Measuring and benchmarking the quality of two different organizational ways in delivering infant vaccination.

The aim of this study was the quality of service evaluation of two different organizational ways in delivering infant vaccination according to a Regional Vaccination Plan. Eleven vaccination centres were selected in two Local Health Units (ASLs) belonging to the Regional Health Service of the Lazio Region, Italy. The services offering paediatric vaccinations for children under three years of age, delivered without an appointment (VACP) or with the need for an appointment (VACL), were investigated. The quality aspects under evaluation were communicational efficiency, organisational efficiency and comfort. Subjective data were collected from different stakeholders and involve the elicitation of best and worst feasible performance conditions for the ASLs when delivering VACP/VACL services. Objective data consists in the observation of current performances of the selected vaccination centres. Quality scorecards were obtained from the combination of all data. Benchmarking between VACP and VACL, i.e., two different organisational ways in delivering infant vaccination, can be performed as a result of the probabilistic meaning of the evaluated scores. An expert of vaccination services, i.e., a virtual combination of patients, doctors and nurses, claims the quality of service delivery of the ASLs under investigation with probability 78.03% and 69.67% for VACP and VACL, respectively. In other words, for short, the quality scores of the ASLs were 78.03% for VACP and 69.67% for VACL. Furthermore our results show how to practically improve the current service delivery. The QuaVaTAR approach can result in improvements of the quality of the ASLs for the two different ways of delivering paediatric vaccinations in a simple and intuitive way.

[European evolution of the copayment in health costs: possible developments and reorganization proposals for Italian health care system. The role of additional kind of assistance]. / L'evoluzione della compartecipazione alla spesa sanitaria in Europa: possibili scenari evolutivi e proposte di riorganizzazione in Italia. Il ruolo delle forme integrative di assistenza.

The ticket, once considered just dissuasive or control instrument, has become citizens sharing of the costs of activities, services and performance of NHS. The difficult economic situation, that applies the main European countries, is leading in Italy to an increase measures of copayment. The use of over-sharing may drive, however, to important consequences in terms of equity, efficiency and cost containment of health. Copayment does not reduce the overall burden of spending, because often counterbalanced by a concomitant increase in private spending. In fact, Italian private expenditure on health "out of pocket" is the highest in Europe and more Italians discover the "low cost health care." The Authors propose to limite the introduction of new ticket or exacerbate the existing, focusing on the adherence of citizens to health and social integrative funds, that are now present on the national scene with about 5 million of members.

Knowledge and worry as basis for different behaviors among university students: the case of pandemic flu H1N1v.

INTRODUCTION: Attitudes towards the pandemic were different across countries and cultures and confounding news caused some to question whether unnecessary alarm and public panic resulted. The aim of this study was to detect behavior, perception and worry about pandemic flu among undergraduate students considered a group at major risk to contract and spread the infection. MATERIALS AND METHODS: In November 2009, during the pandemic peak in Italy, we conducted a survey about pandemic flu by means of anonymous multiple choice self-administered questionnaires among students, attending different courses at the Tor Vergata University in Rome. To investigate the relationship between the level of concern about H1N1v and the attitude to prevention the sample was divided in three groups based on the level of the declared worry. RESULTS: Among the 436 students that answer the questionnaires a statistical correlation was found between the level of worry and the disposition to change habits and the will to undergo vaccination. Males were less worried than females and more students living outside Rome would accept the vaccine. DISCUSSION AND CONCLUSIONS: The results of the study, generally in agreement with those of similar research, confirmed the need to know the relationship between fear and attitude in order to organize effective preventive campaigns.

Neurodevelopment in infants and preschool children with congenital hypothyroidism: etiological and treatment factors affecting outcome.

Studied global intelligence and specific abilities of children from 1 to 5 years old, 108 with congenital hypothyroidism (CH) diagnosed by newborn screening and 71 sibling controls. Intelligence levels of the CH group were within the normal range but differed significantly from controls at age 5. CH demonstrated a language deficit at age 3, which diminished with age, as well as significantly poorer visuospatial and verbal skills at age 5. Children with absent thyroid glands or evidence of hypothyroidism in utero were outperformed by other CH children in most ability areas from 1 year on. Different components of ability were correlated with specific factors reflecting timing or duration of thyroid hormone deficiency, suggesting unique critical periods of thyroid hormone sensitivity for different specific cognitive abilities and their neural substrates. It is concluded that even though screened CH children are markedly improved by neonatal diagnosis, they are still at risk for subtle irreversible deficits, which depend on factors such as type, age at onset, and duration of disease.

Effect of thyroid hormone level on temperament in infants with congenital hypothyroidism detected by screening of neonates.

To determine the effect of congenital hypothyroidism and its treatment on infant behavior, we assessed temperament in 50 six-month-old infants with congenital hypothyroidism detected by means of screening of neonates. Intelligence and temperament were also evaluated at 12, 18, 24, and 36 months. More of these children were classified as "difficult" than children in the nonhypothyroid standardization sample. Temperamental difficulty was associated with increased nervous system sensitivity, reflecting more intense responses and a lower threshold of response to external stimulation. Greater temperamental difficulty was found to persist until at least age 2 years of age and to be associated with higher circulating triiodothyronine and thyroxine levels between 1 and 3 months of age. Our results suggest that behavioral features should be considered, as well as circulating hormone levels, in determining the proper dose of thyroid hormone replacement in infants with congenital hypothyroidism.

Intellectual outcome in children with fetal hypothyroidism.

Eighty children with congenital hypothyroidism detected by newborn screening were grouped for presence of fetal hypothyroidism using skeletal maturity at the time of diagnosis as the index. Forty-five children with bone age less than 36 weeks were assigned to the delayed group; 35 with bone age 37 weeks to term were assigned to the nondelayed group. Although most children with athyrosis were found in the delayed group, the groups did not differ in birth weight, hormone levels, or family background. Assessments of intellectual and behavioral characteristics at 1, 2, 3, 4, and 5 years of age revealed that, although children in the delayed group performed within the normal range, their scores were significantly lower than those of the nondelayed group from age 2 years on. Perceptual-motor, visuospatial, and language areas were most affected. There were no differences in behavior or temperamental characteristics.