[A system for collecting historical professional exposures in the workplace in Piedmont (ESP ALP).] / Un sistema per la catalogazione delle esposizioni storiche professionali negli ambienti di lavoro in Piemonte (ESP ALP).

SUMMARY: Background. ARPA Piemonte carries out occupational exposure measurements of chemical agents in workplace environment to support the Occupatonal Health and Safety Units of Local Health Boards for the assessment of the exposure level of dangerous chemical. Data are reported in internal documents, but are not available for other purposes. Objectives. Organize the occupational exposure measures collected by ARPA Piemonte, in order to facilitate their availability, in accordance with the indications of the European Foundation for the Improvement of Living and Working Conditions. Methods. An application in a relational database environment was defined and developed to collect and structure information relating to companies, interventions, tasks and / or monitored sampling points, samples and measurements performed. Results. Data on chemical exposure related to interventions carried out by ARPA Piemonte in the period from 2005 to part of 2020 have been collected in the ESP ALP application. ESP ALP contains information about 161 companies, 193 interventions, 815 sampling points, 3.490 samples and 18.576 measurements and information on companies obtained from the 2011 Census of Economic Activities and the archives of the National Institute for Insurance against Accidents at Work (INAIL). Discussion. We verified the feasibility of retrieving and organizing the information collected in past years in an integrated environment that facilitates its processing and use. Finally, we confirm the usefulness of collaboration between multidisciplinary professionals.

Impact of COVID-19 on emergency department visits among palliative home care recipients: a retrospective population-based cohort study in the Piedmont region, Italy.

Background: Integrated palliative home care (IHPC) is delivered to patients with progressive end-stage diseases. During the COVID-19 pandemic, IHPC needed to provide high-quality home care services for patients who were treated at home, with the goal of avoiding unnecessary care, hospital admissions, and emergency department (ED) visits. This study aimed to compare the ED visits of IHPC recipients in a large Italian region before and during the first two waves of the COVID-19 pandemic and to find sociodemographic or clinical characteristics associated with changes in ED visits during the first two waves of COVID-19 pandemic, compared with the period before. Methods: Administrative databases were used to identify sociodemographic and clinical variables of IHPC recipients admitted before and during the pandemic. The obtained data were balanced by applying a propensity score. The average number of ED visits before and during the pandemic was calculated by using the Welch's t test and stratified by all the variables. Results: Before and during the pandemic, 5155 and 3177 recipients were admitted to IHPC, respectively. These individuals were primarily affected by neoplasms. ED visits of IHPC recipients reduced from 1346 to 467 before and during the pandemic, respectively. A reduced mortality among IHCP patients who had at least one ED visit during the pandemic (8% during the pandemic versus 15% before the pandemic) was found. The average number of ED visits decreased during the pandemic [0.143, confidence interval (CI) = (0.128-0.158) versus 0.264, CI = (0.242-0.286) before the pandemic; p < 0.001] for all ages and IHPC duration classes. The presence of a formal caregiver led to a significant decrease in ED use. Medium and high emergency ED admissions showed no difference, whereas a decrease in low-level emergency ED admissions during the pandemic [1.27, CI = (1.194-1.345) versus 1.439, CI = (1.3-1.579) before the pandemic; p = 0.036] was found. Conclusion: ED visits among IHPC recipients were significantly decreased during the first two waves of the COVID-19 pandemic, especially in those individuals characterized by a low level of emergency. This did not result in an increase in mortality among IHPC recipients. These findings could inform the reorganization of home care services after the pandemic.

Trajectories and determinants of emergency department use among nursing home residents: a time series analysis (2012-2019).

