[Show abstract][Hide abstract] ABSTRACT: The cross-sectional study has been based on the implementation of the Obstetric Appropriateness Evaluation Protocol (OAEP) in seven hospitals to determine inappropriate hospital admissions and days of stay. The outcomes were: inappropriateness of admission and ''percentage of inappropriateness'' for one hospitalization. A total number of 2196 clinical records were reviewed. The mean percentage of inappropriateness for hospitalization was 22%. The percentage of inappropriateness for the first 10 d of hospitalization peaked in correspondence of the fourth (42%). The logistic regression model on inappropriated admission reported that emergency admission was a protective factor (OR ¼ 0.4) and to be hospitalized in wards with !30 beds risk factor (OR ¼ 5.12). The second linear model on ''percentage of inappropriateness'' showed that inappropriated admission and wards with !30 beds increased the percentage (p50.001); whereas the admission in Teaching Hospitals was inversely associated (p50.001). The present study suggests that the percentage of inappropriate admission depends especially on the inappropriate admission and the large number of beds in obstetric wards. This probably indicates that management of big hospitals, which is very complex, needs improving the processes of support and coordination of health professionals. The OAEP tool seems to be an useful instrument for the decision-makers to monitor and manage the obstetric wards.
Journal of Maternal-Fetal and Neonatal Medicine 09/2014; · 1.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The ideal preparation regimen for pediatric colonoscopy remains elusive, and available preparations continue to represent a challenge for children. The aim of this study was to compare the efficacy, safety, tolerability, and acceptance of 4 methods of bowel cleansing before colonoscopy in children.METHODS: This randomized, investigator-blinded, noninferiority trial enrolled all children aged 2 to 18 years undergoing elective colonoscopy in a referral center for pediatric gastroenterology. Patients were randomly assigned to receive polyethylene glycol (PEG) 4000 with simethicon (PEG-ELS group) or PEG-4000 with citrates and simethicone plus bisacodyl (PEG-CS+Bisacodyl group), or PEG 3350 with ascorbic acid (PEG-Asc group), or sodium picosulfate plus magnesium oxide and citric acid (NaPico+MgCit group). Bowel cleansing was evaluated according to the Boston Bowel Preparation Scale. The primary end point was overall colon cleansing. Tolerability, acceptability, and compliance were also evaluated.RESULTS: Two hundred ninety-nine patients were randomly allocated to the 4 groups. In the per-protocol analysis, PEG-CS+Bisacodyl, PEG-Asc, and NaPico+MgCit were noninferior to PEG-ELS in bowel-cleansing efficacy of both the whole colon (P = .910) and colonic segments. No serious adverse events occurred in any group. Rates of tolerability, acceptability, and compliance were significantly higher in the NaPico+MgCit group.CONCLUSIONS: Low-volume PEG preparations (PEG-CS+Bisacodyl, PEG-Asc) and NaPico+MgCit are noninferior to PEG-ELS in children, representing an attractive alternative to high-volume regimens in clinical practice. Because of the higher tolerability and acceptability profile, NaPico+MgCit would appear as the most suitable regimen for bowel preparation in children.
[Show abstract][Hide abstract] ABSTRACT: To assess the prognostic role of baseline clinical, biochemical and radiological characteristics of patients with hepatocellular carcinoma (HCC) treated with the first transarterial chemoembolization (TACE) procedure.
World journal of gastroenterology : WJG. 07/2014; 20(25):8158-65.
[Show abstract][Hide abstract] ABSTRACT: The increasing incidence of head and neck cancer (HNSCC) highlights the need to better understand the role of Human papilloma virus (HPV) in the development of these cancers. The aim of this study is to conduct a systematic review and a meta-analysis concerning observational studies on the association between HPV infection and HNSCC and to quantify this association obtaining a reliable estimation of the risk infection in its development.
[Show abstract][Hide abstract] ABSTRACT: The objectives of the present study were to evaluate knowledge among general population about the risks factors of waste management, to estimate the feeling of anxiety concerning the waste, and to compare knowledge of two different methods for collecting municipal solid waste (MSW): a street separate collection system and a door-to-door separate collection system. A cross-sectional study was performed, administering an anonymous questionnaire to 180 inhabitants in Aprilia, Latium, Italy. The study sample consisted of 183 citizens: 64 in the intervention group and 119 in the control group. The intervention was represented by a campaign of door-to-door collection. The correct implementation of separate collection of waste was 87.5% in the intervention group and 63% in the control group (p<0.001). For both groups, the favourite type of waste collection was door-to-door (p=0.013); a high difference concerning the quality of information was found (p<0.0001): in the intervention group, 84% declared to be satisfied (67% sufficient and 17.2% good), while in the control group, 21% declared to be satisfied (16.8% sufficient and 4.2% good). The advice mainly reported from the control group respondents was to increase the size of the information pack (80.7%, p=0.024). The information campaign seemed to increase people's awareness about the problem, improving the management of waste and household waste. The door-to-door collection was appreciated and preferred by both groups. The adoption of a door-to-door scheme seems to be a winning option mostly because it is supported by an information and education system for the citizens.
