1,721,247 research outputs found
Modello per la valutazione dell’impatto economico, sociale e di salute derivante dall’utilizzo dei nuovi farmaco oncologici ad alto costo nella Regione Veneto.
No full textANALISI DELL’APPROPRIATEZZA ORGANIZZATIVA DEI RICOVERI ORDINARI ATTRAVERSO L’USO DEI DATI SANITARI CORRENTI
No full textUno degli indicatori di appropriatezza organizzativa più consolidati è la percentuale di ricoveri ordinari di 0-1
giorno. Lo studio propone un’analisi dei determinanti socio-demografici e clinici associati a tale categoria di ricoveri. Metodi:
Sono stati analizzati complessivamente 22000 ricoveri ordinari avvenuti nel 2014 nell’AULSS 13, Regione Veneto. Sono state
considerate le variabili sociodemografiche e sanitarie dei pazienti ricoverati, rilevate attraverso il flusso SDO. Le associazioni
sono state valutate con gli opportuni test di verifica di ipotesi e metodi di aggiustamento del rischio. In particolare è stata
effettuata un’analisi di regressione logistica in cui la variabile dipendente è stata codificata come ricovero ordinario di un
giorno esitato in dimissione del paziente. Risultati: I risultati preliminari dello studio hanno evidenziato che i ricoveri ordinari
di 0-1 giorno conclusi con la dimissione del paziente (circa 5% dei ricoveri) rispetto ai ricoveri più lunghi sono associati al sesso
maschile (OR 1.20; p<0.05), all’età (OR 0.96; p<0.001), al grado di autonomia dei soggetti definito dal punteggio Barthel (OR
1.45 p<0,001), ad un livello di istruzione maggiore (OR=1.12 p<0.05) e alla provenienza da un’altra ULSS (OR=1.35 p<0.01).
Inoltre è stato evidenziato che la tipologia di ricovero, in particolare la modalità di ammissione di tipo programmato non
urgente (OR=5.16 p<0.001) e un DRG ad alto rischio di inappropriatezza (OR=8.15; p<0.001) sono associati a maggiore odd
di ricovero 0 -1 giorno. Conclusioni: I risultati dimostrano che i ricoveri di 0-1 giorno che esitano in dimissione sono associati
a specifiche variabili sociodemografiche dei pazienti, a minore urgenza e ad un DRG ad alto rischio di inappropriatezza
ANDAMENTO DELLE PUBBLICAZIONI SUI PIANI DI ASSISTENZA INDIVIDUALI: ANALISI BIBLIOMETRICA DELLA LETTERATURA.
No full textIntroduzione: L’aumento della prevalenza delle condizioni ad andamento cronico impone, nell’ambito dell’Assistenza
Primaria, un passaggio da logiche di trattamento frammentario a logiche di ricomposizione unitaria dell’assistenza per la
presa in carico degli individui. In questo contesto emerge la necessità di piani individuali personalizzati quali strumenti
che assicurino a ciascun individuo una continuità assistenziale. Lo scopo della presente revisione di letteratura è valutare
l’andamento nel tempo dell’attenzione della comunità scientifica al ruolo dei Piani di Assistenza Individuali (PAI). Metodi: E’
stata condotta una revisione sistematica di letteratura interrogando il database MEDLINE per l’intero periodo di archiviazione
fino al 2014, attraverso specifiche parole chiave. Gli articoli rilevanti ottenuti sono stati successivamente categorizzati in base
all’anno di pubblicazione. L’analisi statistica è stata condotta mediante un modello di regressione lineare in cui l’anno è stato
considerato quale variabile indipendente e il numero di articoli quale variabile dipendente espressa in scala logaritmica in
quanto la regressione risultava non lineare per i parametri. Risultati: Il totale degli articoli ottenuti è stato di 611. In seguito a
revisione per titoli ed abstract, 238 articoli hanno presentano un focus sul ruolo dei PAI e sono stati inseriti nella successiva
analisi. Il modello di regressione ha mostrato un incremento annuo del numero di pubblicazioni dell’8,6% (CI95% 6,7% e
10,5%). Conclusioni: Tale ricerca mostra un interesse scientifico crescente, negli ultimi 30 anni, riguardo allo sviluppo di PAI
che leggano e rispondano adeguatamente alle necessità del singolo. Ulteriori studi sono, tuttavia, necessari per valutare
l’impatto che i Piani di Assistenza Individuali hanno in relazione alla gestione complessiva del paziente, sia in termini di
miglioramento degli outcome di salute che di implementazione dei processi di assisten
Modello per la valutazione dell’impatto economico,sociale e di salute derivante dall’utilizzo del farmaco oncologico Trastuzumab nella Regione Veneto
No full textStudio epidemiologico sull'effetto protettivo contro il melanoma del vaccino anti febbre gialla
Full text linkIntroduction
Unless diagnosed and excised early, malignant melanoma is a cancer which carries a poor prognosis and its incidence is rising world-wide, particularly among fair-skinned people. There is growing evidence from many sources that immune responses are elicited against cancers and may contribute towards prevention of disease and limitation of progression of established cancers. Since the mid 19th century there have been many reports of regressions and remissions of cancers following serious infections such as erysipelas, and the causative organisms have been used therapeutically with some claimed success. A study group of the European Organization for Research and Treatment of Cancer (EORTC) found that a history of vaccinations with BCG and/or vaccinia virus in childhood and/or a history of certain uncommon but serious infections are associated with a reduced risk of melanoma . It has been reported that about 95% of malignant transformed melanocytes express an antigen, HERV-K-MEL, encoded by a human endogenous retrovirus K (HERV-K). This antigen is also expressed in a minority of carcinomas and sarcomas but, with the exceptions of the testis and some naevi, not in normal tissues. In further studies it was established that BCG vaccine, the vaccinia virus and pathogens - that appeared to protect against melanoma - had antigenic determinants showing homology in the sequence of amino acids with the melanoma antigen HERV-K-MEL. Diseases which showed no association with reduced melanoma risk were predominantly caused by pathogens without this homology.
