration of immunization and long-term vaccine efficacy.
Vaccine 01/2008; 25(50):8352-8. · 3.77 Impact Factor
-
L Pagano,
M Caira,
A Nosari,
M T Van Lint,
A Candoni,
M Offidani,
T Aloisi,
G Irrera,
A Bonini,
M Picardi, [......],
R Invernizzi,
D Mattei,
L Melillo, C de Waure,
G Reddiconto,
L Fianchi,
C G Valentini,
C Girmenia,
G Leone,
F Aversa
[show abstract]
[hide abstract]
ABSTRACT: The purpose of our study was to evaluate the incidence and outcome of invasive fungal infection (IFI) among patients who underwent autologous or allogeneic hematopoietic stem cell transplantation (HSCT) at 11 Italian transplantation centers.
This cohort-retrospective study, conducted during 1999-2003, involved HSCT patients admitted to 11 tertiary care centers or university hospitals in Italy, who developed IFIs (proven or probable).
Among 3228 patients who underwent HSCT (1249 allogeneic HSCT recipients and 1979 autologous HSCT recipients), IFI occurred in 121 patients (overall incidence, 3.7%). Ninety-one episodes (2.8% of all patients) were due to molds, and 30 (0.9%) were due to yeasts. Ninety-eight episodes (7.8%) occurred among the 1249 allogeneic HSCT recipients, and 23 (1.2%) occurred among the 1979 autologous HSCT recipients. The most frequent etiological agents were Aspergillus species (86 episodes) and Candida species (30 episodes). The overall mortality rate was 5.7% among allogeneic HSCT recipients and 0.4% among autologous HSCT recipients, whereas the attributable mortality rate registered in our population was 65.3% (72.4% for allogeneic HSCT recipients and 34.7% for autologous HSCT recipients). Etiology influenced the patients' outcomes: the attributable mortality rate for aspergillosis was 72.1% (77.2% and 14.3% for allogeneic and autologous HSCT recipients, respectively), and the rate for Candida IFI was 50% (57.1% and 43.8% for allogeneic and autologous HSCT recipients, respectively).
IFI represents a common complication for allogeneic HSCT recipients. Aspergillus species is the most frequently detected agent in these patients, and aspergillosis is characterized by a high mortality rate. Conversely, autologous HSCT recipients rarely develop aspergillosis, and the attributable mortality rate is markedly lower. Candidemia was observed less often than aspergillosis among both allogeneic and autologous HSCT recipients; furthermore, there was no difference in either the incidence of or the attributable mortality rate for candidemia among recipients of the 2 transplant types.
Clinical Infectious Diseases 12/2007; 45(9):1161-70. · 9.15 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In the last decades, visceral Leishmaniasis infection rate has increased in Western Mediterranean areas. Epidemiological data show that in Italy, especially in some regions, the prevalence of canine form is high. The aim of this study is to evaluate the epidemiological setting of Leishmaniasis in Italy, according to age groups and geographical areas, and to estimate the associated direct medical costs.
The study examined the ordinary and day-hospital discharges and the respective mean of hospital length of stay for Leishmaniasis and visceral Leishmaniasis in Italy, during the period 1999-2003. Moreover, we collected data about notifications of Leishmaniasis, from 1993 to 2004, and mortality due to this infectious disease, from 1993 to 1998. We evaluated the prevalence rates of discharges, the visceral and cutaneous Leishmaniasis notifications incidence rates and the mortality rates from disease, per 1,000,000 residents. Costs analysis was performed getting DRG number 423 rate, which corresponds to "other diagnosis related to infectious and parasitary diseases".
Ordinary discharges decreased in the study period, while day-hospital discharges increased. Sicilia, Campania and Lazio regions showed the highest number of ordinary hospital discharges for Leishmaniasis (prevalence rates were respectively 16.29, 15.02 and 12.83 per 1,000,000 residents, in 2003). Campania and Sicilia showed also the highest prevalence rates of day-hospital discharges (respectively 17.29 and 35.39 per 1,000,000 residents in 2003). The analysis of incidence rates of notifications showed a cyclic trend of the visceral form of the disease, with the highest rates observed in the group aged 0-14 years (incidence rates per 1,000,000: 7.46 in 1996 and 8.59 in 2000). The highest mortality rates were observed in the group aged over 65 years; low but constant mortality rates for Leishmaniasis were seen in the age group 25-64 years. Direct costs for both ordinary and day-hospital admissions were: 1,561,218.46 Euro in 1999; 1,637,256.44 Euro in 2000; 1,459,892.92 Euro in 2001, 1,468,983.58 Euro in 2002 and 1,370,227.80 Euro in 2003.
