Use of health and social care services in a cohort of Italian dementia patients.

The aim of this study, conducted in the Region of Lazio, Italy, in 2008-2010, was to describe the use, over a one-year period, of health and social care services in a cohort of 712 patients with a diagnosis of dementia. These patients had never previously used such services. We evaluated the association between the patients' sociodemographic and clinical characteristics and their use of services.

Methods to increase participation in organised screening programs: a systematic review.

Background: The European Community recommends the implementation of population-based screening programmes for cervical, breast, and colorectal cancers. This recommendation is supported by many observational studies showing that organised programmes effectively reduce mortality and control the inappropriate use of screening tests. We conducted a systematic review of studies assessing the efficacy of interventions to increase participation in organised population-based screening programs.

[Appropriateness of referrals for magnetic resonance imaging in Latium, Italy].

Long wait times for access to Nuclear Magnetic resonance imaging (MRI) examinations are a concern and for this reason the project "Appropriateness of referrals for MRI examinations" has been launched in Latium (Italy). The aim of this preliminary study was to describe the main characteristics of MRI referrals in the region. Findings highlight a large variation in referral rates across the region, with 80% of MRI referrals being ordered by general practitioners and family pediatricians.

[Human Papilloma Virus (HPV), cervical cancer incidence and screening uptake: differences among Northern, Central and Southern Italy].

Objective: this article presents a review of evidences about Human Papillomavirus (HPV) and cervical cancer in Italy, highlighting geographical differences.

Design: two systematic reviews recently published were updated, one collecting studies on the prevalence of HPV types in Italy in the general population and the other collecting prevalence of HPV types in cervical pathologic samples.The search was updated to 31.

How socioeconomic status influences road traffic injuries and home injuries in Rome.

Road traffic injuries (RTI) and home injuries (HI) are a relevant public health problem, especially among people living in deprived areas. The objective of this study was to explore the relationship between morbidity, hospitalisation, mortality from RTI and HI, and socioeconomic status (SES) of the area of residence. RTI and HI surveillance based on the Emergency Information System, the Hospital Information System and the Mortality Registry of Lazio region are the three sources of this study to create a unique surveillance system.

The relationship between avoidable hospitalization and accessibility to primary care: a systematic review.

Background: Avoidable hospitalization (AH) has been widely studied as a possible measure of the performance of primary health care (PHC). However, studies examining the relationship between the efficiency and quality of PHC and AH have found mixed results. Our study aims at highlighting those factors related to the relationship between AH and accessibility to PHC in different countries.

HIV incidence estimate combining HIV/AIDS surveillance, testing history information and HIV test to identify recent infections in Lazio, Italy.

Background: The application of serological methods in HIV/AIDS routine surveillance systems to identify persons with recently acquired HIV infection has been proposed as a tool which may provide an accurate description of the current transmission patterns of HIV. Using the information about recent infection it is possible to estimate HIV incidence, according to the model proposed by Karon et al. in 2008, that accounts for the effect of testing practices on the number of persons detected as recently infected.

[Methods to increase participation in cancer screening programmes].

Objective: to synthesize scientific evidences about methods to increase cervical, breast and colorectal cancer screening participation.

Methods: a multidisciplinary working group has been set up to define the scope of the report and to conduct the evaluation. The scope and the final evaluation have been submitted to a stakeholder committee, including the Ministry of Health, the National Screening Observatory, regional screening program coordinators, scientific societies, and Lega Italiana Lotta ai Tumori, for comments and integrations.

Early and mid-term clinical outcome of emergency PCI in patients with STEMI due to unprotected left main coronary artery disease.

Objectives: Evaluation of acute and mid-term outcomes of patients with ST-elevation myocardial infarction (STEMI) undergoing emergency PCI due to unprotected left main coronary artery (ULMCA) disease.

Background: STEMI patients due to ULMCA disease represent a rare, high risk group. Percutaneous coronary intervention (PCI) may be the preferred strategy of myocardial revascularization but there are few data about this topic.

[Epidemiology of work-related accidents in the Lazio Region of Italy].

Background: Prevention of work-related accidents requires an in-depth epidemiological assessment of the issue. In Italy the most used databases are from the national insurance (INAIL) and research (ISPESL) institutes. However, these data are only available several years after the time of accident.

Can we use the pharmacy data to estimate the prevalence of chronic conditions? a comparison of multiple data sources.

Background: The estimate of the prevalence of the most common chronic conditions (CCs) is calculated using direct methods such as prevalence surveys but also indirect methods using health administrative databases.The aim of this study is to provide estimates prevalence of CCs in Lazio region of Italy (including Rome), using the drug prescription's database and to compare these estimates with those obtained using other health administrative databases.

Methods: Prevalence of CCs was estimated using pharmacy data (PD) using the Anathomical Therapeutic Chemical Classification System (ATC).

Early and late mortality in elderly patients after hip fracture: a cohort study using administrative health databases in the Lazio region, Italy.

Background: Hip fractures represent one of the most important causes of morbidity and mortality in elderly people. We evaluated the risk and the potential determinants of early, mid and long term mortality, in a population-based cohort of subjects aged ≥ 65 years old.

Methods: Using hospital discharge database we identified all hospitalized hip fracture cases of 2006, among residents in Lazio Region aged ≥ 65 years old.

[Analysis of occupational diseases in Lazio region: a comparison between Italian and foreign workers].

