Annali dell'Istituto Superiore di Sanità
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Appropriateness and efficacy of Spa therapy for musculoskeletal disorders. A Delphi method consensus initiative among experts in Italy
Get PDFObjective. The aim of the study was to identify the main aspects concerning appropri-ateness and efficacy of Spa therapy for musculoskeletal pathologies. Methods. A committee of 8 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Clinicians from Italian medical centers specialized in rheumatology, rehabilitation and thermal medicine took part in a Delphi process aimed at obtaining consensus statements among the partici-pants. Results. Large consensus was obtained for statements grouped under the following main themes: treatment indications; choice of treatment modality and treatment efficacy. Conclusions. The experts developed a number of consensus statements which may be used as a practical reference to guide the choice of physicians to treat musculoskeletal diseases with Spa therapy
Assessment of Health Literacy and validation of single-item literacy screener (SILS) in a sample of Italian people
Get PDFBackground. Health literacy (HL) is a complex concept with multiple components; it involves the ability to effectively use and interpret texts, documents, and numbers. The aims of our study were: to measure HL levels among a sample of adult Italian patients; to develop and validate the Italian version of the single-item literacy screener (SILS); to assess the diagnostic accuracy of the SILS as an indicator of limited reading ability regarding health documents, compared to the newest vital sign (NVS). Methods. The subjects were enrolled in emergency departments, primary care settings, and specialist departments. The Italian versions of the NVS and of the SILS were administered to the patients, as well as a questionnaire aimed in collected socio-demographic information. Results. Overall, 174 patients completed the interview (compliance: 87%). Considering the NVS, 24.1% of the subjects presented high likelihood of limited HL, 13.2% a possibility of limited HL, and 62.6% adequate HL. SILS has shown a good concurrent validity compared to NVS (Spearman’s rho r= −0.679; p < 0.001). The diagnostic accuracy of the SILS was high. The best performance parameters in assessing the diagnostic accuracy of SILS are found to be for threshold value of 2 in in identifying subjects with high likelihood of limited HL at the NVS (sensitivity: 83.3%; specificity: 82.6%; accuracy: 82.8%; positive predicted value: 60.3%; negative predicted value: 94%; Cohen\u27s kappa: 0.6). Conclusion. The Italian version of SILS-as an indicator of limited reading and understanding ability regarding health information-is a good tool to measure HL in comparison to more complex measurement instruments of functional HL, like NVS
Survey of health and social-health services for people with dementia: methodology of the Italian national project
Get PDFPeople with dementia have special assistance needs. Worldwide problem is to ensure access to quality health services. Our study, supported by the Italian Ministry of Health, reports methodology features of a large survey project conduct to identify and to collect information on health and social health services for people with dementia in Italy. Among all Italian regions, about two thousand services available to individuals with dementia disease and their caregivers were identified as memory clinics, daycare centers and residential care facilities, totally or partially covered by the public healthcare service. A survey questionnaire was designed to collect information and a web-platform system was developed to manage data from all services. Of note, the web-platform was capable to display surveyed services as an on-line map implemented and regularly updated, easily accessible from the Dementia Observatory website (www.iss.it/demenza)
Cooperating to improve healthcare in Arab countries
Get PDFThis brief note presents a few examples of successful health collaboration to improve healthcare in Arab countries. Considerable growth has been noticed in the past years in the health sector of the Middle East and North Africa region countries due to the need to address health service capacity gaps and improve the quality of health infrastructure. The rising population coupled with the aging demographic is expected to drive healthcare demand in the Arab region, augmenting its demand. In order to meet this demand, a lot of progress within the public sector has been made and several initiatives have taken place to create awareness of the most common diseases affecting the region. Among the steps undertaken in order to face the shortage of experience of medical personnel and the rising cost of the delivery of health services, the most noticeable ones relate to major investments within the realm of healthcare provision. However, country-specific drivers of disease burden should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. Moreover, health gains will need to be sustained by supporting interventions on income, education, and fertility as drivers of health improvement
Trend and variability in open and laparoscopic hysterectomies for patients with benign disease: a retrospective cohort study
Get PDFThe aim of the present analysis on a regional hospital database was to ascertain the variability and 5-year trends of hysterectomy rates and the different surgical approaches used. A retrospective cohort study was conducted in Veneto Region (North-East Italy), based on administrative data collected in 5 years, from 2009 to 2013. Our study showed an overall decline in the hospitalization rates for hysterectomy from 197.5 to 176.3/100.000 and shorter overall hospital stays for this procedure (from 5.5 to 4.6 days). During the five years analyzed, there was an overall increase in the use of laparoscopic surgery (from 28% to 34% of cases). There was also a marked variability within the region considered in terms of the hysterectomy rates and the type of procedure performed. Conclusions: The unwarranted variability in the rates of elective surgical procedures, and the techniques used to perform them, could be monitored electronic hospital records
Continuous Professional Development and Health Governance in Egypt.
