[150 years of hygienic requirements of dwellings in Italy]. / 150 anni di requisiti igienico-sanitari delle abitazioni in Italia.

In Italy Public Health legislation had, since unification of the nation in 1861, a peculiar consideration for building hygiene, with a particular focus on dwellings. The first law about these themes is the number 5849 in 1888, named Crispi-Pagliani, after the Italian prime minister of the time and the hygienist who collaborated in lawmaking. The authors of the present work describe how laws evolved during 150 years of history, passing through social, demographic, political, economical, cultural and scientific changes. In the meantime they try to explain the role of public health practitioners in this field, also in relation with administrative processes that changed in time. Everything considering how indoor environment and home in particular are fundamental determinants of health, nowadays that people in richest countries spend most of their lifetime in this particular environment.

[Evaluation of the appropriateness of public hospital use using AEP, Disease Staging, and other DRG-based criteria (essential levels of care--Italian LEA): results and degree of agreement among the different methodologies]. / Valutazione dell'appropriatezza organizzativa degli ospe- dali pubblici abruzzesi tramite PRUO, Disease Staging, e mediante il calcolo dei DRG ad alto rischio di inappropria- tezza secondo i "nuovi" e "vecchi" LEA: risultati e grado di concordanza tra le diverse metodiche.

Currently, more than one instrument has been found to be reliable and valid for the assessment of hospital admission appropriateness. However; data on the level of agreement among these methodologies are extremely scarce. The study was aimed at evaluating whether the percentages of organizational (in)appropriateness resulting from some of the most diffused instruments (Italian Appropriateness Evaluation Protocol--AEP/PRUO; Disease Staging; Essential Levels of Care--LEA, version 2001 and 2008) are substantially concordant, or they largely depend upon the methodology. For each public hospital of Abruzzo, Italy, the amount of inappropriateness has been computed using six indicators: inappropriate days of care (PRUO1); totally inappropriate admissions (PRU02); early admissions DRGs according to the first Law on Italian LEA (LEA01); admissions assigned to one of the 108 potentially inappropriate DRGs according to the second Law on Italian LEA, currently inactive (LEA08). The sample was composed by all ordinary admissions made in 2006 in the Region, with the exception of PRUO indicators, which were based upon the manual revision of 2% of all admissions that could be assessed using PRUO methodology. We found a good correlation among most indicators based upon administrative discharge data (DS1, DS2 and LEA01), whereas the results obtained using PRUO and new LEA (LEA08) were discordant, and marked differences were observed also between the two PRUO indicators. Although the limitations of the study permit only preliminary conclusions, in future appropriateness evaluations it may be reasonable to use more than one indicator--allowing the creation of combined scores--and rank hospitals in large categories--avoiding excessively precise scores--as such rankings might relevantly differ depending upon the used instrument.

Impact of prior or concomitant seasonal influenza vaccination on MF59-adjuvanted H1N1v vaccine (Focetria) in adult and elderly subjects.

BACKGROUND: When H1N1v vaccines become widely available, most elderly subjects will have already received their seasonal influenza vaccination. Adults seeking H1N1v vaccination may be offered seasonal vaccine as well. We investigated prior seasonal vaccination in adult and elderly subjects, and concomitant vaccination with seasonal vaccine in adults, on the tolerability and immunogenicity of the Novartis MF59-adjuvanted H1N1v vaccine, Focetria. METHODS: A total of 264 adult (four groups) and 154 elderly (three groups) subjects were enrolled. The licensure study cohorts for plain (Agrippal) and MF59-adjuvanted (Fluad) 2009-2010 seasonal vaccines were invited to receive Focetria 3 months later, with seasonal vaccine-naïve controls, and adults who received Focteria and seasonal vaccine concomitantly. Immunogenicity of all vaccines was assessed by haemagglutination inhibition on Days 1 and 22, safety and reactogenicity were monitored using patient diaries. RESULTS: All adult and elderly groups met all the European CHMP licensing criteria for H1N1v, as did adults receiving concomitant seasonal vaccine for the three seasonal strains. Vaccines were generally well tolerated, causing no SAEs, and profiles typical of MF59-adjuvanted vaccines. Reactions were mainly mild or moderate and transient, and unaffected by prior or concomitant seasonal vaccination except for elderly subjects previously given MF59-adjuvanted seasonal vaccine, whose reaction rates to Focetria were about half those seen in groups receiving their first MF59 vaccine. CONCLUSION: One dose of MF59-adjuvanted H1N1v vaccine met the licensure criteria for adult and elderly subjects 3 months after seasonal vaccination, or concomitantly with seasonal vaccine in adults, without impacting the tolerability or immunogenicity of either vaccine, thus facilitating mass influenza immunisation campaigns.

