[show abstract][hide abstract] ABSTRACT: In Italy the prevalence of genital warts in women (15--64 years) is approximately 0.6% with an incidence of 0.4% per year. Treatments for GW are usually long, with moderate success and high costs. The aim of the study was to evaluate the diagnostic-therapeutic pathway, duration and setting of treatment, costs of episodes of condyloma in a population attending a regional STI clinic in Piedmont.
This was a retrospective observational study conducted using medical records of outpatients who first visited the STI Clinic of San Lazzaro Dermatological Hospital in 2008. The patients' medical histories were analysed for episodes that occurred and were cleared in 18 months following the initial visit. Data on screening methods for STIs, type of diagnosis for condyloma, treatment type, treatment setting, and anatomic lesion site were obtained from medical records. The costs were calculated for each episode.
A total of 450 episodes were analysed (297 men,153 women). The most frequently affected anatomic site was the genital area (74%) in both genders. With regard to treatment setting, 78.44% of patients received outpatient treatment at the STI clinic, 4% were treated at home, and 0.22% were hospitalised; 11.11% were treated in multiple settings. The mean number of treatments per episode was 2.03; although many patients received only 1 treatment (n = 207, 46%), exspecially cryotherapy or diathermy coagulation (64.73% versus 28.02% of episodes, respectively). The mean episode duration was 80.74 days. The mean cost (in 2011 euros) for an episode was [euro sign]158.46 +/- 257.77; the mean costswere [euro sign]79.13 +/- 57.40 for diagnosis and [euro sign]79.33 +/- 233.60 for treatment. The mean cost for treatment in a STI-Clinic setting was [euro sign]111.39 +/- 76.72, that for home treatment was [euro sign]160.88 +/- 95.69, and that for hospital care was [euro sign]2825.94.
The treatment of and associated costs for genital warts are significant. Several factors affect the cost, and internal STI clinic protocols, such as the 6 month window used to consider a recurrence or new diagnosis, create bias. Nonetheless, our findings how costs similar to those reported in the international literature and should be considered when deciding on which HPV vaccination programs should be provided by the public health system.
[show abstract][hide abstract] ABSTRACT: Small-gauge vitreoretinal techniques have been shown to be safe and effective in the management of a wide spectrum of vitreoretinal diseases. However, the costs of the new technologies may represent a critical issue for national health systems. The aim of the study is to plan a Health Technology Assessment (HTA) by performing a comparative analysis between the 23- and 25-gauge techniques in the management of macular diseases (epiretinal membranes, macular holes, vitreo-macular traction syndrome). In this prospective study, 45-80-year-old patients undergoing vitrectomy surgery for macular disease were enrolled at the Torino Eye Hospital. In the HTA model we assessed the safety, clinical effectiveness, and cost and financial evaluation of 23-gauge compared with 25-gauge vitrectomies. Fifty patients entered the study; 14 patients underwent 23-gauge vitrectomy and 36 underwent 25-gauge vitrectomy. There was no statistically significant difference in post-operative visual acuity at 1 year between the two groups. No cases of retinal detachment or endophtalmitis were registered at 1-year follow-up. The 23-gauge technique was slightly more expensive than the 25-gauge: the total surgical costs were EUR1217.70 versus EUR1164.84 (p = 0.351). We provide a financial comparison between new vitreoretinal procedures recently introduced in the market and reimbursed by the Italian National Health System and we also stimulate a critical debate about the expensive technocratic model of medicine.
[show abstract][hide abstract] ABSTRACT: OBJECTIVES: The goal of this study was to describe and analyse interventions performed in the emergency department (ED) of an Italian hospital with the aim of humanising the patient care pathway. The actions taken are described and the changes analysed to determine whether they resulted in an increased level of patient satisfaction. METHODS: An observational study was conducted between October 2010 and March 2011. The data were collected via a telephone questionnaire administered to patients who were admitted to the ED before and after humanisation interventions. The respondents were questioned about their general condition and their level of satisfaction. RESULTS: The study population included 297 patients (158 before and 139 after the interventions). The highest overall patient satisfaction after the interventions was highly correlated with the humanisation interventions and not with other factors such as gender, age, educational level or the severity code triage. Specifically, in patients who went to the ED after the changes had been made, there was a greater level of satisfaction regarding comfort in the waiting room, waiting time for the first visit and the privacy experienced during the triage. CONCLUSION: The results demonstrate that the interventions implemented in this study, designed to humanise the ED, improved overall patient satisfaction. Interventions may be taken to reduce the depersonalisation of patients in the emergency room.
Emergency Medicine Journal 07/2012; · 1.65 Impact Factor
[show abstract][hide abstract] ABSTRACT: The objective of this study is to compare the three methods internationally used for estimating days of hospitalization attributable to hospital infections by applying them to the same population. The methods are: (1) unmatched comparison group; (2) matched control method-based; and (3) Appropriateness Evaluation Protocol method. A study of the prevalence of infections was performed among patients during hospitalization for an ordinary single sampling department. The survey was completed within eight working days between 15 and 24 October 2007. All patients admitted at least 24 hours to the survey day in each department were included in the study, as well as patients discharged/transferred to another hospital or department. During the prevalence study 621 patients were observed, 70 of which with infection (equal to 11.27%).
The 70 uninfected patients needed for comparison using method 1 were selected through a procedure based on propensity score on demographic variables and clinical trials of patients. The Shapiro-Wilk test was used to verify the normality of quantitative variables. In comparing the three methods Kruskall-Wallis test was used (alpha = 0.05), while comparisons between pairs of methods were performed with the Mann-Whitney test (alpha = 0.017).