Waste management & research : the journal of the International Solid Wastes and Public Cleansing Association, ISWA. 06/2014; 32(6):556-561.
[Show abstract][Hide abstract] ABSTRACT: There is an increasing interest of European Institutions towards economical impact assessment of animal health control programmes . The implications of bovine tuberculosis (bTB) for Public Health and trade are well known. Notwithstanding the economic effort and political commitments of the European Union (EU), the eradication of bTB has not been achieved in Europe.
The aim of this study was to quantify the direct costs of the bTB eradication plan carried out in the twelve Local Health Units (LHU) of the Latium region from 2007 to 2011. The secondary objectives were the description of costs trend, and the relationship between the estimated costs and the EU co-funding.
The perspective of the regional government was adopted, by following a three-step procedure: identification and quantification of resources and attribution of the economic value. Three types of relevant resources were identified as follows: personnel, transportation and supplies. Data were collected mainly from official EU report and a face-to-face questionnaire submitted to the heads of the Veterinary Service of the LHUs.
The estimated cost over the whole study period was € 5,814,210. We found that costs significantly decreased when a territory was declared disease-free, the personnel accounted for almost 90% of the total cost, and the EU co-funding covered 9.5% of the total cost. Costs evaluation is a necessary step to implement a full economic analysis, and this study represents an evidence-based methodology applied in the field of Animal Health.
VI International M.bovis Conference, Cardiff (UK); 06/2014
[Show abstract][Hide abstract] ABSTRACT: Vancomycin-resistant enterococci (VRE) represent a major problem in healthcare settings worldwide. It is still unclear which is the most effective infection control and prevention (ICP) measure to reduce the spread of hospital-acquired VRE.
Cochrane databases, MEDLINE, EMBASE and CINAHL were searched until June 2012 to find studies comparing wards/hospitals where ICP measures to prevent VRE transmission were investigated. In the absence of heterogeneity, a fixed-effects model was used to estimate the pooled risk ratio (RR). Study quality was assessed according to Cochrane Effective Practice and Organisation of Care (EPOC) criteria.
The search strategy retrieved 549 studies and 9 studies (1 randomized clinical trial, 3 controlled clinical trials and 5 interrupted time series) with 30 949 participants were included. The overall study quality was low. Implementation of hand hygiene was associated with a 47% decrease in the VRE acquisition rate (pooled RR 0.53, 95% CI 0.39-0.73, I(2) 26%) while contact precautions did not significantly reduce the VRE acquisition rate (pooled RR 1.08, 95% CI 0.63-1.83, I(2) 0%). Due to the low number of studies, meta-analysis was not applied for surveillance screening, environmental cleaning and antibiotic formulary interventions. No studies were available on the effectiveness of isolation and cohorting of patients and staff.
Available evidence on the ICP measures to reduce VRE spread in adult hospitalized patients is poor. This systematic review suggests a significant role for the implementation of hand hygiene. Further studies with appropriate study design are urgently needed to define ICP measures able to reduce the acquisition of VRE among hospitalized patients.
Journal of Antimicrobial Chemotherapy 01/2014; · 5.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives. The aim of this study was to quantify the level of health related quality of life and burnout in a call centers sample of precarious workers. Methods. An observational study was carried out in Italy. A self-reported anonymous questionnaire was administered to temporary workers in order to estimate burn-out and quality of life levels. Results. 227 questionnaires were collected. 78% of the sample was female and the mean age was 35.48 years (SD = 9.91). Among the participants, 40% were smokers, 42% regularly drinkers, 65% changed the body weight (more than 5 kg, in 1 year). The mental component score (MCS) was significantly better in subject that have a regularly life style, for example in those no change their body weight (p = 0.001), sleep more than 7 hours (p = 0.018) and followed a diet (p = 0.035). The DP (depersonalization) is significant higher in former smokers (p = 0.031), in underweight subjects (p = 0.025) and in the group that have a precarious employment of over 2 years (p = 0.013). Conclusions. This investigation shows that in this particular category of atypical workers depressive symptoms and quality of life were lower than the general population. It is important to underline that the interpretation of the results is limited partly by the observational character of the study.