[Different use/abuse patterns (overweight/obesity, alcohol, smoking, drugs, cannabis, opiates, cocaine) according to job category. Results of a survey on 4024 young workers from Abruzzo, Italy: the Valentino Study]. / Gli abusi farmacologici, alimentari, da alcool, fumo e droga nelle diverse categorie professionali. Risultati di un'indagine conoscitiva su 4024 giovani lavoratori abruzzesi: il Progetto Valentino.

Using a multidisciplinary questionnaire containing items from previously validated instruments (i.e. CAGE), during the year 2007 a survey (Valentino Project) was carried out on 4024 young workers (18-35 y) from Abruzzo, Italy to investigate the prevalence of use/abuse of alcohol, food, smoking, and drugs in different types of job categories, and to evaluate the potential association between occupational class and type of use/abuse. With the exception of cannabis use/abuse (13.5%), the prevalence of incorrect behaviours was higher than the young-adult general population (workers and non-workers) from Central-South Italy: overweight/obesity = 30.8%; current smoking = 45.7%; alcohol addiction = 17.3%; use/abuse of psychotropic legal drugs = 4.7%; cocaine = 4.5%; opiates = 1.0%; > 1 illegal drug (multiple abuse) = 3.9%. This negative scenario is accentuated by a probable > or = 25% underestimation of illegal drug use/abuse, and because drug use/abuse is inversely associated with age. Using logistic regression analyses (controlling for age, gender marital status, education, job-strain, self-reported health, and all other types of use/abuse), a significant independent association was found for the first time between specific types of use/abuse and some job categories (i.e. cocaine for traders/consultants; legal psychoactive drugs and cannabis for unqualified professions such as itinerants or precarious workers; smoking for Call-Center operators; overweight/obesity for farmers/artisans). These findings should be used to maximize the efficacy of substance use/abuse preventive strategies, which could be more precisely targeted to different professions, and raise the need to control for job category in future multivariate analyses investigating substance use/abuse predictors.

Influenza vaccine effectiveness for the elderly: a cohort study involving general practitioners from Abruzzo, Italy.

INTRODUCTION: In all Italian regions influenza vaccine is routinely administered to the elderly population. However, vaccination impact has been rarely evaluated because of the high costs of conventional cohort investigations. A promising low-cost alternative approach uses administrative discharge data to derive vaccine effectiveness indicators (hospitalizations and/or deaths) and involves General Practitioners (GPs) to document the exposure. We conducted a cohort analysis using such approach to assess influenza vaccine effectiveness and to investigate the feasibility and validity of that methodology for routine vaccine evaluation. METHODS: During October 2006, all GPs from two Local Health Units (LHUs) were requested to indicate immunization status of all their patients in a specific form containing patient's demographic records. Immunization status information were also collected from Prevention Departments. Main outcomes were hospitalizations for influenza and/or pneumonia. Analyses were based upon random-effect logistic regression. RESULTS: Of a total of 414 GPs assisting 103,162 elderly, 116 GPs (28%) provided data on 32,457 individuals (31.5%). The sample was representative and had an overall 66.2% vaccina-tion rate. During the first semester 2007, the hospitalization rate was low in the sample, with only 7 elderly patients admitted for influenza and 135 for pneumonia. At either bivariate or multivariate analysis, vaccination did not significantly reduce the risk of in-hospital death, influenza or pneumonia admission. DISCUSSION: The study had minimal costs, recruited a large and representative sample size, and had no evidence of a substantial selection bias. Administrative and GP's data may be successively pooled to provide routine assessment of vaccination effectiveness.