BACKGROUND: Emergency department (ED) use among nursing home (NH) residents is an internationally-shared issue that is understudied in Italy. The long term care in Italy is part of the health system. This study aimed to assess trajectories of ED use among NH residents and determinants between demographic, health supply, clinical/functional factors. METHODS: A pooled, cross-sectional, time series analysis was performed in an Italian region in 2012/2019. The analysis measured the trend of ED user percentages associated with chronic conditions identified at NH admission. A GLM multivariate model was used to evaluate determinants of ED use. The variables collected were sex, age, assistance intensity, destination after discharge from NH, chronic conditions at NH admission, need for daily life assistance, degree of mobility, cognitive impairments, behavioural disturbances and were taken from two databases of the official Italian National Information System (FAR and C2 registries) that were combined to create a unique and anonymous code for each patient. RESULTS: A total of 37,311 residents were enrolled; 55.75% (20,800 residents) had at least one ED visit. The majority of the residents had cardiovascular (25.99%) or mental diseases (24.37%). In all pathologies, the percentage of ED users decreased and the decrease accelerated over time. These results were confirmed in the fixed effects regression model (coefficient for linear term (b = - 3.6177, p = 0, 95% CI = [- 5.124, - 2.1114]); coefficient for quadratic term = - 0.7691, p = 0.0046, 95% CI = [- 1.2953, - 0.2429]). Analysis showed an increased odds of ED visits involving males (OR = 1.27, 95% CI 1.24;1.30) and patients affected by urogenital diseases (OR = 1.16, 95% CI [1.031-1.314]). The lowest odds of ED visits were observed among subjects aged > 90 years (OR = 0.64, 95% CI [0.60-0.67]), who required assistance for their daily life activities (OR = 0.86; 95% CI = [0.82, 0.91]), or with serious cognitive disturbances (OR = 0.86; 95% CI = [0.84, 0.89]), immobile (OR = 0.93; 95% CI = [0.89, 0.96]), or without behavioural disturbances (OR = 0.92; 95% CI = [0.90, 0.94]). CONCLUSIONS: The percentage of ED users has decreased, through support from the Italian disciplinary long-term care system. The demographic, clinical/functional variables associated with ED visits in this study will be helpful to develop targeted and tailored interventions to avoid unnecessary ED use.

Impact of the Timing of Integrated Home Palliative Care Enrolment on Emergency Department Visits.

BACKGROUND: The association between timing of integrated home palliative care (IHPC) enrolment and emergency department (ED) visits is still under debate, and no studies investigated the effect of the timing of IHPC enrolment on ED visits, according to their level of emergency. This study aimed to investigate the impact of the timing of IHPC enrolment on different acuity ED visits. METHODS: A retrospective, pre-/post-intervention study was conducted from 2013 to 2019 in Italy. Analyses were stratified by IHPC duration (short ≤30 days; medium 31-90 days; long >90 days) and triage tags (white/green: low level of emergency visit; yellow/red: medium-to-high level). The impact of the timing of IHPC enrolment was evaluated in two ways: incidence rate ratios (IRRs) of ED visits were determined (1) before and after IHPC enrolment in each group and (2) post-IHPC among groups. RESULTS: A cohort of 17 983 patients was analysed. Patients enrolled early in the IHPC programme had a significantly lower incidence rate of ED visits than the pre-enrolment period (IRR=0.65). The incidence rates of white/green and yellow/red ED visits were significantly lower post-IHPC enrolment for patients enrolled early (IRR=0.63 and 0.67, respectively). All results were statistically significant (P<.001). Comparing the IHPC groups after enrolment versus the short group, medium and long IHPC groups had a significant reduction of ED visits (IRR=0.37, IRR=0.14 respectively), showing a relation between the timing of IHPC enrolment and the incidence of ED visits. A similar trend was observed after accounting for triage tags of ED visits. CONCLUSION: The timing of IHPC enrolment is related with a variation of the incidence of ED visits. Early IHPC enrolment is related to a high significant reduction of ED visits when compared to the 90-day pre-IHPC enrolment period and to late IHPC enrolment, accounting for both low-level and medium-to-high level emergency ED visits.

Emergency-department accesses in home care paediatric patients: Occurrence and risks of use in a six-year retrospective investigation in Northern Italy.

