Determinants of aggression against all health care workers in a large-sized university hospital.

BACKGROUND: The paper aims to describe the 3-year incidence (2015/17) of aggressive acts against all healthcare workers to identify risk factors associated to violence among a variety of demographic and professional determinants of assaulted, and risk factors related to the circumstances surrounding these events. METHODS: A retrospective observational study of all 10,970 health workers in a large-sized Italian university hospital was performed. The data, obtained from the "Aggression Reporting Form", which must be completed by assaulted workers within 72 h of aggression, were collected for the following domains: worker assaulted (sex, age class, years worked); profession (nurses, medical doctors, non-medical support staff, administrative staff, midwives); aggressive acts (activity type during aggressive acts, season, time and location of aggressive acts); and type of aggressive acts (verbal, non-verbal, consequences, aggressors). RESULTS: Three hundred sixty-four (3.3%) workers experienced almost one aggression. The majority of the assaulted workers were female (77.5%), had worked for 6/15 years and were Nurses (64.3%). The majority of aggressive acts occurred during assistance and patient care (38.2%), in the spring and during the afternoon/morning shifts and took place in locations where patients were present (47.3%). The most prevalent aggression type was verbal (76.9%). The patient was the most common aggressor (46.7%). 56% of those assaulted experienced interruptions in their work. Being female, being < 50 years of age, having worked for 6-15 years were significant risk factors for aggression. Midwives suffered the highest risk of experiencing aggression (RR = 12.95). The risk analysis showed that non-verbally aggressive acts were related to assistance and patient care with respect to activity type, to the presence of patients and during the spring and afternoon/evening. CONCLUSIONS: The findings suggest the parallel use of future qualitative studies to clarify the motivation behind aggression. These suggestions are needed for the implementation of additional adequate prevention strategies on either an organizational or a personal level.

Patterns of amenable child mortality over time in 34 member countries of the Organisation for Economic Co-operation and Development (OECD): evidence from a 15-year time trend analysis (2001-2015).

OBJECTIVES: To analyse the trends of amenable mortality rates (AMRs) in children over the period 2001-2015. DESIGN: Time trend analysis. SETTING: Thirty-four member countries of the Organisation for Economic Co-operation and Development (OECD). PARTICIPANTS: Midyear estimates of the resident population aged ≤14 years. PRIMARY AND SECONDARY OUTCOME MEASURES: Using data from the WHO Mortality Database and Nolte and McKee's list, AMRs were calculated as the annual number of deaths over the population/100 000 inhabitants. The rates were stratified by age groups (<1, 1-4, 5-9 and 10-14 years). All data were summarised by presenting the average rates for the years 2001/2005, 2006/2010 and 2011/2015. RESULTS: There was a significant decline in children's AMRs in the <1 year group in all 34 OECD countries from 2001/2005 to 2006/2010 (332.78 to 295.17/100 000; %Δ -11.30%; 95% CI -18.75% to -3.85%) and from 2006/2010 to 2011/2015 (295.17 to 240.22/100 000; %Δ -18.62%; 95% CI -26.53% to -10.70%) and a slow decline in the other age classes. The only cause of death that was significantly reduced was conditions originating in the early neonatal period for the <1 year group. The age-specific distribution of causes of death did not vary significantly over the study period. CONCLUSIONS: The low decline in amenable mortality rates for children aged ≥1 year, the large variation in amenable mortality rates across countries and the insufficient success in reducing mortality from all causes suggest that the heath system should increase its efforts to enhance child survival. Promoting models of comanagement between primary care and subspecialty services, encouraging high-quality healthcare and knowledge, financing universal access to healthcare and adopting best practice guidelines might help reduce amenable child mortality.

The Evaluation of Organizational Well-Being in An Italian Teaching Hospital Using the ANAC Questionnaire.

