[Atrial fibrillation: use of healthcare resources and expenditures in the Lazio region (Italy)]. / Fibrillazione atriale: attività assistenziale e assorbimento di risorse nella Regione Lazio.

Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia and is an important risk factor for mortality and morbidity related mainly to an increased risk of cerebrovascular events and heart failure.An observational cross-sectional study was performed to evaluate the use of healthcare resources (including hospital and outpatient care) by patients with AF in the Lazio region (central Italy), from 1 January 2006 to 31 December 2008.Atrial fibrillation is an important source of healthcare resource utilization because of repeated emergency room visits, hospital admissions, outpatient consultations and procedures and extensive use of laboratory tests and pharmacological treatments.Results show that 55% of costs are attributable to hospital admissions and Emergency Room visits, 37% to pharmacological treatment and the remaining 8% to outpatient care. These results are consistent with the international literature.The impact of AF in terms of cost is not negligible and it is therefore desirable to implement an organizational scheme that safeguards the appropriateness of care, taking charge of the patient as early as possible. The aims of early diagnosis of AF are to improve the appropriateness of care and optimize the use of specialized tests, thereby reducing hospital admissions for complications or recurrences of AF.

[Prioritizing prescriptions in a ambulatory care setting: a tool to achieve appropriateness of care in public health management]. / Il sistema di prioritarizzazione delle prescrizioni nell'ambito della specialistica ambulatoriale: uno strumento operativo nell'ottica dell'appropriatezza assistenziale.

Waiting lists are one of the main Public Health issues within developed countries. To promote appropriateness about General Practitioners' (GPs) prescriptions, during 2009 the project "Priority setting in outpatient prescriptions" in Latium Region has been approved. Regional referees, Latium Public Health Agency managers and advisors, managers and advisors of three Local Public Health Units (LPHUs) within the Latium region and some voluntarily recruited General Practitioners (each one with more than 800 patients enrolled) were included in a team work with the duty to develop the project. During two selected months of 2010, 46 GPs have forwarded overall 2.229 medical prescriptions. The six most numerous prescriptions were picked out and analyzed by the team work. 42% of these prescriptions were identified as belonging to category D of the priority level--"standard", while 42% and 41% of prescriptions bore the expressions of "control" and "diagnostic purpose" respectively. Among these ones, 75% were represented by bilateral mammography, prescribed to women aged between 50 and 69 years: but for those people bilateral mammography is already provided free of charge within the regional program of breast cancer screening, making the routine prescription by their physician a useless duplication, unacceptable in a healthcare system of good quality. Therefore at the conclusion of the project, the team work suggests proper standards be applied by healthcare professionals and GPs to achieve a significant objective: mammography appropriateness prescriptions.

[Hospitals between present and future]. / L'ospedale tra presente e futuro.

What role will hospitals play in the future of the healthcare system, and how this role will be changing? Hospitals of the future will confront difficult challanges: new kinds of disease, rapidly evolving medical technologies, aging of the population and evolving budget restrictions. All features that make it difficult to foresee the hospital of the future. The aim of this paper is to analyze the different challanges that hospital have to face in a modern scenario of evolution of public health services.

Factors associated with HIV testing: results from an Italian General Population Survey.

BACKGROUND: HIV testing, with appropriate counseling, can help prevent the spread of HIV infection. This study is the first national survey in Italy that examines factors associated with serotesting among Italian heterosexuals and is part of a European Concerted Action. METHODS: In 1998, a cross-sectional telephone survey was conducted on a random sample (n = 2,603) of the Italian population ages 18-49 years. Associations between HIV testing and risky sexual behaviors (multiple sexual partners in the past 5 years, intercourse with prostitutes, not always using condoms with a new sexual partner) and sociodemographic variables are examined separately for men and women using multiple logistic regression. RESULTS: The prevalence of having ever been tested for HIV, whether voluntarily or not, among heterosexual men and women is 27.0 and 32.8%, respectively. Voluntary testing is reported by 8.4% of heterosexual men and 6.1% of heterosexual women. Multivariate analysis shows that having multiple sexual partners significantly increases the odds of testing (Men: OR = 2.10; 95% CI: 1.3-3.4. Women: OR = 3.03; 95% CI: 1.7-5.4). Multiple logistic regression, controlling for risky behavior, shows also that persons ages 30-39 years have significantly higher probability of being tested than younger subjects (Men: OR = 3.30; 95% CI: 1.4-7.9. Women: OR = 2.61; 95% CI:1.1-6.4). Better educated women tend to have a higher probability of testing, but this increase is not significant at the 5% level. CONCLUSIONS: The prevalence of voluntary serotesting in Italy is lower than in other countries. Risky sexual behavior is associated with higher odds of testing; however, a high proportion of at-risk heterosexuals never sought testing. Particular attention should be dedicated to younger persons and to less educated women.

[Prevention focused on sexual behavior]. / La prevenzione mirata al comportamento sessuale.