OBJECTIVE: To assess the determinants of ED use in paediatric patients enrolled in an Integrated Paediatric Home Care (IPHC) program. METHODS: A retrospective study was conducted using administrative databases on a cohort of patients enrolled in an IPHC program between January 1st, 2012, and December 31st, 2017, in Northern Italy. ED visits that occurred during the IPHC program were considered. Data were collected considering sociodemographic, clinical and organizational variables. A multivariable stepwise logistic regression analysis was performed. The dependent variable to identify possible associations was ED visit. RESULTS: A total of 463 ED visits occurred in 465 children, with an incidence rate of 1. The risk of ED visits significantly increased among children involved in the IPHC program after hospital discharge (OR 1.94). Additionally, the risk of ED visits increased significantly as the duration of IPHC increased (OR 5.80 between 101 and 200 days, to OR 7.84 between 201 and 300 days, OR 12.54 between 301 and 400 days and OR 18.67 to more than 400 days). CONCLUSION: The overall results represent a practical perspective to contribute improving both the service quality of IPHC and reducing low acuity and improper ED use.

[The family and community nurse-led proactive management of COPD patients: experience of an Italian health district]. / La gestione proattiva dei pazienti BPCO a cura degli infermieridi famiglia e comunità: l'esperienza di un Distretto del Piemonte.

. The family and community nurse-led proactive management of COPD patients: experience of an Italian health district. INTRODUCTION: Integrated care management for COPD may reduce healthcare utilisation, improving cost-efficiency. AIM: To assess the primary outcomes of a family and community nurse-led proactive management of COPD patients of an Italian health district. METHODS: Target population comprised men and women >60 years, resident in the municipalities of Collegno and Grugliasco (metropolitan area of Turin). Administrative databases (hospital discharge records, drug prescriptions, legal exemptions) were first used to identify patients with diagnosis of COPD; the cases were validated by the General Practitioners (GPs). The 335 patients were enrolled from July 1, 2015 to November 30, 2016. Family and community nurses were responsible for anamnesis, spirometry, assessment of adherence to therapy, counselling and healthy lifestyles education. GPs were responsible for the clinical staging and revision of therapy. Patients were followed-up to 12 months. RESULTS: Improvements were observed in smoking cessation (prevalence of smokers from 23.9% to 20%), BMI normalization (in 13.4% of patients out of standard), physical activity (from 32.5% to 64.5% of patients), and pneumococcal vaccinations (from 14.9% to 58%). The last two outcomes were statistically significant. Patients showed high levels of satisfaction; 12-months compliance was 62.1%. CONCLUSION: A family and community nurse-led proactive management of COPD patients in primary care is feasible and effective. Interventions should be structured, personalised and multi-component, oriented at motivating, engaging and supporting the patients. Positive results led to continue and extend the programme.

Determinants Associated With the Risk of Emergency Department Visits Among Patients Receiving Integrated Home Care Services: A 6-Year Retrospective Observational Study in a Large Italian Region.

BACKGROUND: Allowing patients to remain at home and decreasing the number of unnecessary emergency room visits have become important policy goals in modern healthcare systems. However, the lack of available literature makes it critical to identify determinants that could be associated with increased emergency department (ED) visits in patients receiving integrated home care (IHC). METHODS: A retrospective observational study was carried out in a large Italian region among patients with at least one IHC event between January 1, 2012 and December 31, 2017. IHC is administered from 8 am to 8 pm by a team of physicians, nurses, and other professionals as needed based on the patient's health conditions. A clinical record is opened at the time a patient is enrolled in IHC and closed after the last service is provided. Every such clinical record was defined as an IHC event, and only ED visits that occurred during IHC events were considered. Sociodemographic, clinical and IHC variables were collected. A multivariate, stepwise logistic analysis was then performed, using likelihood of ED visit as a dependent variable. RESULTS: A total of 29 209 ED visits were recorded during the 66 433 IHC events that took place during the observation period. There was an increased risk of ED visits in males (odds ratio [OR]=1.29), younger patients, those with a family caregiver (OR=1.13), and those with a higher number of cohabitant family members. Long travel distance from patients' residence to the ED reduced the risk of ED visits. The risk of ED visits was higher when patients were referred to IHC by hospitals or residential facilities, compared to referrals by general practitioners. IHC events involving patients with neoplasms (OR=1.91) showed the highest risk of ED visits. CONCLUSION: Evidence of sociodemographic and clinical determinants of ED visits may offer IHC service providers a useful perspective to implement intervention programmes based on appropriate individual care plans and broad-based client assessment.