In Italy, the Italian National Anti-Corruption Authority (Autorità Nazionale Anti-corruzione-ANAC) has developed a questionnaire to assess the organizational well-being of employees within public agencies. The study aimed to explore the relationship among variables in the ANAC questionnaire: Several job resources (lack of discrimination, fairness, career and professional development, job autonomy, and organizational goals' sharing) and outcomes of well-being at work, such as health and safety at work and sense of belonging. The research was carried out among workers in an Italian hospital in Northwest Italy (N = 1170), through an online self-report questionnaire. Data were grouped into two job categories: Clinical staff (N = 939) and non-clinical staff (N = 231). The hypothesized model was tested across the two groups through multi-group structural equation modeling. Results showed that health and safety at work and sense of belonging had significant positive relationships with the other variables; some differences emerged between the determinants of the two outcomes and among groups. The study aims to identify some reflections and suggestions regarding the assessment of well-being in the health care sector; implications for practice are identified to promote organizational well-being and health in organizations.

Increasing early surgery within 2 days for hip fracture: a time trend in 15 EU countries (2000-13).

OBJECTIVE: To analyse the trajectories of hip-fracture surgery rates within 2 days of admission to the hospital and the ratios of procedures initiated within the same day (Day 0) and the following day (Days 0-1) to procedures performed on the 2nd day. To study the association between socioeconomic, health input variables and early surgery. DESIGN: A pooled, cross-sectional, time-series analysis was used to evaluate secondary data from 15 European countries, during 2000-13. RESULTS: The rate of patients aged ≥65 years that were operated on within 2 days of hip-fracture has changed over time with an EU average annual increase of 0.42% (95% CI = 0.25, 0.59; P < 0.001) and with a significant linear trend. Multiple slopes from all the countries compete with this result. In contrast, the ratios of procedures initiated within the same day (Day 0) and the following day (Days 0-1) compared to procedures performed on the 2nd day are constant.No association was found between the rate of patients treated within 2 days of admission and demographic structure, health expenditure, health resources. However, the rate of patients treated within 2 days of admission is significantly associated with surgical volumes. CONCLUSIONS: As the early surgery rate is growing, policy makers should be encouraged to undertake further policies to support the quality of care, and the providers should be driven to improve their organizational effectiveness by taking actions aimed at acting on specific organizational and logistical causes that represent a barrier to early surgery.

Organized screening programmes for breast and cervical cancer in 17 EU countries: trajectories of attendance rates.

BACKGROUND: The aim was to analyse participation trajectories in organised breast and cervical cancer screening programmes and the association between socioeconomic variables and participation. METHODS: A pooled, cross-sectional, time series analysis was used to evaluate secondary data from 17 European countries in 2004-2014. RESULTS: The results show that the mammographic screening trend decreases after an initial increase (coefficient for the linear term = 0.40; p = 0.210; 95% CI = - 0.25, 1.06; coefficient for the quadratic term = - 0.07; p = 0.027; 95% CI = - 0.14, - 0.01), while the cervical screening trend is essentially stable (coefficient for the linear term = 0.39, p = 0.312, 95% CI = - 0.42, 1.20; coefficient for the quadratic term = 0.02, p = 0.689, 95% CI = - 0.07, 0.10). There is a significant difference among the country-specific slopes for breast and cervical cancer screening (SD = 16.7, p < 0.001; SD = 14.4, p < 0.001, respectively). No association is found between participation rate and educational level, income, type of employment, unemployment and preventive expenditure. However, participation in cervical cancer screening is significantly associated with a higher proportion of younger women (≤ 49 years) and a higher Gini index (that is, higher income inequality). CONCLUSIONS: In conclusion three messages: organized cancer screening programmes may reduce the socioeconomic inequalities in younger people's use of preventive services over time; socioeconomic variables are not related to participation rates; these rates do not reach a level of stability in several countries. Therefore, without effective recruitment strategies and tailored organizations, screening participation may not achieve additional gains.

