Organizational Health Literacy as a supportive tool for the effective implementation of the 2013/59/EURATOM Directive in Italy.

INTRODUCTION: Since 2013, European countries have transposed the 2013/59/EURATOM Directive that lays down basic safety standards for protection against dangers arising from exposure to ionising radiation. In the years between the issuance of the European Directive and its formal transposition, Italian researchers investigated solutions to renew the technological, educational, and organizational culture in radiology departments. SCOPE: This article proposed a reflection on the contribution of Organizational Health Literacy (OHL) to implement Legislative Decree 101/2020 in the practice of Italian radiology departments. RESULTS: By implementing OHL principles, examinations with exposure to ionizing radiation and related informative processes could be personalized based on patients' knowledge, abilities, and competencies, as well as on the services' provision. These principles can be in fact integrated with the organizational, training, and management requirements set by the Directive. CONCLUSIONS: According with the state-of-the-art, decision-makers and health managers could support the application of OHL principles in Italian radiology departments.

Governance models for historical hospitals: evidence from Italy.

Many hospitals and health care organizations over the centuries have inherited handcrafts of artistic value, objects of worships, donations from pilgrims, votive offerings, legates as a result of their centuries-old activity in the social and health care of their community. The value of these artistic assets and the role in the territory of these hospitals have transformed them into cultural heritage over time, introducing the issue of the coexistence of cultural and care management. Therefore, the aim of this paper is to identify governance models of what we will call historical hospitals, that is, hospitals that because of their history, their assets, and their artistic heritage, far from being places only dedicated to provision of health care services represent cultural heritage. To pursue this research objective, five Italian historical hospitals were selected and identified as significant case studies for their historic and artistic relevance. Through the analysis of these case studies the paper identifies models of governance of historical hospitals and the reasons of their adoption.

Art therapy in Alzheimer's disease. An opportunity of collaboration between intersectoral public and private organizations in the co-design of health and social care services.

Introduction: The World Health Organization (WHO) has recognized art therapy as an effective supportive mechanism for the maintenance and restoration of mental health. In recent years, art therapy has been integrated in the assistance pathways of older people affected by neurocognitive disorders according to the demonstrated benefits, as no conflicts with pharmacologic treatments and the reduction of anxiety and stress. The shortage of organizational, economic, and professional resources in social-health public organizations does not allow for guaranteeing the provision of these services without the help of the private ones, not exclusively belonging to social-health sector. This research aims to investigate how the collaboration between public and private organizations of different sectors in the co-provision of non-pharmacological approaches guarantees the economic sustainability and the quality improvement of the provided services. Methods: The Alzheimer Café of Prato was selected as a significant case study. Results and Discussion: Art therapy programs intended for taking care of older people in the first stages of the Alzheimer's disease have been developed, planned, supplied, and managed over the years as a result of the integration of resources, ideas, and professionals provided both by public and private sectors, the social-health sector, and cultural organizations. Conclusions: The peer-to-peer co-responsibility of all organizations (public and private, from the cultural sector as well as the social and health sector) involved in the co-design of art therapy programs, not limiting their actions to only co-financing and/or co-delivery of the service, enabled the achievement of the economic sustainability of the services and the improvement of their quality.

Health literacy and breast cancer screening adherence: results from the population of Tuscany, Italy.

Mammographic screening can reduce breast cancer (BC) mortality in women. In Italy, although attendance rates increased recently, they are still far from the recommended levels internationally. Inadequate health literacy (HL) may be a reason for poor awareness and/or knowledge about the importance of completing cancer screening. This study examined the relationship between HL, other sociodemographic determinants, and their influence on participation in both opportunistic and organized BC screenings among women aged 50-69 in Tuscany. The study analyzed 2017-2019 data from the Tuscan population subsample in the Italian Behavioral Risk Factor Surveillance System PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia). HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6). Among the 2250 interviewees, 75.3% underwent the organized BC screening and 9.4% on voluntary basis. Although to a different extent, HL was significantly associated to compliance rates with both opportunistic and organized screenings. Among sociodemographic factors, only occupational status was associated with opportunistic screening attendance rates. As expected, being invited by letter resulted to be strongly associated with participation to organized screening programs and the medical advice predicts for participating to both opportunistic and organized screening. This study highlights the relevant role that HL plays in BC, opportunistic and organized, screening adherence in a universal healthcare system. To increase BC screening participation rates, healthcare systems would benefit by implementing interventions for improved HL at population level or within healthcare organizations.

Catecholamine-induced Takotsubo syndrome: a case series.

Background: Catecholamine-induced Takotsubo Syndrome (cat-TS) is a type of secondary Takotsubo syndrome, characterized by rapid onset of symptoms, high rate of complications during the acute phase, good short-term prognosis, and frequent apical sparing at echocardiogram. We present two clinical cases of cat-TS treated in our department. Case summary: Case one: 78-year-old man, admitted to Ear Nose and Throat Unit for surgical removal of oral squamous cellular carcinoma. During surgery, the occurrence of hypotensive episode was treated with catecholamines. After surgery, the occurrence of atrial fibrillation was followed by evidence of phasic increase of troponin levels and akinesia of midventricular segments. Angiography showed the absence of significant coronary stenoses, and during hospital stay, we observed rapid recovery of wall motion abnormalities. Case two: 64-year-old woman, admitted for hysteropexy surgery, during which cardiac arrest occurred, treated with epinephrine i.v.1 mg and DC shock. Two hours after resuscitation, the patient developed pulmonary oedema, troponin levels increased progressively, and the echocardiogram demonstrated hypokinesia in all midventricular segments with apical sparing. Afterwards, an urgent angiography highlighted normal coronary anatomy. Cardiac magnetic resonance imaging (MRI) revealed oedema corresponding to hypokinetic areas. On the seventh day, echocardiogram showed a complete remission of wall motion abnormalities. Discussion: These cases warn the physicians about the importance of routinely screening myocardial impairment through clinical assessment, electrocardiogram (ECG) monitoring, and serial cardiac troponin testing after catecholamine i.v. bolus administration. In case of alterations of these exams, performing a prompt echocardiogram allows early detection of cat-TS, to provide immediate suitable medical support and avoid complications.