Additional information on the impact of vaccination with vaccinia virus and/or BCG on the risk of melanoma has been derived from epidemiological studies. Vaccinations given neonatally or during the first two years of life was associated with a life-long reduced risk of melanoma, although the protective effect waned after the age of 50 years. Among those who had been vaccinated but nevertheless developed melanoma, their risk of dying of the disease within an 8-year follow-up period after surgical resection of the primary tumour was significantly reduced, although use of vaccinia and/or BCG as therapeutic agents for established melanoma has generally been unsuccessful. This suggests that, for protection, the immune responses induced by vaccination need to be established long before the tumour is clinically evident. The temporal pattern of association seems to depict a "crucial point" in the natural history of melanoma. Yellow fever vaccine (YFV) contains an antigenic determinant with a close homology to HERV-K-MEL antigen and to the homologous sequences in BCG and vaccinia virus. However, to date, there is no evidence as whether vaccination with YFV has a protective effect against melanoma. Thus, an epidemiological study was undertaken in order to investigate whether there is such an association and, if there is, to determine the temporal pattern of the association, as any such protection might be optimal at a very early stage of malignant transformation, perhaps preceding the presentation of overt melanoma by many years.
Methods
The study was carried out in Veneto in the North-Eastern part of Italy, where a large part of the region was covered by the Veneto Tumor Registry (VTR). According to Italian law, YFV must only be administered in an authorized health service (AHS) and personal data of vaccinated subjects must be recorded. The study protocol was presented at a meeting to most physicians working in these AHSs. Among eligible AHSs (those corresponding to areas covered by VTR), seven agreed to collaborate: Padova, Verona, Vicenza, Treviso, Bassano, Montebelluna, Ufficio di Sanità Marittima ed Aerea. After approval for the study had been granted by the Ethics Committee of the University of Padova, all the records of subjects vaccinated against yellow fever in the collaborating vaccination centers were collected. Information on the incidence of cancer in this group of subjects was obtained through a record-linkage with cancer data of VTR. The age at vaccination and at the diagnosis of cancer, and the years elapsed from the date of vaccination to the date of diagnosis of cancer (latency) were calculated. In the statistical analysis, latency was divided into four classes: to 5; >5 to 10; and >10 years. The first class (<0) included subjects vaccinated after the date of cancer diagnosis considerable as non exposed. In order to determine the time-effect relationship between the risk of melanoma and YFV administration we used a classical cohort study with Veneto general population as reference and an internal cohort analysis with Poisson regression where the references were subjects with latency <0 years.
Furthermore we carried out a cohort nested case-control study. The cases were 60 patients with melanoma and the controls were 178 patients affected by tumours of brain, cervix uteri, colon and rectum, kidney, as well as with mesothelioma and lymphoid leukaemia. The HERV-K-MEL gene has not been found to be expressed in these tumours, and therefore, for control purposes, they may be regarded as "normal" with respect to such gene expression. The TSV class ">0 to 5" was taken as the reference subgroup with an assumed risk of 1.0. The odds ratio (OR) for melanoma, 95% confidence interval (CI), error probability for a two-tail test (p-value) were estimated through logistic regression analysis, stratified by vaccination centres. The dependent variable was dichotomous (1 for cases and 0 for controls); the independent variables were age at incidence, age at vaccination, gender and the polytomous variable TSV at multivariate analysis, and TSV only at univariate analysis
Results
The standardized incidence ratio (SIR) was 1,25 (IC 0,90-1,42) in the overall cohort. Latency analysis showed a SIR=1,29 (IC 0,81-2,06), 1,52 (IC 0,93-2,50) and 0,56 (IC 0,48-1,74), respectively in the latency categories 0-5, 5-10, and ?10 years.