Trends and Characteristics of Emergency Medical Services in Italy: A 5-Years Population-Based Registry Analysis.

Background: Emergency Medical Services (EMS) plays a fundamental role in providing good quality healthcare services to citizens, as they are the first responders in distressing situations. Few studies have used available EMS data to investigate EMS call characteristics and subsequent responses. Methods: Data were extracted from the emergency registry for the period 2013-2017. This included call and rescue vehicle dispatch information. All relationships in analyses and differences in events proportion between 2013 and 2017 were tested against the Pearson's Chi-Square with a 99% level of confidence. Results: Among the 2,120,838 emergency calls, operators dispatched at least one rescue vehicle for 1,494,855. There was an estimated overall incidence of 96 emergency calls and 75 rescue vehicles dispatched per 1000 inhabitants per year. Most calls were made by private citizens, during the daytime, and were made from home (63.8%); 31% of rescue vehicle dispatches were advanced emergency medical vehicles. The highest number of rescue vehicle dispatches ended at the emergency department (74.7%). Conclusions: Our data showed that, with some exception due to environmental differences, the highest proportion of incoming emergency calls is not acute or urgent and could be more effectively managed in other settings than in an Emergency Departments (ED). Better management of dispatch can reduce crowding and save hospital emergency departments time, personnel, and health system costs.

Violence detection explanation via semantic roles embeddings.

BACKGROUND: Emergency room reports pose specific challenges to natural language processing techniques. In this setting, violence episodes on women, elderly and children are often under-reported. Categorizing textual descriptions as containing violence-related injuries (V) vs. non-violence-related injuries (NV) is thus a relevant task to the ends of devising alerting mechanisms to track (and prevent) violence episodes. METHODS: We present VIDES (so dubbed after VIOLENCE DETECTION SYSTEM), a system to detect episodes of violence from narrative texts in emergency room reports. It employs a deep neural network for categorizing textual ER reports data, and complements such output by making explicit which elements corroborate the interpretation of the record as reporting about violence-related injuries. To these ends we designed a novel hybrid technique for filling semantic frames that employs distributed representations of terms herein, along with syntactic and semantic information. The system has been validated on real data annotated with two sorts of information: about the presence vs. absence of violence-related injuries, and about some semantic roles that can be interpreted as major cues for violent episodes, such as the agent that committed violence, the victim, the body district involved, etc.. The employed dataset contains over 150K records annotated with class (V,NV) information, and 200 records with finer-grained information on the aforementioned semantic roles. RESULTS: We used data coming from an Italian branch of the EU-Injury Database (EU-IDB) project, compiled by hospital staff. Categorization figures approach full precision and recall for negative cases and.97 precision and.94 recall on positive cases. As regards as the recognition of semantic roles, we recorded an accuracy varying from.28 to.90 according to the semantic roles involved. Moreover, the system allowed unveiling annotation errors committed by hospital staff. CONCLUSIONS: Explaining systems' results, so to make their output more comprehensible and convincing, is today necessary for AI systems. Our proposal is to combine distributed and symbolic (frame-like) representations as a possible answer to such pressing request for interpretability. Although presently focused on the medical domain, the proposed methodology is general and, in principle, it can be extended to further application areas and categorization tasks.