Estimation results of recovery days with infection using the three comparison tests showed that there is a statistically significant difference between the three methods (P = 0.016) and there is a significant difference between 1 versus 3 (P = 0.013) and between 2 and 3 (P = 0.017), whereas between 1 and 2 no difference was found (P = 0.82).
In conclusion, the three methods are not showing the same estimations and thus may not be exchangeable.
Journal of Evaluation in Clinical Practice 07/2011; 18(4):776-80. · 1.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: Recent international sources have described how the rapid expansion of the Internet has precipitated an increase in its use by the general population to search for medical information. Most studies on e-health use investigated either through the prevalence of such use and the social and income patterns of users in selected populations, or the psychological consequences and satisfaction experienced by patients with particular diseases. Few studies have been carried out in Europe that have tried to identify the behavioral consequences of Internet use for health-related purposes in the general population.The aims of this study are to provide information about the prevalence of Internet use for health-related purposes in Italy according to demographic and socio-cultural features, to investigate the impact of the information found on health-related behaviors and choices and to analyze any differences based on health condition, self-rated health and relationships with health professionals and facilities.
A multicenter survey was designed within six representative Italian cities. Data were collected through a validated questionnaire administered in hospital laboratories by physicians. Respondents were questioned about their generic condition, their use of the Internet and their health behaviors and choices related to Internet use. Data were analyzed using descriptive statistics and logistic regression to assess any differences by socio-demographic and health-related variables.
The sample included 3018 individuals between the ages of 18 and 65 years. Approximately 65% of respondents reported using the Internet, and 57% of them reported using it to search for health-related information. The main reasons for search on the Internet were faster access and a greater amount of information. People using the Internet more for health-related purposes were younger, female and affected by chronic diseases.
A large number of Internet users search for health information and subsequently modify their health behaviors and relationships with their medical providers. This may suggest a strong public health impact with consequences in all European countries, and it would be prudent to plan educational and prevention programs. However, it could be important to investigate the quality of health-related websites to protect and inform users.
BMC Medical Informatics and Decision Making 04/2011; 11:21. · 1.60 Impact Factor
[show abstract][hide abstract] ABSTRACT: The scientific literature on HIA is particularly rich in Anglo-Saxon countries (United Kingdom, Canada, New Zealand), in Sweden and in the Netherlands, while in Italy there are not many scientific studies published on this theme. The study conducted showed that in Italy no laws relating to HIA have been enacted yet and that all laws enacted so far considered only EIA. Actually, legislation on environmental impact is in continuous expansion, even if at present, some regions have not yet passed a specified EIA-dealing law. In Italy the protection of health is promoted almost exclusively at a strictly medical level; decisions with strong social and environmental impact are not normally designed with particular regard to health issues. To increase in our country the interest for HIA, it would seem appropriate to discuss the usefulness of introducing health impact assessment in national and regional legislation. A possible law may indeed sensitize non-health decision makers to HIA, bringing Italy among the most innovative countries.
Annali di igiene: medicina preventiva e di comunità 22(2):147-55.
[show abstract][hide abstract] ABSTRACT: A cross-sectional, multicenter study was carried out in 6 Italian cities (Cassino, Chieti, Naples, Rome, Siena, Turin) in order to highlight differences in Web use to find out health information and its related consequences on behavioral choices and to describe the distribution of the phenomenon in Italy. Data were collected from October 2009 to September 2010 on a sample of volunteers recruited from laboratory analysis, with face-to-face interview, including information about socio-demographic, health, and Web use to health. Data analysis shows that e-health use is greater in Northern Italy, in women aged 30-41 years, in chronic patients and those who have been caught up medical malpractice. Behavioral changes are associated with the Region; in particular Rome and Cassino show to choose/change professionals and facilities, engaging in alternative therapies and buy drugs online more frequently. Living in Southern Italy, a lower educational level and the infrequent drugs use are associated with a greater probability of incurring in negative behaviors. Positive results on the behavior are instead low and not significant. Given the regional differences, the potentiality and the risks of e-health use, it will be important to identify strategies for risks containment and implementation of the web in prevention.
Annali di igiene: medicina preventiva e di comunità 23(4):283-94.
[show abstract][hide abstract] ABSTRACT: Background: Oral and poster presentations at congresses are essential to spread scientific knowledge among the medical community. Many scientific societies have analyzed the quality of papers presented at their meetings but no information on abstracts' evaluation has been presented in Public Health field. Design and methods: This study aims to examine the quality of abstracts presented at annual meetings of Italian Public Health Society (SItI) in the period 2005-2010 through a validated checklist grid, evaluating eight dimensions: Inherency, Structure, Originality, Objectives, Study design, Sources, Results, Conclusions. Each item was scored from 0 to 3 points (max score: 24) and we used the average score in our study (15) as threshold of good quality. A multivariate analysis was performed in order to investigate predictors of score of abstracts presented. Results: A total of 4,399 abstracts (1,172 oral communications, 3,227 posters) was examined. Around 60% were submitted by Universities and around 40% were from Central Italy. The highest quality was found in the fields of Vaccines (average score 18.9), Infectious Diseases (18) and in abstracts submitted by Universities (16.4). Predictors of lower quality identified were geographical area and affiliation (p= 0.002). Abstracts containing well-written Results, Conclusions and Objectives (3 points) were more likely to be of high quality(OR=55.6, OR=41.9, and OR=157.4; p>0.001) Conclusions: This is the first European study evaluating the quality of abstracts in the public health field. A reliable evaluation tool is fundamental to offer a transparent methodology of assessment and to improve the quality of research.
Annali di igiene: medicina preventiva e di comunità 25(5):377-87.