[Differences in in-hospital mortality in patients treated with aortocoronary bypass for cardiopathic ischemia, Rome 1996]. / Differenze di mortalità intraospedaliera in pazienti sottoposti a bypass aortocoronarico per cardiopatia ischemica, Roma 1996.

Data from Health Information Systems (HIS) have been used in recent years to evaluate effectiveness and quality of care. We analyzed in-hospital mortality occurring within 30 days following operation among 1984 patients (age > or = 35 yrs, males 84%) who underwent Coronary Artery Bypass Graft (CABG) surgery in seven hospitals in Rome in 1996. Data were extracted from the Lazio HIS run by the Regional Health Authority. The HIS database includes up to four diagnoses and surgical procedures (ICD-9); the following variables were considered a priori risk factors: type of ischemic disease, comorbidities, and others surgical interventions during the same admission. Logistic regression was performed in order to evaluate the association between hospital and risk of mortality after adjusting for potential confounders (ORs and 95% CI). The overall in-hospital mortality was 4.7% (ranged from 0.0 to 14.7%). Predictors of outcome included: older age, acute myocardial infarction, chronic myocardial ischemia, other heart diseases, chronic renal diseases, peripheral vascular diseases, other heart and vascular interventions. Statistically significant variability in mortality was observed across hospitals; taking hospital A as reference, hospitals D and E showed the highest risks (OR = 6.36 and OR = 3.12, respectively). We conclude that the observed differences in mortality rates among hospitals cannot be explained by differences in case mix, nor by varying coding styles. They are likely to reflect differences in currently unknown aspects of patient care.

[Evaluation of training programs for purchasing and using pesticides]. / Valutazione dei corsi per l'abilitazione all'acquisto ed uso dei fitofarmaci.

Courses to enable farmers to use pesticides are an ideal opportunity to implement prevention programs. The aim of this study was to evaluate the efficacy of the courses and to define parameters to validate the teaching methods used. The population consisted of 307 individuals who followed the courses during 1991 in the province of Viterbo. A multiple choice questionnaire was administered before and after the course. A knowledge coefficient (KC) was considered as an indicator of knowledge improvement gained by the course. Wilcoxon's non-parametric test was used to compare pre- and post-test scores. A multivariate logistic model was designed to assess the effect of descriptive variables (age, educational level, years of work in agriculture, etc.) on KC. Post-test scores were significantly higher than pre-test scores and the mean KC was 60%, suggesting a general efficacy of the courses. A marked effect of age and educational level on KC was observed: KC values decreased with increase in age and with decrease in educational level. It is recommended to vary the courses according to age and educational level in view of the high proportion of older subjects and the low educational level (about 50%). Active learning methods should also be used as far as possible.