Predictors and trajectories of ED visits among patients receiving palliative home care services: findings from a time series analysis (2013-2017).

BACKGROUND: Current policies recommend integrating home care and palliative care to enable patients to remain at home and avoid unnecessary hospital admission and emergency department (ED) visits. The Italian health care system had implemented integrated palliative home care (IHPC) services to guarantee a comprehensive, coordinated approach across different actors and to reduce potentially avoidable ED visits. This study aimed to analyze the trajectories of ED visit rates among patients receiving IHPC in the Italian healthcare system, as well as the association between socio-demographic, health supply, and clinical factors. METHODS: A pooled, cross-sectional, time series analysis was performed in a large Italian region in the period 2013-2017. Data were taken from two databases of the official Italian National Information System: Home Care Services and ED use. A clinical record is opened at the time a patient is enrolled in IHPC and closed after the last service is provided. Every such clinical record was considered as an IHPC event, and only ED visits that occurred during IHPC events were considered. RESULTS: The 20,611 patients enrolled in IHPC during the study period contributed 23,085 IHPC events; ≥1 ED visit occurred during 6046 of these events. Neoplasms accounted for 89% of IHPC events and for 91% of ED visits. Although there were different variations in ED visit rates during the study period, a slight decline was observed for all diseases, and this decline accelerated over time (b = - 0.18, p = 0.796, 95% confidence interval [CI] = - 1.59;1.22, b-squared = - 1.25, p < 0.001, 95% CI = -1.63;-0.86). There were no significant predictors among the socio-demographic factors (sex, age, presence of a non-family caregiver, cohabitant family members, distance from ED), health supply factors (proponent of IHPC) and clinical factors (prevalent disorder at IHPC entry, clinical symptoms). CONCLUSION: Our results show that use of ED continues after enrollment in IHPC, but the trend of this use declines over time. As no significant predictive factors were identified, no specific interventions can be recommended on which the avoidable ED visits depend.

[Suicide mortality in Piedmont Region (Northern Italy): epidemiological suggestions for prevention]. / La mortalità per suicidio in Piemonte: spunti epidemiologici per la prevenzione.

OBJECTIVES: to describe intentional self-harm related deaths in Piedmont Region (Northern Italy) analysing trends by gender, age, area of residence, socio-economic level. DESIGN: descriptive study of mortality using data from the Italian National Institute of Statistics (Istat). SETTING AND PARTICIPANTS: resident population in Piedmont Region in the period 2003-2014. MAIN OUTCOME MEASURES: age-standardized suicide (ICD-10: X60-X84) rates, by gender, health district of residence and educational level; frequencies of suicide method and place of occurrence by gender and age. RESULTS: in a context of declining injury related mortality, especially that due to traffic accidents, the regional trend of suicides shows only a slight decrease, becoming the main cause of injury deaths since 2009, equal to 21% of all injury deaths in the studied period. Among the largest Italian Regions, Piedmont is the one with the highest rate of suicide. There are no significant trend variations related to the recent period of economic crisis. The occurrence is higher among men in general and particularly in older people, persons with low educational level and those living in mountain areas. The main suicide method used by women is "jumping from a high place" (36.7%) while the main one for men is "hanging, strangulation and suffocation" (50%). This is globally the most frequent method for all ages. "Self-poisoning" gains importance between 30 and 49 years old. Suicides occur for over half of cases in home, without any difference by gender and age. CONCLUSION: suicides are a public health and social concern. Yet despite its extent, this problem is still not adequately considered in public health prevention programmes. Important contributions to a deeper understanding of the determinants can be obtained from health information systems, in particular data from emergency care and multiple causes of deaths records.

Therapy With Agents Acting on the Renin-Angiotensin System and Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

Exposure to agents acting on the renin-angiotensin system was not associated with a risk increase of COVID-19 infection in 2 Italian matched case-control studies, 1 nested in hypertensive patients and the other in patients with cardiovascular diseases or diabetes.