[Disease staging analysis of the timeliness and appropriateness of hospital admissions: no relevant improvements in the Abruzzo Region of Italy from 2001 to 2005]. / Analisi tramite Disease Staging della tempestività dei ricoveri quale indice di appropriatezza di utilizzo dell'assistenza ospedaliera: assenza di miglioramento nella Regione Abruzzo nel quinquennio 2001-2005.

The study was aimed at evaluating whether the degree of hospital admission inappropriateness and timeliness was improved in the Abruzzo Region of Italy between the year 2001 and 2005. All hospital admissions for the year 2001 (n = 286,924) and 2005 (n = 280,761) in the Region were analysed (SDO discharge data), and three diseases were in-depth reviewed: diabetes mellitus; cholecystitis/cholelithiasis; and bacterial pneumonia. Using Disease Staging methodology, the timeliness of hospitalisation was assessed by grouping admissions in three categories: premature or medically unnecessary, timely, and late. Overall, the rate of medically unnecessary admissions for diabetes mellitus was 72.3% in 2001 and 73.4% in 2005. The percentage of late hospitalizations for the same disease was still 20.2% in 2005, when the rate of late admissions for cholelithiasis/cholecystitis was 53.3% (+10.5% compared to 2001);for bacterial pneumonia 14.5%. The rate of early admissions did not improve for any disease, and any of the six local health units in Abruzzo showed an improvement in all the measures evaluated. In the period 2001 and 2005, in the Abruzzo Region there is no evidence of an improvement in the rates of inappropriate hospital admission, both early and late, which are still excessively high for all diseases examined excepted bacterial pneumonia. Interventions to address this issue are strongly needed.

Long-term adherence to first-line highly active antiretroviral therapy in a hospital-based cohort: predictors and impact on virologic response and relapse.

A high level of adherence to highly active antiretroviral therapy (HAART) is essential to minimize the risk of treatment failure and HIV disease progression. This cohort study evaluated the prevalence and predictors of long-term adherence with first-line HAART in a hospital-based unselected sample of HIV patients from central Italy, and examined the association between adherence and virological response or relapse. Between July 1996 and June 2004, 171 patients (67.3% males; mean age, 41.2 years) were followed for at least 24 weeks and up to 8 years. Adherence was measured by patient self-reports and confirmed using pharmacy records. The prevalence of high-level adherence (>or=90%) at 6 months was 88.3%; slightly less than 80% at 12 months. The incidence of adherence failure in the sample remained fairly stable until 24 months of follow-up, then it declined about 5% every 6 months. Cox analysis showed that compared to single/separated patients, homeless and married persons were, respectively, 1.95 times more likely and two times less likely to experience adherence failure (p < 0.05). The adjusted risk of adherence failure among patients who did not suffer drug-related toxicity was 0.57 (p < 0.05). Medication adherence was significantly associated with shorter time to virological response and longer time to relapse. Adherents were 1.69 times more likely to achieve viral suppression and nine times less likely to experience relapse than nonadherents (p < 0.01). Efforts at improving adherence should be prolonged for at least 24 months. A protective role of marriage for adherence failure is promising but requires confirmation in further research, that should also clarify the exact mechanisms determining the association.

[Epidemiology of hospital loads in patients with multiple hospitalizations due to diabetes]. / Epidemiologia dei carichi assistenziali ospedalieri in pazienti con ricoveri ripetuti per diabete.