The inequalities reduction through healthcare decentralisation in low-middle income countries: The case of Tunisia.

Healthcare decentralisation is a model of public service management founds on the wider distribution of the decisional power about healthcare. The decision power is split by central government also with the local health authorities. Since the 1980s, at worldwide level this reform has being applied for guaranteeing equity, efficiency, quality and financial sustainability in the healthcare services provision. In the last years, healthcare decentralisation is happening especially in low-middle income countries. With regard to the analysis of the effectiveness of decentralisation in healthcare, the obtained results are mixed. This study aims to investigate the contribution of management in the first steps of decentralisation's implementation for reducing health inequalities in Tunisia. To have the management's point of view, a survey was sent to all directors of the Tunisian regional hospitals. Health management was able to offer operative and timely solutions to the homogenisation and the improvement of healthcare services supply in Tunisia. For healthcare managers the guarantee of an equal and effective Tunisian healthcare system is into the application of a differentiated decentralisation. The differentiated decentralisation of healthcare system allows to resolve regional issues in Tunisia. These interventions permit to obtain consistent positive results about the satisfaction of Tunisian population health needs. The differentiated decentralisation of healthcare system could also be useful for similar countries, for example, of MENA are of low-middle income countries.

The Contribution of Cultural Heritage Owned by Local Health Authorities in the Humanization of Care: The Point of View of Top Management.

After the COVID-19 pandemic, reforms in healthcare systems have the purpose to fully recover the relationship of healthcare organizations with their patients. For centuries, art was used throughout Europe in the healthcare context for its power to engage and support patients in their illnesses. This approach can be rediscovered by utilizing the cultural heritage owned by Local Health Authorities. In this context, tradition, art, innovation, and care coexist. This study aims to investigate the interest in developing projects for the humanization of care by the top management of Italian Local Health Authorities, in particular exploiting their cultural heritage. The evaluation of the proposal was conducted using semi-structured interviews with the top management of two Local Health Authorities, in which the Santa Maria Nuova hospital in Florence and the Santo Spirito in Sassia Hospital in Rome are located, as the two selected cases for this study. The interviewees welcomed the proposal to develop humanization of care projects involving the use of their cultural heritage. Moreover, they expressed their desire to invest human, economic, and structural resources in the development of these initiatives. The implementation of humanization of care projects using cultural heritage owned by Local Health Authorities is useful to apply specific policies to enhance the governance of the cultural heritage according to the health mission. On the other hand, it permits the search for additional or ad hoc resources. Finally, it is possible to humanize and improve patients' experience while increasing awareness among the health workforce and trainees.

[BRIC-59 study: first results and considerations on the pathway on the access to health care for malignant pleural mesotheliomas]. / Studio BRIC-59: primi risultati e riflessioni sul percorso sanitario dell'accesso alle cure per mesotelioma maligno pleurico.

OBJECTIVES: to define the most frequent health pathways of cases affected by malignant pleural mesothelioma according to those suggested and evaluated by the most recent specific guidelines. DESIGN: epidemiological descriptive study. SETTING AND PARTICIPANTS: 100 cases histologically or cytologically well defined during 2015-2017 are extracted from the archive of two Regional Mesothelioma Registries: in Tuscany Region (Central Italy) they are randomly extracted, while in Lombardy Region (Northern Italy) cases treated by a highly-specialized health centre are collected. MAIN OUTCOME MEASURES: frequency of the diagnostic and therapeutic procedures; development and application of the checklist with evaluation of the duration of some phases of the predefined pathway. RESULTS: all hospital medical records were collected only for 34 cases in Tuscany and 20 cases in Lombardy. The health examinations were supplied according to each case's health condition and it was not possible to define one or more structured and standardized pathways. The pre-diagnostic phase has a variable duration according to the initial health condition of the patient, also for his/her comorbidity, and to the hospital where he/she was hospitalized at first. The examinations in outpatient services (medical examinations, blood chemistry tests and radiological examinations) are several, but they are specially requested during the pre-diagnostic phase and during the period of chemotherapy. The checklist applied to a subset of Tuscan cases shows a large variation of the length of the pre-diagnostic phase (6-330 days), of the time interval between diagnosis and reporting to mesothelioma registry (1-200 days), and of the survival time (8 days - alive at 31.12.2019). CONCLUSIONS: to obtain the best health pathways for malignant pleural mesotheliomas, it is necessary a strong network among the health regional services with a clinical multiprofessional coordination located in hospitals characterized by a long experience on these cases, and with an active regional monitoring on all clinical, psychological, epidemiological, and legal aspects of the pathway. The regional mesothelioma registries could give a high contribution thanks to their epidemiological skills which are necessary for the monitoring.