In 2000-2009 in Lazio Region (Italy), 3% of reported occupational diseases occurred among foreign workers. Compared with foreigners, Italian workers more frequently reported Neoplasia (2.2% vs.

Perinatal outcomes among immigrant mothers over two periods in a region of central Italy.

Background: The number of immigrants has increased in Italy in the last twenty years (7.2% of the Italian population), as have infants of foreign-born parents, but scanty evidence on perinatal outcomes is available. The aim of this study was to investigate whether infants of foreign-born mothers living in Italy have different odds of adverse perinatal outcomes compared to those of native-born mothers, and if such measures changed over two periods.

A case-control study on risk factors of domestic accidents in an elderly population.

The aim of this study was to evaluate the combined influence of several lifestyle, health and housing factors in the occurrence of home injuries (HIs) among the elderly. The subjects were recruited from 10 hospitals in Rome, Italy. This study is a paired case-control study.

Distribution of high and low risk HPV types by cytological status: a population based study from Italy.

Background: HPV type distribution by cytological status represents useful information to predict the impact of mass vaccination on screening programs.

Methods: women aged from 25 to 64 who attended cervical cancer screening in five different Italian regions were tested for HPV infection with Hybrid Capture II (HCII) low and high risk probes. Women repeating Pap-test upon unsatisfactory or positive results, or as a post-treatment and post-colposcopy follow-up analysis, were excluded from our study.

Severe postpartum morbidity and mode of delivery: a retrospective cohort study.

The aim of this population-based study was to estimate the risk of postpartum maternal complications associated with mode of delivery in a population of low-risk pregnancies. Data from 324,883 full-term singleton births between 2001 and 2007 were retrieved from birth and hospital discharge databases of the Lazio Region, Central Italy. Women with breech presentation births and those with chronic/pregnancy-related diseases in the mother/fetus were excluded.

Triage and Injury Severity Scores as predictors of mortality and hospital admission for injuries: a validation study.

Background: Many emergency departments use a rating system to establish priority based on urgency: "triage". The aim of this study was to evaluate the validity of triage in predicting hospitalization and mortality compared to that of the ICD-9-CM based Injury Severity Score (ISS).

Sources: The Emergency Information System 2000, the Hospital Information System 2000-2001 and the Mortality Register 2000-2001, of the Lazio Region.

[Defining a set of indicators for the evaluation of healthcare needs and of the performance of local health authorities].

A set of indicators for assessing healthcare needs and evaluating healthcare services are needed. This paper presents a set of indicators for evaluating healthcare districts, defined by a local health authority in the city of Rome. The set of indicators was developed by selecting 11 areas of interest and assigning to each area indicators that would allow an evaluation of its main functional aspects.

Primary paediatric care models and non-urgent emergency department utilization: an area-based cohort study.

Background: The aim of this study was to evaluate the association between different primary paediatric practice models (individual, network -affiliated but in separate office-, and group practice) and non urgent utilization of the Emergency Department (ED).

Methods: The data sources were: the 2006 Regional Paediatric Patient files (0-6 years old), the Regional Community-based paediatrician (CBP) file and the 2006 Emergency Information System. We recorded and studied the ED visits of children, excluding planned ED visits, visits for trauma/poisoning and those that were assigned non deferrable/critical triage codes.

An emergency clinical pathway for stroke patients--results of a cluster randomised trial (isrctn41456865).

Background: Emergency Clinical Pathways (ECP) for stroke have never been tested in randomized controlled trials (RCTs).

Objective: To evaluate the effectiveness of an ECP for stroke patients in Latium (Italy) emergency system.

Methods: cluster-RCT designed to compare stroke patient referrals by Emergency Medical Service (EMS) and Emergency Room (ER) health professionals trained in the ECP, with those of non-trained EMS and ER controls.

Continuing medical education and evidence-based clinical pathways. Training emergency health workers in Latium, Italy.

Background: In recent decades, studies that evaluate training programmes have shown that continuing education for physicians is not very effective in improving performance and behavioural changes. One of our goals was to create a Continuing Medical Education Programme (CMEP) that would result in changing the behaviour of health professionals. In early 2005, a new CMEP was offered to emergency medical services and emergency room professionals to introduce an Emergency Critical Pathway (ECP) for the management of acute stroke patients.

Can colorectal cancer mass-screening organization be evidence-based? Lessons from failures: the experimental and pilot phases of the Lazio program.

Background: Screening programmes should be organized to translate theoretical efficacy into effectiveness. An evidence-based organizational model of colorectal cancer screening (CRCS) should assure feasibility and high compliance.

Methods: A multidisciplinary Working Group (WG), reviewed literature and guidelines to define evidence-based recommendations.

[Implementation of an emergency clinical pathway for ST-elevation myocardial infarction in the Lazio Region: results of a pilot study].

Background: Timely reperfusion therapies (primary angioplasty and pre-hospital thrombolysis) remain a key component in improving the survival of patients with ST-segment elevation myocardial infarction (STEMI). The Lazio Region emergency organization has a complex mixed logistic (the large city of Rome, presence of complex orography), therefore the use of telemedicine technologies by the emergency medical system (EMS) is mandatory. Emergency clinical pathways (ECP) for the management of STEMI patients were designed, focusing on early pre-hospital diagnosis and best appropriate treatment through the ECG transmission and teleconsultation among EMS and cardiologists in coronary care units (CCU).