[Thromboembolic vein disease (TVD): antithrombotic therapy choice in ASL TO3.] / Malattia tromboembolica venosa: scelta della terapia antitrombotica nei pazienti della ASL TO3.

BACKGROUND: Thromboembolic vein disease (TVD) comprises of deep vein thrombosis (DVT) and pulmonary embolism (PE). Standard therapy consists of the administration of low molecular weight heparin (LMWH) imbricated with antivitamin K agonists (AVK). Recently a new series of oral anticoagulants known as the direct oral anticoagulants (DOACs) has been introduced. CHEST 2016 guidelines recommend the use of DOACs rather then AVKs for the treatment of TVD. AIM: The aim of this study was to analise the choice of antithrombotic treatment and to see if CHEST 2016 guidelines were used in the ASL TO3 district for TVD therapy. METHODS: Data obtained from the SISR archives was used to perform a cohort retrospective study. Patients who had been recovered for TEVD were selected 6 months after dismissal. Based on Chest guidelines, the period that ranged from 01/01/2014 to 30/06/2017 was divided into two parts. The cohort was classified according to antithrombotic therapy administered to these patients. RESULTS: 475 patients that had been dismissed after recovery for TVD were identified and enrolled into this study. 1st period: from 275 patients, 247 had a prescription: 132 TAO, 73 DOACs, 42 eparine, 0 ASA. 2nd period: from 200 patients, 185 had a prescription: 55 TAO, 95 DOACs, 34 eparine, 1 ASA. DISCUSSION AND CONCLUSIONS: Our analysis shows a significant difference between the choice of antithrombotic therapy during both periods, this difference is greater among males. We can conclude that antithrombotic prescriptions carried out in the ASL TO3 area have been adherent to Chest guidelines.

[Contribution of amenable mortality to the decrease of overall mortality in Piedmont Region (Northern Italy), 1980-2011]. / Il contributo della mortalità amenable alla diminuzione della mortalità generale in Piemonte dal 1980 al 2011.

OBJECTIVES: to describe overall and amenable mortality trends over the last 30 years in the Local Health Authorities (LHAs) of Piedmont Region (Northern Italy). By comparing these trends, it is possible to analyse intraregional variability in the performance of the healthcare system. DESIGN: descriptive study. SETTING AND PARTICIPANTS: mortality data from the Italian National Institute of Statistics (Istat) for the population between 0 and 74 years resident in Piedmont Region for the period 1980-2011. MAIN OUTCOME MEASURES: overall and amenable age-standardised death rates, by gender and health unit; ratio of the differences in amenable and in all-cause mortality (standardised rate difference - SRD: SRDamenable/SRDall-cause) over the observation period. RESULTS: between 1980 and 2011, overall mortality in Piedmont has decreased from 425.8 x100,000 to 205.5 x100.000 among women, and from 891.6 x100,000 to 390.7 x100,000 among men. The rate of amenable mortality on overall mortality decreased from 40% to 32% among women, and from 33% to 21% among men. Furthermore, amenable mortality contributed to 48% of the overall mortality reduction among women and to 35% among men. Regional results show heterogeneity between health units. This heterogeneity decreased over the three decades and was higher in men than in women. CONCLUSION: although Piedmont is one of the Italian Regions with the highest amenable mortality rate, a considerable decrease of its contribution to the overall mortality was seen in the last three decades. This improvement was not equally among LHAs, and substantial intraregional differences are still present, probably due to different timing and way of introduction of healthcare innovations for prevention and care for amenable to healthcare diseases. The proportion of amenable mortality on overall mortality is much higher among women than men, and it probably depends on the diseases considered in the definition itself.

Gender, socioeconomic position, revascularization procedures and mortality in patients presenting with STEMI and NSTEMI in the era of primary PCI. Differences or inequities?