[The missed care in Nursing Homes: a pilot study]. / Le Missed Care negli ospiti delle residenze sanitarie per anziani:risultati di uno studio pilota.

. The missed care in Nursing Homes: a pilot study. INTRODUCTION: To date missed care have been described mostly in hospitals and data on nursing homes (NH) are missing. AIM: To describe missed care in NH residents identifying their perceived impact and seriousness. METHODS: A pilot study was conducted in 10 Piedmont NHs. For each omitted or delayed care on 20 residents observed for 3 consecutive days, the nurses provided information on the type of care, and information on the residents and on the organization were collected. RESULTS: Twenty-three nurses reported 57 missed care for 44/200 residents (22%; median 5 for each NH, range 0-13). Twenty-five missed/omitted care on 20 residents were considered of medium/high severity: 14 (56%) involved drug therapies and 5 (20%) the monitoring of vital signs. The level of severity derived from the distress caused to the resident, the risk of deterioration of residents'conditions and the repeated omissions on the same resident. Of the 32 missed care on 25 residents, judged of limited impact, the more frequent were dressing changes (12, 37.5%), and drugs administration (10, 31.3%). The most frequent reasons for delay/omission were unplanned events (16, 28.1%), shortage of nurses (12, 21.1%), and residents' clinical conditions (9, 15.7%). CONCLUSIONS: Missed care occur also in NHs. If staff shortage play a key role among potentially modifiable factors, a sizeable number of omission is associated to unlikely forseeable or avoidable events.

Predictors and trajectories of antibiotic consumption in 22 EU countries: Findings from a time series analysis (2000-2014).

BACKGROUND: This study analyzes the trajectories of antibiotic consumption using different indicators of patients' socioeconomic status, category and age-group of physicians. METHODS: This study uses a pooled, cross-sectional, time series analysis. The data focus on 22 European countries from 2000 to 2014 and were obtained from the European Center for Disease and Control, Organization for Economic Co-operation and Development, Eurostat and Global Economic Monitor. RESULTS: There are large variations in community and hospital use of antibiotics in European countries, and the consumption of antibiotics has remained stable over the years. This applies to the community (b = 0.07, p = 0.267, 95% -0.06, 0.19, b-squared <0.01, p = 0.813, 95% = -0.01, 0.02) as well as the hospital sector (b = -0.02; p = 0.450; CI 95% = -0.06, 0.03; b-squared <0.01; p = 0.396; CI95% = > -0.01, <0.01). Some socioeconomic variables, such as level of education, income, Gini index and unemployment, are not related to the rate of antibiotic use. The age-group of physicians and general practitioners is associated with the use of antibiotics in the hospital. An increase in the proportion of young doctors (<45 years old) leads to a significant increase in antibiotics consumption, and as the percentage of generalist practitioners increases, there use of antibiotics in hospitals decreases by 0.04 DDD/1000 inhabitants. CONCLUSIONS: Understanding that age-groups and categories (general/specialist practitioners) of physicians may predict antibiotic consumption is potentially useful in defining more effective health care policies to reduce the inappropriate antibiotic use while promoting rational use.

The switch between cataract surgical settings: Evidence from a time series analysis across 20 EU countries.