This study describes the results of a retrospective study carried out to evaluate the hospitalizations of patients with type 2 diabetes admitted from January to June 2001 in the teaching hospital "SS. Annunziata" of Chieti. This research evaluates the generic appropriateness using the PRUO manual and the specific appropriateness using the guidelines approved by Italian Diabetes Association, Italian Diabetes Society and Italian College of General Practitioners. A sample of 196 medical charts was examined. The percentage of inappropriate admission was 21.9%. The "critical" clinical conditions of patients were responsible for only 23.7% of inappropriate admissions. The first reason of the inappropriateness of the admission was the execution of diagnostic examinations (60.5%), followed by the execution of medical therapy (23.2%) and waiting for surgical intervention (16.3%). 46.5% of inappropriate hospitalization was prescribed by specialists. Concerning specific appropriateness, 42.3% of hospitalization was inappropriate. These findings suggest that a system for the assessment of disease management of diabetes should be started up in the Abruzzo region. Moreover, guidelines utilization should be implemented in order to get a more correct utilization of acute hospital by specialists and GPs.

[Prevalence of obesity, overweight and hypertension in children and adolescents from Abruzzo, Italy]. / Prevalenza di obesità, sovrapeso e ipertensione nei bambini e adolescenti della provincia di Pescara.

The present survey was aimed at determining the prevalence of overweight, obesity, hypertension, their correlation and the association with gender, age and provenience, in the pediatric population of Pescara province, Italy. During the academic year 2001-2002, the body mass index (BMI) and blood pressure of 15.612 scholars aged 6-14 years (mean age 9.9), coming from all province schools, have been measured. Two scales have been used to define obesity and overweight status (one developed by the National Center for Health Statistics--NCHS--the other by Cacciari et al.); while hypertension has been attributed using National Institute of Health curves. Several multiple logistic regression models have been fitted to analyze data. According to NCHS standards, the prevalence of childhood and adolescence overweight and obesity was, respectively, 40.6% and 19.5%. Using curves by Cacciari, the prevalence were 33.3% and 7.7%. Hypertensive subjects were 11.1%. With both scales, the prevalence of weight problems widely decreased after 12 years of age, and either obesity or overweight were significantly related with male sex, hypertension and rural area residence. A strong independent association was found between living inside the city and hypertension. Although the differences in the dimension of the problem "overweight" according to the used scale, and a potential overestimation of hypertension must be taken into account, the overall data suggest an urgent need, especially for primary school children, of preventive interventions aimed at reducing both overweight and blood pressure.

Smoking behaviour, cessation attempts and the influence of parental smoking in older adult women: a cross-sectional analysis from Italy.

OBJECTIVES: To investigate the association between parental smoking during infancy/adolescence and smoking prevalence in older adult women, and to provide a description of smoking and smoking cessation patterns in this subset of the population. STUDY DESIGN: Cross-sectional survey. METHODS: Between 1999 and 2001, trained physicians in 11 health agencies throughout the Abruzzo Region, Italy, conducted semi-structured interviews on 9708 women aged 50-70 years attending mammographic screening (overall response rate 89%). Information was collected on sociodemographic characteristics, smoking habits, parental smoking during their infancy and/or adolescence, and exposure to environmental tobacco smoke (ETS) inside or outside the family. RESULTS AND CONCLUSIONS: The overall prevalence of current smoking was 15.6% (n=1516), and that of former smoking was 13.2%. Women whose parent(s) smoked were more likely to be current smokers, especially if only the mother smoked (adjusted odds ratio 4.27; 95% confidence interval 2.24-8.12). Other factors significantly associated with current smoking in the multivariate analysis were younger age, lower body mass index, higher level of education, unmarried status, and exposure to ETS either inside or outside the family environment. Eighteen percent of all current smokers were non-inhalers, and more than 60% of ex-smokers quit smoking on their first attempt. Our findings expand the existing evidence suggesting that a strong effect of parental conduct on a daughter's smoking behaviour may persist throughout life. Although more research is needed, especially to clarify the role of genetic and environmental factors in determining the mother-child smoking association, our results suggest that intensifying smoking prevention efforts directed at women with children might considerably reduce the risk of ever smoking in future female generations.