BACKGROUND: Several studies have reported gender and socioeconomic differences in the use of revascularization procedures in patients with acute myocardial infarction. However, it is not clear whether these differences influence patients' survival. Moreover, most of the studies neither considered STEMI and NSTEMI separately, nor included primary PCI, which nowadays is the treatment of choice in case of AMI. In an unselected population of patients admitted to hospital with a first episode of STEMI and NSTEMI we examined gender and socioeconomic differences in the use of cardiac invasive procedures and in one-year mortality. METHODS: Subjects hospitalized with a first episode of STEMI (n=3506) or NSTEMI (n=2286) were selected from the Piedmont (Italy) hospital discharge database. We considered the percentage of patients undergoing PCI, primary PCI and CABG, and in-hospital mortality. Out of hospital mortality was calculated through record linkage with the regional register. The relation between outcomes and gender or educational level was investigated using appropriate multivariate regression models adjusting for available confounders. RESULTS: After adjustment for age, comorbidity and hospital characteristics, women and low educated patients had a lower probability of undergoing revascularization procedures. However, neither in-hospital, nor 30-day, nor 1-year mortality showed gender or social disparities. CONCLUSIONS: Despite gender and socioeconomic differences in the use of revascularization, no differences emerged in in-hospital and 1-year mortality. These findings could suggest that patients are differently, but equitably, treated; differences are more likely due to an inability to fully adjust for clinical conditions rather than to a selection process at admission.

Resource consumption and healthcare costs of acute coronary syndrome: a retrospective observational administrative database analysis.

The objective of this study was to estimate resource consumption and direct healthcare costs of patients with a first hospitalization for acute coronary syndrome (ACS) in 2008 in the Piedmont Region, Italy. Subjects hospitalized with a first episode of ACS in 2008 were selected from the regional hospital discharge database. All hospitalizations, drug prescriptions, and outpatient episodes of care in the 12 months following discharge were considered to estimate resource consumption and direct healthcare costs from the Piedmont Regional Health Service perspective. The analysis was carried out separately for ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA) populations. In the accrual period, 7765 subjects (1.75‰ of the total population) were hospitalized for ACS (64.2% men). The average age was 66.5 for men and 75.4 for women. The average in-hospital mortality was 6.5% (n = 508). The total ACS population was classified as: STEMI 45.2%, NSTEMI 29.4%, and UA 25.4%. The average yearly costs per patient alive at the end of follow-up (n = 6851) were 14,160.8&OV0556; (18,678.7 USD): 83.9% for inpatient admissions [11,881.2&OV0556; (15,671.8 USD)], 9.3% for drugs [1311.6&OV0556; (1730.1 USD)], 5.0% for diagnostic and therapeutic procedures and outpatient visits [708.2&OV0556; (934.1 USD)], and 1.8% for 1-day hospital stays [259.8&OV0556; (342.7 USD)]. The average yearly direct healthcare costs by ACS event were 14,984.5&OV0556; (19,765.2 USD) for STEMI, 14,554.1&OV0556; (19,197.4 USD) for NSTEMI, and 12,481.5&OV0556; (16,463.6 USD) for UA. In each subpopulation, costs were significantly higher for men than for women. ACS imposes a significant burden in terms of morbidity and mortality and generates major public health service costs.

[Usefulness of databases of general practitioners: the study of chronic cardiovascular diseases in a health district of Turin, Italy]. / Utilità delle informazioni raccolte tramite medici di medicina generale: lo studio delle malattie cardiovascolari croniche in un distretto sanitario torinese.

