[Adapting a private health care facility to the new Peruvian Public Health Sistem. Quality rating in a Middle Income Economy country]. / L'adeguamento di una struttura sanitaria privata alla nuova sanità pubblica Peruviana. Valutazione di qualità in un paese a Middle Income Economy.

The aim of the study is the Assessment of Quality Sevices provided by a no-profit Medical Center in Peruvian Sierra, through an evidence-based decision-making process to identify infrastructure and capacity building interventions, to achieve accreditation and economic sustainability and increase competitiveness in the renewed Peruvian National Health System. The quali-quantitative collection of data shows how is fundamental an Healthcare Management focused on the responsiveness of services to the real needs and the local culture to reach the goals.

The influence of doctor-patient and midwife-patient relationship in quality care perception of italian pregnant women: an exploratory study.

BACKGROUND: The study focuses on the perceived nature / technique opposition in pregnancy and delivery emerging from gynaecologist/ midwife/ pregnant woman relationships. We developed a cross-sectional survey to identify, by means of a multidimensional data-driven approach, the main latent concepts structuring the between items correlation correspondent to the different general opinions present in the data set. The obtained results can set the basis to improve patient satisfaction while decreasing healthcare costs. METHODS: The sample is made of 90 pregnant women within 24-48 hours after natural or operative birth, from three maternity units in Italy. Women filled in a questionnaire about their relationship with gynaecologist and midwife during pregnancy and hospital stay for delivery. RESULTS: Participation rate approached 100%. The emerging factorial structure gave a proof-of-concept of the hypothesis of 'nature vs. technique' as the main dimension shaping women opinions. The results highlighted the role of midwife as the 'link' between the natural and technical dimension of birth. The quality of welcome and the establishing of an empathic relation between mother and healthcare professional was shown to decrease further request of care in the post-partum period. CONCLUSIONS: The "fault plane" between nature and technique is a very critical zone for litigation. Women are particularly sensitive to the consideration and attention they receive at their admission in the hospital, as well as to the quality of human relationship with midwife. The perceived quality of welcome scaled with a decreased need of additional care and, more in general, with a more faithful attitude towards health professionals. We hypothesize that increasing the quality of welcome can exert an effect on both welfare costs and litigation. This opens the way (through an extension of this pilot study to wider populations) to relevant ameliorative actions on quality of care at practically null cost.

Dietary habits and growth: an urban/rural comparison in the Andean region of Apurimac, Peru.

INTRODUCTION: The efficacy of interventions against children malnutrition crucially depends on a myriad of factors other than the simple food intake, that must be carefully studied in order to plan a balanced policy. The relation between dietary patterns and growth is at the very heart of the problem, especially in consideration of the fact that dietary pattern involves dimension other than pure caloric intake in its definition. In this work we investigated the relations between dietary pattern and growth comparing children from a rural and a urban area in Andean Peru, in terms of food habits and anthropometric variables to develop a model usable in context interventions against malnutrition. MATERIAL AND METHODS: A sample of 159 children (80 from urban, 79 from rural area), aged from 4 to 120 months (72.7 ± 37.5 SD) was collected. The data were investigated by a multidimensional (principal component analysis followed by inferential approach) analysis to correlate the different hidden dimensions of both anthropometric and dietary observables. The correlation between these dimensions (in the form of principal components) were computed and contrasted with the effects of age and urban/rural environments. RESULTS: Caloric intake and growth were not linearly correlated in our data set. Moreover urban and rural environment were demonstrated to show very different patterns of both dietary and anthropometric variables pointing to the marked effect of dietary habits and demographic composition of the analyzed populations. The relation between malnutrition and overweight was at the same time demonstrated to follow a strict area-dependent distribution. DISCUSSION AND CONCLUSION: We gave a proof-of-concept of the non-linear character of the relation between malnutrition (in terms of caloric intake) and growth, pointing to the need to calibrate interventions on food pattern and not only quantity to contrast malnutrition effects on growth. The education toward a balanced diet must go hand-in-hand with the intervention on caloric intake in order to prevent effects on health.

HIV-1 non-B subtypes in Italy: a growing trend.

Sequence analysis plays an important role in the management of patients chronically infected with HIV-1. Knowledge of the viral genotype and drug resistance mutations is crucial for the correct management of these patients. From this point of view, the experience of researchers in the HIV-1 field and the introduction of the HIV-1 genotyping resistance test has been fundamental. Several molecular tools are available to assist the provider in interpreting genotypic test results including phylogenetics. However, it should be remembered that antiretroviral drug designs, resistance studies and interpretation systems have been largely based on HIV-1 subtype B, which has been historically the most prevalent subtype in Western countries. Due to increased migration towards Europe, especially from Africa and South- East Asia, the molecular epidemiology of HIV-1 in Western Europe, including Italy, is changing. HIV-1 non-B subtypes have entered Europe and their prevalence has increased over the last years. In Italy, the estimated percentage of infection with non-B subtypes ranges from 2.4 % to 19.4%. However, the true prevalence of HIV-1 non-B subtypes in this country is still not well known and probably underestimated. This may have important clinical and diagnostic implications. A strict molecular epidemiological survey and a reinforced sequencing strategy are required.

Antonovsky's Sense of Coherence Scale: Cultural Validation of Soc Questionnaire and Socio-Demographic Patterns in an Italian Population.

BACKGROUND: The theory of salutogenesis entails that the ability to use resources for one's wellbeing is more important than the resources themselves. This ability is referred to as the Sense of Coherence (SOC). This paper present the cross-culturally adapted version of the Italian questionnaire (13 items), and the psychometric and statistical testing of the SOC properties. It offers for the first time a view of the distribution of SOC in an Italian sample, and uses a multivariate method to clarify the effects of socio-demographic determinants on SOC. METHODS: The cross-cultural adaptation of the English SOC questionnaire was carried out according to the guidelines reported in literature. To evaluate the psychometric and statistical properties we assessed reliability, validity and frequency distribution of the collected data. A Generalised Linear Model was used to analyse the effects of socio demographic variables on SOC. RESULTS: The Italian SOC scale demonstrates a good internal consistency (α = 0.825). The model obtained with factorial analysis is not related to the traditional dimensions of SOC represented in more than one factor. The multivariate analysis highlights the joint influence of gender, age and education on SOC. CONCLUSION: The validated Italian questionnaire is now available. Socio-demographic variables should be taken into account as confounders when SOC values among different populations are compared. Presenting data on SOC of the Italian population makes a control population available for comparisons with specific subgroups, such as patient populations. Now, the Italian challenge is to integrate the salutogenic approach into Public Health police.