In Italy, studies on the sexual behaviour of young persons are rare, especially those conducted among samples that are representative of the same-age general population. This report presents the preliminary results of a knowledge, attitudes and practices survey on sexual behaviour among a representative sample of individuals 18-26 years of age. The study was begun in 1994, and as of 30 June 1997, 8533 (32%) of the 26,536 questionnaires sent so far have been completed: 3947 (46%) by males and 4586 (54%) by females. 70% of the males and 64% of the females reported that they are sexually active; the median age at first sexual experience is 18 years for both genders. The proportion of respondents who use condoms with occasional sexual partners is low, and only half of the respondents demonstrated an adequate level of knowledge regarding the transmission of HIV.

Sunscreen use, wearing clothes, and number of nevi in 6- to 7-year-old European children. European Organization for Research and Treatment of Cancer Melanoma Cooperative Group.

BACKGROUND: Previous epidemiologic studies have suggested that sunscreen use is associated with an increased risk of melanoma skin cancer. Because high nevi (mole) count in adults is a strong predictor of melanoma, we conducted a study examining the number of nevi in 6- to 7-year-old European children, according to their sunscreen use. METHODS: Whole-body and site-specific counts of nevi 2 mm or larger were performed in 631 children in their first year of primary school in four European cities. Independently, parents were interviewed regarding sun exposure, sunscreen use, and physical sun protection of their child. RESULTS: After adjustment for sun exposure and host characteristics (e.g., skin phototype, eye color), the relative risk for high nevus count on the trunk was 1.68 (95% confidence interval [CI] = 1.09-2.59) for the highest level of sunscreen use and 0.59 (95% CI = 0.36-0.97) for the highest level of wearing of clothes while in the sun. The sun protection factor had no effect on nevus counts despite a high median value of 17.4. Sunburn number was not associated with nevus count. The highest risk associated with sunscreen use was found among children who had never experienced sunburn. CONCLUSIONS: In white, European children, sunscreen use appears to be associated with development of nevi, probably because it allows longer sun exposures. Wearing clothes may be an effective way to prevent proliferation of nevi. Since a high nevus count is a strong predictor of melanoma, sunscreen use may be involved in melanoma occurrence because it may encourage recreational sun exposure.

[AIDS: knowledge, attitudes and sex behavior of young people attending AIED family planning health services]. / AIDS: conoscenze, attitudini e comportamenti sessuali di giovani utenti dei consultori familiari AIED.

PIP: A research group of the G. Sanarelli Institute of La Sapienza University, Rome, Italy, conducted a survey on the knowledge, attitudes, and sexual behavior of young people at 14 family planning counseling centers of the Italian Association of Demographic Education (AIED). Data were collected by means of an anonymous, self-administered questionnaire containing 70 questions during the 12-month period from March 1, 1995 to February 29, 1996. Respondents were 19-24 years old. The purpose was to gain information about AIDS-related risk behavior. A total of 1085 questionnaires were collected representing the views of 978 women (90.1%) and 107 men (9.9%) with an average age of 21.9 years for the women and 21.7 years for the men. For 84% of the females and 78% of males, the source of information about AIDS was television; for 61% of males and 59% of females it was daily newspapers; and only 33% of men and 40% of women obtained such information from school. The average score of accurate knowledge about the transmission of HIV was 78% vs. 75.6% of a national sample. The respondents were more sexually active than the subjects of the national sample. 96% of males and 91% of females had experienced sexual intercourse; the average age of sexual debut was 17.7 years for males and 18.0 years for females, with an average of 4.2 partners for males and 3.0 partners for females. 6% of males had sex with prostitutes (16% in the national sample), while some women had had bisexuals (4%) or drug addicts (6.5%) as partners. The practice of anal sex was above the national average (29% for males and 24% for females). 73% of males and 79% of females always used condoms with casual sexual partners, but only 20% of males and 15% of females used condoms with steady partners.^ieng

Knowledge of HIV/AIDS modes of transmission and means of protection in different European countries.

This study was undertaken to assess the state of the european population's knowledge on HIV transmission and means of protection. Data were delivered from different national surveys based on questionnaires administered to general population samples. The results showed that the population's knowledge on HIV/AIDS are insufficient or even incorrect.

Cold-defense function of brown adipose tissue during sleep.

Rats with chronically implanted electroencephalograph scalp electrodes and thermistors were exposed to 24 and 4 degrees C ambient temperatures during the light hours before and after acclimation to 4 degrees C ambient temperature for 9 days. During synchronized sleep, deep interscapular temperature was higher at 4 degrees C than at 24 degrees C both before and after acclimation to cold. After ablation of brown adipose tissue, deep interscapular temperature was lower at 4 degrees C than at 24 degrees C during synchronized sleep. In the presence of brown adipose tissue, deep interscapular temperature decreased sharply during desynchronized sleep at 4 degrees C both before and after acclimation to cold. This decrease was subsequent to and correlated with an increase in the temperature of the nasal mucosa. The decrease in deep interscapular temperature during desynchronized sleep at 4 degrees C ambient temperature was markedly reduced by ablation of the interscapular brown adipose tissue.