BACKGROUND: The aim of this study was to evaluate the prevalence of chronic cardiovascular diseases in the territory of a health district in Turin (Italy) to achieve better management of healthcare services according to healthcare needs. METHODS: In order to assess healthcare needs, we surveyed the prevalence of five cardiovascular chronic diseases in the general population, using data from the general practitioners of one health district. RESULTS: Eighty-six general practitioners participated in the study, collecting data regarding 87 885 attendees, for the year 2010. Among men, the following prevalence rates were estimated: 2% prior myocardial infarction, 2.4% other forms of chronic ischemic heart disease, 2% cardiac arrhythmias, 0.4% heart failure, 0.9% late effects of cerebrovascular disease. Prevalence rates were lower among women, except for dysrhythmias and heart failure, and were increasing with age. Prevalence rates were higher than those previously reported by the Italian Cardiovascular Epidemiological Observatory for northwestern regions. In addition, differences in disease distribution were observed among patients when comparing male doctors and female doctors. CONCLUSIONS: Our findings show several critical issues in primary care, suggesting the need for improving the healthcare delivery system within the health district according to local care needs.

The impact of different communication and organizational strategies on mammography screening uptake in women aged 40-45 years.

BACKGROUND: Several factors can influence access to population breast cancer screening. The aim of the study was to evaluate the impact of different information approaches, women's socio-demographic characteristics and organizational factors on mammography screening uptake. METHODS: We selected 5744 women aged 40-45 years who were randomly assigned to be given letters with: (i) a pre-fixed appointment plus standard leaflet (Group 1); (ii) a pre-fixed appointment plus a more comprehensive booklet (Group 2); (iii) point (ii) plus the offer of a counselling session (Group 3); and (iv) an invitation to contact the centre to get information and arrange participation (Group 4). RESULTS: Ninety-five women were excluded before the invitation and 5649 were randomized. After excluding undelivered letters (n = 41) and women reporting an exclusion criterion following our invitation (n = 248), the final eligible population was 5360 women. Participation rates following the first contact were 36.5, 39.9, 35.8 and 16.5% for Groups 1-4, respectively. The rates increased to 40.9, 43.6, 40.1 and 35.1% after the reminder letters. Women receiving more complete information had a higher uptake (Group 2), although not statistically significant. Differences among the four groups were maintained by controlling the effect of socio-demographic and attendance determinants. Regardless of intervention, participation was higher among married, higher educated, white-collared women, those born in northern Italy, living closer to the screening unit and with a female-collaborative doctor. CONCLUSION: Invitation letters with a fixed appointment correlate with a higher attendance rate. Providing women with more information on procedures, risks and benefits of mammography screening does not modify their participation.

[MADEsmart: a web-based system for accessing data and healthcare indicators]. / MADEsmart: un sistema in ambiente web per l'accesso dinamico a dati e indicatori sanitari.

Methods for accessing information have evolved making thus possible the planning of a new generation of web applications. In the Piemonte region, tools for accessing demographic data and main health and epidemiologic indicators are available since several years. A new application named MADEsmart (from the Italian for "Engine for demographic and epidemiological analysis") provides various functions that allow the user to obtain information useful for creating health reports and health profiles at the subregional level.

[Road accidents in piedmont (Italy): factors affecting mortality among drivers]. / Incidenti stradali in piemonte: i fattori che influenzano la mortalità tra i conducenti.

OBJECTIVES: Italy is one of the industrialized countries with the highest mortality from road accidents. The mortality index of road accidents in Piemonte is one of the highest in Italy. This study assesses the main factors affecting the mortality among drivers. DESIGN: Police reports of 95,944 road traffic accidents occurred between 1999 and 2004 in Piemonte, involving 178,230 drivers, were analysed. Multivariate logistic regression models were used to estimate the association of drivers' and accidents' characteristics with mortality among drivers. Analyses were stratified for car, truck and two-wheel vehicle drivers. RESULTS: Mortality is affected by age and gender. In addition, the main risk factors are night-time, extra-urban roads, mountain areas and two wheel vehicles. The drivers license penalty point regulation law introduced in Italy on July 2003 seems to have had a protective effect on mortality during the early months of application. CONCLUSIONS: Official data are useful for estimating potential determinants of road injuries' outcome. Factors affecting the occurrence of accidents are not necessarily predictors of outcome severity. An effective prevention policy of frequency of accidents, mortality and disability should be based on drivers'safety education, structural interventions, targeted road controls and law enforcement.