No full textThe Authors present the main activities and results of a Project financed by the Italian-Egyptian Debt Swap Agreement (IEDDS/DS) of the Italian Development Cooperation to repay public debt. The Health Governance Project operated within the Egyptian health reform paradigm and aimed at producing evidence for policy makers to direct and reorient the health sector and service management. It developed along three phases: i) preparatory training of trainers, ii) training in health governance according to modern andragogic methods, such as problem-based learning, iii) following implementation. Project strategy focused on a training of trainers method that allowed establishing a Health Governance Unit, that is successfully replicating the Health Governance Course. It established a collaborative ground in Alexandria Governorate, jointly with public and private sector stakeholders
The professional quality criteria of Italian breast screening radiologists: results from a national survey comparing the programmes started in 2000-2012versus the ones started in 1990-1999
Get PDFIntroduction. In Italy, because of increasing health care budget and staff shortages, the most recent local mammography screening programmes have been established under poorer conditions compared with earlier programmes.Methods. Using data from a national questionnaire survey, we made a comparison of main professional characteristics between the radiologists working in programmes established in 2000-2012 and those working in programmes established in 1990-1999.Results. The former reported more years of experience and a greater clinical mammogram reading volume. Conversely, they dedicated less working time to breast imaging, and were less likely to participate in the diagnostic assessment of screen-detected lesions, to work in large-staffed screening centres, and to have a screening and a total (screening and clinical) mammogram reading volume ≥5000 per year.Conclusion. Most of major experience-related characteristics of Italian mammography screening radiologists have deteriorated over time
Micronized palmitoylethanolamide/trans-polydatin treatment of endometriosis-related pain: a meta-analysis.
Get PDFObjectives. 1. To demonstrate clinical effectiveness of micronized palmitoylethanolamide-trans-polydatin combination in reducing endometriotic chronic pelvic pain (main objective); 2. To reduce other endometriotic-associated pain; 3. To assess the effects of this treatment in patient sub-groups; 4. To demonstrate that such therapy modifies natural history of the disease. Data sources. Systematic reviews of PubMed, SCIELO, Scopus, and AJOL, without regard to time frame and other limits. Study eligibility criteria. Randomized trials and observational studies reporting a visual analogue scale for pain or similar assessments at enrollment and at least at one follow-up in endometriotic patients. Study appraisal and synthesis methods: stringent, subjective, semi-quantitative assessment of study quality in relation to data availability and results exposure; additional assessment of study availability to meet meta-analysis objectives. Quantifying of mean improvement of visual analogue scale (or visual analogue scale-like) scores at enrollment and at a three month-follow-up. Interpreting data from a clinical point of view, according to generally accepted criteria. Results. Data were collected from 4 studies of poor quality (5 effect sizes). These were unable to satisfy objectives 3 and 4, and partially answered objective 2. In a heterogeneous sample of endometriotic patients with pain, the oral administration of micronized palmitoylethanolamide/trans-polydatin (400 mg/40 mg) twice a day for three months provided a clinically relevant improvement in chronic pelvic pain and dysmenorrhea while improving deep dyspareunia to a limited degree. No clinically relevant improvement was found for dyschezia. Conclusion. The combination of micronized palmitoylethanolamide/trans-polydatin appears to be a promising treatment for chronic pelvic pain and, possibly, other acute pain in endometrioic patients. More good-quality evidence on this treatment is warranted
Research on biological materials of human origin. Jurists and scientists face to face
Get PDFOn 3rd October 2016 a convention was held in the Aldo Moro room of the Chamber of Deputies on “Research on biological materials of human origin. Jurists and scientists face to face”. The convention was organised by the Bioethics Unit of the Istituto Superiore di Sanità (ISS, Italian National Institute of Health) in conjunction with the Italian Academy of the Internet Code (IAIC) and the Fondazione Centro di Iniziativa Giuridica Piero Calamandrei. The present contribution reports the topics discussed and the key conclusions reached. As a follow-up to the discussion, the scientists, jurists and institutions concerned are resolved to take further steps towards the formulation of operational proposals intended to facilitate research using human biological materials within a framework of precise and strict regulations