Annali di igiene : medicina preventiva e di comunità
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Vaccination of all healthy children against rotavirus (RV) has been recommended, since the availability of vaccines, both in Europe (PIDJ) and Italy (pediatricians). The aims of universal vaccination against RV include the protection of children against moderate/severe gastroenteritis forms by RV (GARV), prevent hospitalizations, reduce the severity and duration of the disease, and reduce morbidity and socioeconomic costs. Payers need to informed regarding the efficacy and the healthcare utilization related to RV vaccination in order to decide in favour of its extensive implementation. ⋯ The indirect effects of the vaccine (HI) could generate protection even in unvaccinated children with health gain and a number of cases by GARV much less than those that would vaccinating small groups of children and with a cost of illness, for NHS, which would be reduced significantly, despite the additional costs of the vaccine as early as the second year of vaccination. Productivity losses due to absence from work of a parent, as well as all other costs included in the model, show that is precisely the society to pay the consequences, from economic and social point of view. Considering the citizen in the role of private payer, we must stress as for him, the savings generated by vaccination, whether universal or with demand for cost-sharing by the health service, prove significant with a major health gain for the population under study.
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To evaluate laboratory confirmed bloodstream infection (LC-BSI) aetiology we carried out a prospective study in the general 13 bed ICU of the teaching hospital Policlinico Umberto I in Rome. According to CDC case definitions for LC-BSI, all patients admitted >48h between 2000-2007 to ICU were included. Risk factors (i.e. age, sex, SAPS II), invasive procedures (i.e. endotracheal intubation, vascular and urinary catheterisation), microbiological isolates and their antibiotic susceptibility were screened. ⋯ P. aeruginosa and A. baumannii showed respectively 25% and 68.7% multidrug-resistance. Over 1/3 of Eneterobacteriaceae isolates were extended spectrum beta-lactamase (ESBL), but non resulted resistant to carbapenems. Surveillance showed a high incidence of LC-BSI associated to invasive procedures and the presence of multiresistant bacteria.
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Because of a continued increase of complex patients and the development of many areas of sub-specialities in medicine, the use and quality of interdisciplinary communication has been found to be lacking, especially between hospital and primary care physicians, causing a significant gap in the documentation, coverage and care of individual patients. The study focuses on state of the art interdisciplinary communication, with consideration given to current used tools and priorities. An ad hoc questionnaire surveyed 118 physicians about their profession, the types of patients, the frequency of complex cases, the tools used to communicate with each patient and how the physicians rated these tools. ⋯ Many Doctors (71%) value the actual interdisciplinary communication of low quality, despite the fact that it is considered to have a significant influence on the quality of health care. New tools and methods are needed. For example, dedicated standards of multidisciplinary and multi-professional Continuing Medical Education (CME), as well as the use of computer tools allowing for shared clinical records.
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The aim of the study is showing the results of the experience of "Hospital without pain" in the Lazio Region, in order to plan a specific regional project. This was a cross-sectional study conducted through the administration of a questionnaire during the month of October 2007, sent by the Social Department of the Regional Direction Health Planning to the General Directors of Local Health units, Hospital Trusts and Teaching Hospitals. 24 hospitals entered the study (response rate 80%). 37.5% of responders declare that pain level is routinely controlled by a trained health professional, mainly in smaller hospitals (50% vs. 20% in larger ones). In most hospitals (62.5%), pain monitoring is based on the use of the Visual analogue scale (VAS), whereas other scales are less frequently used (20.8%). ⋯ In the last case, these protocols are predominant in the roman (76.9%; p = 0.045), larger (80%; p = 0.069) and teaching hospitals (100%; p = 0.064). The management of pain in the Lazio Region shows a high heterogeneity, both in terms of geographical and dimensional issues. This study highlighted critical elements to be considered for the improvement of the situation at the regional level.
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The aim of this contribution is to present the Report of 'Commission on Social Determinants of Health' (Who) published in August 2008, 30th Alma Ata Conference anniversary. The Report highlights major inequalities in life expectancy and rates of disease between rich and poor within countries as well as among different parts of the world. The report makes wide ranging recommendations in order to 'close the gap in a generation', emphasizing action on living conditions, access to services, social support, information and research. We will discuss the echoes from the scientific and media world and their impact on national and global scale.