Addition of teicoplanin or vancomycin for the treatment of documented bacteremia due to gram-positive cocci in neutropenic patients with hematological malignancies: microbiological, clinical and economic evaluation.

A prospective, randomized, double-blind trial was conducted on 124 febrile patients with hematological malignancies to compare teicoplanin with vancomycin as an addition to the initial empiric amikacin-ceftazidime regimen after documented bacteremia due to gram-positive cocci. At enrollment, patients in both groups were comparable with respect to age, sex, underlying hematologic disorders and duration of neutropenia. Rates of therapeutic success were 55/63 (87.3%) in the teicoplanin group and 56/61 (91.8%) in the vancomycin group (p = 0.560). The mean duration of treatment was similar, being 12.2 and 11.4 days, respectively (p = 0.216). Patients treated with teicoplanin remained febrile for slightly longer than those treated with vancomycin (4.9 vs. 4.0 days) (p = 0.013). Thirteen patients experienced an adverse drug reaction, but without any significant difference in the two arms. Isolated staphylococci showed a progressive and significant decrease in susceptibility to both glycopeptides during the 8 study years. The economic analysis performed showed that the addition of vancomycin is cost-saving.

[Appropriateness of hospitalization in the teaching hospital of Chieti using the P.R.U.O. approach]. / Valutazione dell'appropriatezza dei ricoveri con la metodica P.R.U.O. nell'ospedale clinicizzato di Chieti.

This study describes the results of a research carried out to evaluate inappropriate admissions and totally inappropriate hospitalizations (RTI) in the teaching hospital "SS. Annunziata" of Chieti using the 1999 version of the PRUO manual. A random sample of 1218 medical charts, drawn from all the medical charts of patients admitted from June to December 2000 in the units of Medicine, Surgery and Orthopaedics, was selected. The percentage of inappropriate admissions was 38.2%, while totally inappropriate hospitalizations were 18.1%. The highest percentage of inappropriate admissions was in the class of age 55-64 years. Moreover, inappropriate admissions were more frequent in the morning hours (7:00-12:59) and, within the week, on Monday. The first reason of inappropriateness of the admission, was the execution of diagnostic examinations (62.2%), followed by the execution of medical therapy (19.3%) and waiting of surgical intervention (13.4%). Short hospitalizations (2-3 days) are more frequently totally inappropriate as compared to longer hospitalizations. These findings suggest that a system for the assessment of appropriateness of hospitalizations should be established in the Abruzzo region including all accredited public and private hospitals.

-Dual nucleoside therapy for HIV infection: analysis of results and factors influencing viral response and long term efficacy.

We performed a retrospective analysis of our experience with dual nucleoside regimens to look for predictors of long term benefit. The study evaluated a cohort of 68 HIV-infected patients treated at 3 Italian hospital-based facilities. The results were evaluated using univariate and multivariate statistical analysis. Fourty-three males and 25 females were treated for 22 +/- 14 months. Sixty three patients (92.6%) suffered no or low-grade side-effects. Thirty-four patients (50%) reached a viral load <400 copies/ml (undetectable). Viremia remained persistently undetectable in 9 cases (13.2%). Variable relapses of viremia were seen in 13 patients (19.1%) even though their therapys were not modified. Eight patients (11.8%) showed relapsing viremias persistently around or below 10,000 copies/ml. All patients reaching undetectable viremia but one showed increasing or stable CD4+ cell counts. Factors predicting favourable response were: pre-treatment CD4+ T-cells >150/microl, pre-treatment viremia <50,000 copies/ml, pre-treatment lymphocytes >1,500/microl, and no previous exposure to NRTI. Total lymphocyte counts and CD4+ T-cells showed a significant correlation. Dual NRTI regimens may be still considered for patients unable to tolerate HAART regimens and presenting with favourable predictors of response.