OBJECTIVES: To analyze trajectories of cataract surgery rates and to confirm the switch between inpatient cases and day surgery or outpatient cases. DESIGN: Pooled, cross-sectional, time series analysis. METHODS: Data on 20 European countries from 2004 to 2014 retrieved from the OECD. RESULTS: The number of cataract surgery cases per 100,000 population has increased since 2004 (b = 31.1, p < 0.001, 95% CI = 26.7, 35.6). A reversal of the inpatient cases and same-day cases was found: the first ones decreased (b = -14.7, p < 0.001, 95% CI = -17.7, -11.8) while day surgery and outpatient cases increased (b = 37.5, p < 0.001, 95% CI = 31.6, 43.4, and b = 8.3, p = 0.001, 95% CI = 3.6, 13.1, respectively). Since 2004, the ratio of day surgery and outpatient cases to inpatient cases has grown significantly (b = 3.3, p < 0.001, 95% CI = 2.5, 4.0), reaching a share of 31.7 in 2014. However, this slope of 3.3 was not constant and slowed over the years: from 4.5 per year during the first five years to 1.9 in the second five. No association was found between cataract surgery rate and two regressors: elderly people, and health care expenditure per capita. CONCLUSION: EU countries have preserved cataract surgery, and this preservation is probably affected by the switch from inpatient to same-day surgery, thanks to the decrease in the cost and equivalent clinical outcomes. However, the slope of the switch slowed over time. Consequently, health care systems must support this process of change especially through reforms in financial and organizational fields.

Medication discrepancies across multiple care transitions: A retrospective longitudinal cohort study in Italy.

PURPOSE: Medication discrepancies are defined as unexplained differences among regimens across different sites of care. The problem of medication discrepancies that occur during the entire care pathway from hospital admission to a local care setting discharge (namely all types of settings dedicated to formal care other than hospitals) has received little attention in the medical literature. The present study aims to (1) determine the prevalence of medication discrepancies that occur during the entire care pathway from hospital admission to local care setting discharge, (2) describe the discrepancy and medication type, and (3) identify potential risk factors for experiencing medication discrepancies in patient care transitions. Evidence from an integrated health care system, such as the Italian one, may explain results from other studies in different healthcare systems. METHODS: A retrospective longitudinal cohort study of patients admitted from July 2015 to July 2016 to the Giovanni Bosco Hospital serving Turin, Italy and its surrounding territory was performed. Discrepancies were recorded at the following four care transitions: T1: Hospital admission; T2: Hospital discharge; T3: Admission into local care settings; T4: Discharge from local care settings. All evaluations were based on documented regimens and were performed by a team (doctor, nurse and pharmacists). RESULTS: Of 366 included patients, 25.68% had at least one discrepancy. The most frequent type of discrepancy was from medication omission (N = 74; 71.15%). Only discharge from a long-stay care setting (T4) was significantly associated with the onset of discrepancies (p = 0.045). When considering a lack of adequate documentation, not as missing data but as a discrepancy, 43.72% of patients had at least one discrepancy. CONCLUSIONS: This study suggests that an integrated health care system, such as Italian system, may influence the prevalence of discrepancies, thus highlighting the need for structured multidisciplinary and, if possible, computerized medication reconciliation to prevent medication discrepancies and improve the quality of medical documentation.

Trajectories of long-term care in 28 EU countries: evidence from a time series analysis.

Background: This study aims to confirm whether an increase in the number of elderly people and a worsening in the auto-evaluation of the general health state and in the limitation of daily activities result in increases in the offered services (beds in residential LTC facilities), in the social and healthcare expenditure and, consequently, in the percentage of LTC users. Methods: This study used a pooled, cross-sectional, time series design focusing on 28 European countries from 2004 to 2015. The indicators considered are: population aged 65 years and older; self-perceived health (bad and very bad) and long-standing limitations in usual activities; social protection benefits (cash and kind); LTC beds in institutions; LTC recipients at home and in institutions; healthcare expenditures and were obtained from the Organization for Economic Co-operation and Development and Eurostat. Results: The proportion of elderly people increased, and conversely, the percentage of subjects who had a self-perceived bad or very bad health decreased. Moreover, there was an orientation to reduce the share of elderly people who received LTC services and to focus on the most serious cases. Finally, the combination of formal care at home and in institutions resulted in most Member States shifting from institutional care to home care services. Conclusions: Demographic, societal, health changes could considerably affect LTC needs and services, resulting in higher LTC related costs. Thus, knowledge of LTC expenditures and the demand for services could be useful for healthcare decision makers.