[Show abstract][Hide abstract] ABSTRACT: Aims
To present the interim results of a phase I trial on stereotactic radiosurgery (SRS) delivered using volumetric modulated arc therapy (VMAT) in patients with primary or metastatic tumours in different extracranial sites.
Materials and methods
Patients were enrolled in different arms according to tumour site and clinical stage, and sequentially assigned to a given dose level. Acute toxicity, tumour response and early local control were investigated and reported.
One hundred lesions in 65 consecutive patients (male/female: 30/35, median age: 66 years; range: 40–89) were treated. Of these 100 lesions, 21 were primary or metastatic lung tumours, 24 were liver metastases, 30 were bone metastases, 24 were nodal metastases and one was a primary vulvar melanoma. The prescribed dose ranged from 12 (BED2Gy,α/β:10 = 26.4 Gy) to 28 Gy (BED2Gy,α/β:10 = 106.4 Gy) to the planning target volume. Twenty-one patients (32.3%) experienced grade 1–2 acute toxicity, which was grade 2 in only two cases. The overall response rate based on computed tomography/magnetic resonance imaging was 52% (95% confidence interval 40.1–63.2%) and based on positron emission tomography scan was 90% (95% confidence interval 76.2–96.4%). As of November 2013, the median duration of follow-up was 11 months (range = 1–38). Recurrence/progression within the SRS-VMAT treated field was observed in nine patients (total lesions = 18): the inside SRS-VMAT field local control expressed on a per lesion basis was 87.8% at 12 months and 71.9% at 24 months.
The maximum tolerable dose has not yet been reached in any study arm. SRS-VMAT resulted in positive early clinical results in terms of tumour response, local control rate and acute toxicity.
[Show abstract][Hide abstract] ABSTRACT: The aims of the present research are to investigate the possible predictors of pancreatic cancer, in particular smoking status, alcohol consumption, hypercholesterolemia, and diabetes mellitus, in patients with histologically confirmed pancreatic carcinoma and to examine the synergism between risk factors. A case-control study (80 patients and 392 controls) was conducted at the Teaching Hospital "Agostino Gemelli" in Rome. A conditional logistic regression was used for the statistical analysis and results were presented as odds ratio (OR) and 95% confidence intervals (95% CI). We also investigated the possible interactions between risk factors and calculated the synergism index (SI). The multivariate analysis revealed that hypercholesterolemia and alcohol consumption resulted in important risk factors for pancreatic cancer even after the adjustment for all variables (OR: 5.05, 95% CI: 2.94-8.66; OR: 2.25, 95% CI: 1.30-3.89, resp.). Interestingly, important synergistic interactions between risk factors were found, especially between ever smoking status and alcohol consumptions (SI = 17.61) as well as alcohol consumption and diabetes (SI = 17.77). In conclusion, the study confirms that hypercholesterolemia and alcohol consumption represent significant and independent risk factors for pancreatic cancer. Moreover, there is evidence of synergistic interaction between diabetes and lifestyle factors (drinking alcohol and eating fatty foods).
BioMed Research International 01/2014; 2014:481019. · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. Systemic lupus erythematosus (SLE) is treated with anti-inflammatory and immunosuppressive drugs and off-label biologics. Belimumab is the first biologic approved after 50 years as an add-on therapy for active disease. This paper summarizes a health technology assessment performed in Italy. Methods. SLE epidemiology and burden were assessed using the best published international and national evidences and efficacy and safety of belimumab were synthesized using clinical data. A cost-effectiveness analysis was performed by a lifetime microsimulation model comparing belimumab to standard of care (SoC). Organizational and ethical implications were discussed. Results. Literature review showed that SLE affects 47 per 100,000 people for a total of 28,500 patients in Italy, 50% of whom are affected by active form of the disease despite SoC. These patients, if autoantibodies and anti-dsDNA positive with low complement, are eligible for belimumab. SLE determines work disability and a 2-5-fold increase in mortality. Belimumab with SoC may prevent 4,742 flares in three years being cost-effective with an incremental cost-effectiveness ratio of €32,859 per quality adjusted life year gained. From the organizational perspective, the development of clear and comprehensive clinical pathways is crucial. Conclusions. The assessment supports the use of belimumab into the SLE treatment paradigm in Italy.