[Factors related to the uptake of breast cancer screening (mammography and breast ultrasound): a retrospective survey on a sample of resident women, 50-70 years aged, from Abruzzo region]. / Fattori predittivi dell'utilizzo di metodiche preventive per il tumore del seno (mammografia ed ecografia mammaria): indagine retrospettiva su un campione di donne abruzzesi, di età compresa tra 50 e 70 anni.

Within the context of a large breast cancer screening program we conducted a retrospective survey to identify the personal, socioeconomic and behavioural characteristics associated with previous use of mammograms (Ma) and breast ultrasound examination (US). Contact was made with a sample of more than 10,000 resident women who were asked to complete three questionnaires. Achieving an answer rate of 86%, we collected data from 9,087 women, 50-70 years aged, coming from Abruzzo, a central Italian region. 61% of the participants performed Ma, while US was performed by 34%, and 67% of women attended at least one of those examinations. Multiple logistic regression results indicated that older age, low level of education, not performing diets and breast self examination were significant predictors of a lower use of both examinations. Women that were married, mothers, on menopause, with a family history of cancer, uterine fibroma, past users of oral contraceptives were more likely to having performed Ma, but not US. Age at menarche, BMI and smoking were found not to be significant in predicting attendance for both screening examinations, with the exception of ex-smokers for US. Our findings represent an important contribution to the development of the needed tailored interventions to increase breast screening participation.

Factors influencing psychological stress levels of Italian peacekeepers in Bosnia.

OBJECTIVE: The present study evaluated the factors that contribute to stress and the psychological difficulties of the Italian military component of the United Nations Mission in Bosnia and Herzegovina. This group was compared with a homogeneous group stationed in Italy. METHODS: A cross-sectional study was performed in two groups of career military personnel: 452 subjects who were stationed in Bosnia as peacekeepers and 166 who were stationed in Italy. All subjects completed two multiple-choice questionnaires (a stress self-evaluation test and a socioeconomic questionnaire) during various periods of duty. RESULTS: The responses to the stress self-evaluation test indicated that the peacekeepers did not show a statistically significant increase in stress. Those who were affected by stress, though, indicated that the level was high. The principal variables that were associated with a greater level of stress were length of the mission, lack of recreational or athletic activities during the mission, more than three family members, and unemployment before enrollment. CONCLUSIONS: Peacekeepers come from an economically poor environment, have large families, and usually have a history of unemployment. Along with these preenrollment risk factors, the effective time spent in recreational activities and the length of the mission also influence stress levels. Individual and group techniques for stress management should be implemented.

Survey of Lyme disease in Abruzzo (Italy).

This study reports the diagnostic activity for the serological diagnosis of Lyme Disease (LD) in the patients of Abruzzo, a central region of Italy. During the period from August 1994 to July 1999, serological examinations for anti-Borrelia burgdorferi antibodies were performed on 1089 samples from 769 patients with symptomatology consistent with LD. Using an immunoenzymatic technique which was confirmed with Western Blot, 29 patients were diagnosed positive. Twenty-five of these patients contracted the disease in Abruzzo, two during a trip to the USA, one was from Molise and one from Marche. Overall the patients were young, 64% were women and residents of costal areas who frequently engaged in naturalistic activities. The most common symptoms were articular and one patient presented Bannwarth Syndrome. The various antibiotic therapies used gave good results in most cases. These are the first cases reported in literature for this region and for Molise. We believe that LD is underestimated, especially due to the favorable climatic and environmental conditions present in this region. Therefore, we suggest an intensification of clinical and epidemiological controls.

Routine preoperative investigation. Results of a multicenter survey in Italy. Collaborator Group.

We conducted a study to acquire information on the current behavior of a sample of Italian surgeons and anesthesiologists about prescribing, interpreting, and using routine preoperative investigations. Consultants in surgery and anesthesiology in 60 hospitals in northern, central, and southern Italy were interviewed. Prescription of these procedures by doctors were driven more by personal experience than by updated scientific knowledge. This practice often led to ineffective and inefficient clinical practice, with healthy patients undergoing useless, time-consuming, costly, and sometimes harmful procedures.