Discharges for Leishmaniasis showed non-homogeneous trend in Italy, especially in coastal Regions. Leishmaniasis notifications have slowly increased after 1993 and a high number of notifications was observed in the 0-14 years old group. The highest mortality rates were reported in the extreme age-groups: mortality was relevant for patients over 65 years. Moreover, cost analysis showed that health care of human Leishmaniasis requires long time of hospitalization with consequent high costs. Conclusion. Preventive measures have to be turned to extreme age groups. For future studies issues such as high costs of treating disease, cost-effectiveness evaluation of the 'current therapeutic approach compared to preventive interventions on dogs and vector insects would be of interest.
Journal of preventive medicine and hygiene 04/2007; 48(1):27-36.
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of the study was to investigate the association between socio-demographic variables and "at high risk of inappropriateness" of hospital admissions. We used hospital admissions data of Local Health Unit (LHU) Rome H (year 2004). We investigated the relationship between socio-demographic variables (sex, age, job activity, marital status, nationality, place of residence, educational level) and a high risk of inappropriate hospital stay. We computed univariate and multivariate analysis using chi2 test and logistic regression model. Out of 32,233 hospital admissions, 4685 (14.5%) resulted at high risk of inappropriateness. The following variables were associated with high risk of inappropriateness: age (for patients aged 0-15 and 46-65 OR: 1.83 (95% C.I.: 1.57-2.13) and 1.56 (95% C.I.: 1.42-1.72) respectively); job activity (for employed OR: 1.98 (95% C.I.: 1.81-2.17), for students OR: 1.34 (95% C.I.: 1.16-155)); marital status (for unmarried OR: 1.37 (95% C.I.: 1.23-1.51)); place of residence (for patients belonging to LHU Rome H OR:1.09 (95% C.I.: 1.02-1.78)); nationality (for foreign nationals OR: 0.71 (95% C.I.: 0.58-0.87)); educational level (for high school degree and graduated people OR: 0.89 (95% C.I.: 0.81-0.98)). Our study demonstrates that socio-demographic variables are related to the high risk of inappropriate hospital admissions. We believe that these variables could be considered as potential factors to modulate the offer of health services.
Annali di igiene: medicina preventiva e di comunità 19(4):369-80.
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of our study was to evaluate the appropriateness of admission and hospital stay in pediatric wards of a Teaching Hospital in Rome using the Italian version of pediatric Appropriateness Evaluation Protocol (AEP). We reviewed 263 medical records of patients admitted in hospital during 2004. For each hospitalisation a judge on appropriateness/inappropriateness of admission and hospital stay was elaborated. We retrieved also data on type of ward, date, time and type of admission, date of discharge and data related to each patient. We carried out an univariate and a multivariate logistic regression analysis. Our results showed that the risk of an inappropriate admission is associated to residence out of Rome (OR = 2.45; CI 95%: 1.35-4.47) while the urgent admission is protective against inappropriateness (OR = 0.14; CI 95%: 0.07-0.25). The inappropriate hospital stay is associated to inappropriate admission (OR = 5.82; CI 95%: 3.17-10.70) and hospitalisation in a medical ward (OR = 3.26; CI 95%: 1.81-5.90). Stay in hospital in spring or summer periods is protective against hospitalisation inappropriateness (OR = 0.52; CI 95%: 0.30-0.91). The percentage of inappropriate admission and hospital stay is, respectively, 42.1%, and 50.2%, thus pointing out that there is the need of organisational interventions to reduce inappropriate hospitalisations.
Annali di igiene: medicina preventiva e di comunità 20(1):17-26.
-
[show abstract]
[hide abstract]
ABSTRACT: The object of our study was to evaluate health care perception by families of children affected by oncological diseases admitted to hospitals. The main aim was to investigate the importance of availability of particular services and of clients' satisfaction for them in determining high quality levels in health care. A survey was carried out in two reference centres for treating children's cancer in Italy, one in North and the other in Central Italy. The study was performed interviewing, by a questionnaire, in hospital children's parents about perception and judgment on health care. Descriptive statistical analyses were carried out. Mann-Whitney and Chi square tests were used setting the statistical significance at p < or = 0.05. We administered 53 questionnaires. Five (9.4%) negative judgment of quality of health care were observed. The evaluation of communicative ways and the relationship between psychologists and families influenced significantly the final judgment of quality of medical-nursing care. Our study highlights the importance of high quality psychological and sociological supports in the treatment of oncological children and in determining perceived quality of medical-nursing assistance. Finally, the importance of communication between medical staff and oncological children's parents was confirmed.
Annali di igiene: medicina preventiva e di comunità 20(5):495-502.