BioMed Research International 01/2014; 2014:704207. · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction. This paper presents the final results of a cross-sectional study started in 2010. It compares the perceived efficacy of different types of tobacco health warning (texts versus shocking pictures) to quit or reduce tobacco use. Methods. The study conducted between 2010 and 2012 in Italy enrolled adults smokers. Administering a questionnaire demographic data, smokers behaviors were collected. Showing text and graphic warnings (the corpse of a smoker, diseased lungs, etc.) the most perceived efficacy to reduce tobacco consumption or to encourage was quit. Results. 666 subjects were interviewed; 6% of responders referred that they stopped smoking at least one month due to the textual warnings. The 81% of the smokers perceived that the warnings with shocking pictures are more effective in reducing/quitting tobacco consumption than text-only warnings. The younger group (<45 years), who are more motivated to quit (Mondor's score ≥ 12), and females showed a higher effectiveness of shocking warnings to reduce tobacco consumption of, 76%, 78%, and 43%, respectively with P < 0.05. Conclusions. This study suggests that pictorial warnings on cigarette packages are more likely to be noticed and rated as effective by Italian smokers. Female and younger smokers appear to be more involved by shock images. The jarring warnings also appear to be supporting those who want to quit smoking. This type of supportive information in Italy may become increasingly important for helping smokers to change their behavior.
BioMed Research International 01/2014; 2014:723035. · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. The aim of the present work is to describe the state of the art of tobacco habits in Italy, eight years after the law was introduced. Methods. Time series analyses, based on estimates of smoking prevalence/consumption derived from the openly available data of national surveys performed during the 2001-2013 period, were performed. Data have been expressed in percentage of smokers and daily cigarettes consumption. Time changes are expressed as expected annual percentage change (EAPC). Results. Over time, the percentage of Italian smokers shows a constant and statistically significant decrease (from 28.9% in 2001 to 20.6% in 2013, EAPC = -2.6%, and P < 0.001). Regarding data stratified by gender, we found a stronger reduction among men (EAPC = -2.9%, P < 0.001) than in women (EAPC = -2.5%, P < 0.001). Similarly, the consumption of tobacco smoking, measured as the number of daily cigarettes smoked, registered a downward trend (P < 0.001). No join point (time point when a significant trend change is detected) resulted from the trend analysis. Conclusions. Data show a constant decrease of tobacco consumption in Italy, with no join point related to the introduction of the banning law. These findings require to reflect on the priorities of the smoking banning policies that may be focused on other intervention activities such as to increase the price of cigarettes.
BioMed Research International 01/2014; 2014:293219. · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A growing importance has been placed on the recognition and supervision of non-motor features of Parkinson's disease (PD). Depression has been estimated to affect 1 in 3 individuals with PD and can lead to worse health outcomes and decreased quality of life. Anxiety, apathy and anhedonia further complicate PD outcomes. In this double-blind, placebo-controlled trial, participants (individuals with mild to moderate PD; n = 24) were randomly assigned to treatment (800 mg/d docosahexaenoic acid (DHA) and 290 mg/d eicosapentaenoic acid, a precursor to DHA) or placebo (an equicaloric amount of corn oil). Treatment duration was 6 months. Treatment had no statistically significant effect on rate of change on either Unified Parkinson's Disease Rating Scale or Hoehn-Yahr Scale score. However, 75% of DHA-treated patients, reduced Hamilton Rating Scale for Depression total score by at least 50%, compared with only 25% into the placebo group. At the end of the six-month study, DHA integration reduced the depressive symptoms.
[Show abstract][Hide abstract] ABSTRACT: To assess the efficacy of topical dorzolamide for treating cystoid macular edema in patients with retinitis pigmentosa and minimize the secondary effects of maintenance therapy in patients with retinitis pigmentosa (RP) who present with chronic microcystic macular edema.
[Show abstract][Hide abstract] ABSTRACT: Objective. The Health Technology Assessment (HTA) approach was applied to denosumab in the prevention of osteoporotic fractures in postmenopausal women. Method. Epidemiological, clinical, technical, economic, organizational, and ethical aspects were considered. Medical electronic databases were accessed to evaluate osteoporosis epidemiology and therapeutical approaches. A budget impact and a cost-effectiveness analyses were performed to assess economic implications. Clinical benefits and patient needs were considered with respect to organizational and ethical evaluation. Results. In Italy around four millions women are affected by osteoporosis and have a higher risk for fractures with 70,000 women being hospitalized every year. Bisphosphonates and strontium ranelate are recommended as first line treatment for the prevention of osteoporotic fractures. Denosumab is effective in reducing vertebral, nonvertebral, and hip/femoral fractures with an advantage of being administered subcutaneously every six months. The budget impact analysis estimated a reduction in costs for the National Health Service with the introduction of denosumab. Furthermore, the economic analysis demonstrated that denosumab is cost-effective in comparison to oral bisphosphonates and strontium ranelate. Denosumab can be administered in outpatients by involving General Practitioners in the management. Ethical evaluation is positive because of its efficacy and compliance. Conclusion. Denosumab could add value in the prevention of osteoporotic fractures.
BioMed research international. 01/2014; 2014:975927.