In order to compare the risk estimates within the cohort, we made an internal analysis using Poisson regression. After more than 10 years elapsed from the vaccination, the risk of melanoma reduced to 0.38. The risk estimates increased with age and calendar periods and were higher in women than in men.
In the nested case-control study, subjects vaccinated against YF from 0 to 4.99 were the reference group in the logistic regression analysis. Melamona cases were compared with 178 tumors not expressing HERV-K-MEL gene. OR significantly (p=0.01) reduced to 0.19 in the class >10 years of latency.
Discussion
The conclusion of this study is that yellow fever 17D vaccine appears to protect against melanoma if subjects were vaccinated 10 or more years before the clinical presentation of the disease, but ineffective later on. Our findings indicate that a simple preventive strategy against melanoma is possible although confirmatory studies are required before administration of yellow fever 17D vaccine can be advocated for the prophylaxis of this aggressive form of cancer
Association Between Religiosity and Spirituality and Cocaine Use: A Systematic Review
Full text linkPrevious literature has evidenced a possible impact on health, mental health, and health-related faith behaviors due to the effects of an individual’s spiritual dimension. The aim of this study is to collect and summarize all current data from observational studies regarding the association between religiosity or spirituality (R/S) and cocaine use (CU). A systematic literature search of analytical observational studies on the association between religiosity or spirituality and the use of cocaine was performed in PubMed and Scopus databases. Twenty observational studies were included in this review. Fifteen of the twenty observational studies found that a higher level of religiosity was associated with lower lifetime and actual cocaine use, both in adults and adolescents. However, one study conducted in a sexual minorities sample found that higher religiosity—measured as frequency of private religious activities such as prayer—was associated with a higher probability of cocaine use. Two studies found no evidence of any association between religiosity and cocaine use, and two found mixed results. This review found a possible protective role of religiosity on cocaine use, even if the cross-sectional nature of the greater part of the studies prevented drawing any casual relation. Future studies with a longitudinal approach are required. However, the support of activities aimed at broadening a religious attitude and beliefs could result in creating an environment protective for young people against cocaine use
Association between religiosity or spirituality and internet addiction: A systematic review
Full text linkIntroduction: The literature provides evidence of religiosity being associated with physical and mental health, and also with behavioral addictions. This systematic review examines the data on the link between religiosity or spirituality and the emerging internet addictions.
Methods: A systematic literature review was conducted in the PubMed and Scopus databases to identify observational (cross-sectional, cohort, and case-control) studies conducted on adolescents and young adults to investigate the association between religiosity or spirituality and internet addiction. Of the 854 articles identified in the databases, 13 met our inclusion criteria and were included in our systematic review.
Results: Eleven of the 13 studies reviewed specifically investigated religiosity and internet addiction: six found an inverse association between religiosity and internet addiction; three found no evidence of any association; and one found a direct association. One study examining both religiosity and spirituality generated mixed results. Only one study investigated spirituality unrelated to religion, and found a direct association with internet addiction. Two of three studies specifically considering internet gaming addiction found it inversely associated with high levels of religiosity, while the third found no association.
Conclusion: This review supports a possible role for religiosity as a protective factor, as emerged from the majority of the studies examined. Religiosity also seemed to be associated with lower internet gaming rates among adolescents
[Instrument for evaluating autonomy of elderly patients in assuming oral medication]
No full textThe study deals with the problems facing elderly patients in rehabilitation structures having to autonomously assume oral medication. Often, elderly people who were previously capable of doing so, become confused and disoriented when admitted to rehabilitation. This may be due to physical or mental deterioration subsequent to their recent pathological experience (e.g. Trauma, falls, surgery), to a lack of knowledge about their medication or to reduced motivation. Patients who do not regain their independence not only represent increased health expenditure but also an increase in the risks connected with erroneous self-medication
Evidenze scientifiche per il trattamento logopedico in bambini con Disturbo specifico del linguaggio. Una revisione sistematica della letteratura.
No full textthe Specific Language Impairment (SLI) is a developmental language disorder characterized by a language deficit on different linguistic levels (phonetic, phonological, lexical, semantic, morphological, syntactic and narrative) for which there are different approaches to rehabilitation, with differences in treatment according to the levels involved. Objective: The aim of this research is a systematic review of the indexed literature for detecting the scientific evidence produced in relation to the treatment of SLI in developmental age. Materials and methods: a literature search was conducted on PubMed and Cochrane Library. Selected studies were analyzed with respect to: type of proposed intervention, treatment and patient characteristics, external validity, study design, internal validity, results and effectiveness of the intervention, level of evidence of the intervention. Results: 22 studies published from 1998 to 2008 were selected. A vast heterogeneity was found in the proposed treatments, that did not allow to synthesize the results but rather to assess separately the different levels of evidence for each treatment, in relation to different linguistic levels addressed by each study
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