22 research outputs found
Utilization of big data to improve management of the emergency departments. Results of a systematic review
No full textBackground. The emphasis on using big data is growing exponentially in several sectors including biomedicine, life sciences and scientific research, mainly due to advances in information technologies and data analysis techniques. Actually, medical sciences can rely on a large amount of biomedical information and Big Data can aggregate information around multiple scales, from the DNA to the ecosystems. Given these premises, we wondered if big data could be useful to analyze complex systems such as the Emergency Departments (EDs) to improve their management and eventually patient outcomes.
Methods. We performed a systematic review of the literature to identify the studies that implemented the application of big data in EDs and to describe what have already been done and what are the expectations, issues and challenges in this field.
Results. Globally, eight studies met our inclusion criteria concerning three main activities: the management of ED visits, the ED process and activities and, finally, the prediction of the outcome of ED patients. Although the results of the studies show good perspectives regarding the use of big data in the management of emergency departments, there are still some issues that make their use still difficult. Most of the predictive models and algorithms have been applied only in retrospective studies, not considering the challenge and the costs of a real-time use of big data. Only few studies highlight the possible usefulness of the large volume of clinical data stored into electronic health records to generate evidence in real time.
Conclusion. The proper use of big data in this field still requires a better management information flow to allow real-time application
Prevalence of non-adequate health literacy in Europe. A systematic review and meta-analysis
No full textBackground:
Many studies show that a low level of health literacy (HL) is associated with several adverse outcomes. The aim of this systematic review was to estimate the prevalence of nonadequate HL (NAHL) in European countries and outline the main needs for interventions.
Methods:
The systematic search was performed in April 2019 and updated in June 2019. PubMed, Embase and Scopus were searched. Articles were considered eligible if they were cross-sectional studies published in English after 2000 and estimating the NAHL prevalence in European countries. Globally, 15490 articles were retrieved. Adapted Newcastle-Ottawa Scale was applied for the quality assessment. Several stratified metaanalyses were carried out. We also performed a metaregression analysis to test the association between variables and NAHL.
Results:
In total, 59 articles of heterogeneous quality were included, providing data for 98 studies to include in the proportion meta-analysis. Overall, quantitative analysis yielded a pooled NAHL prevalence of 40% (95%CI, 36%-43%). Despite the prevalence varied considerably by country, it seemed to follow a geographic gradient, with the northern countries clearly having a lower prevalence than the other European counterparts. The pooled prevalence estimates (PEs) varied significantly according to the different type of HL assessment method applied. Also, high study quality was found to be significantly associated with a reduction of NAHL in the PEs. Grouping the sample in general population, oncology patients, chronic disease patients and refugees, the meta-regression analysis showed a significantly lower prevalence of NAHL in oncology patients.
Conclusions:
Although the PEs varied in relation to several factors (e.g. either among population groups, or depending on the HL assessment method), this study shows that more than one in every three surveyed participants had NAHL. Targeted strategies and coordinated policies aiming at improving HL in the Region are needed
Increasing subnational commitment for measles and rubella elimination: the role of regional reports
No full textIssue/problem
To assess the progress towards measles and rubella elimination in the WHO European Region, the National Verification Committee of each Member State is requested to submit an annual status report (ASR) to the WHO Verification Commission for review and evaluation. Documentation required for Italian ASR are provided by the Ministry of Health, the National Institute of Health, and the 21 Regions. However, these ASR do not allow Regions to understand deeply their situation in the elimination process.
Description of the problem
The aim of this project is to produce regional synthetic annual reports, using the same data sources of the national ASR, that are sent to Regions to give them feedback about their progress towards elimination. A set of indicators has been identified within the framework of the national ASR. A green or red flag has been assigned to each indicator when regional data are better or worse than the national average, respectively. Where available, international targets were provided.
Results
In 2014 the incidence of measles and rubella in Italy was respectively 27 and 0.4 per million population. For all Regions coverage for both 1st and 2nd doses of routine measles and rubella vaccines was below the target of 95%. Analyzing those Regions with a percentage of red flags higher than the average percentage of red flags of the country, it emerged that 6/8 Regions were in the South of Italy (75%), 4/9 in the North (44.4%) and 1/4 in the Centre (25%).
Lessons
Regional reports are a valid tool to enhance the verification process at the sub-national level and may encourage regional and local authorities to implement appropriate strategies to remove barriers to the elimination goals. Southern Regions of Italy need to increase their efforts compared to other Regions.
Key messages:
In line with WHO recommendations to reinforce the commitment of the 21 Italian Regions, regional reports are able to provide Regions with detailed information about their progress and critical issues
Regions of South Italy should mobilize better their financial, technical and human resources to achieve the elimination goals
Regional reports for the subnational monitoring of measles elimination in Italy and the identification of local barriers to the attainment of the elimination goal
No full textAlthough most countries in the WHO European Region were verified in 2017 as having interrupted endemic measles transmission, nine countries were still endemic. Among these, Italy accounted for the second highest number of measles cases reported in Europe in 2017. The elimination of measles is verified at national level by each country's National Verification Committee (NVC) through the production of an Annual Status Update (ASU). Since in Italy decentralization has led to an inhomogeneous implementation of immunization strategies among the 21 administrative Regions, the Italian NVC proposed that measles elimination should also be documented at the subnational level through regional ASUs and Synthetic Regional Reports (SRRs). The regional ASUs and the SRRs for 2014, 2015 and 2016 were produced and appraised by the NVC to evaluate the Regions' performances in each individual year as well as over the whole period. A specific analysis of vaccination coverage, including official immunization data for 2017, was performed. Moreover, the measles epidemic of 2017 was examined. Firstly, in the period 2014±2016, low immunization rates were registered in most Regions. Sixty-three per cent of southern Regions reported rates below the national mean and an overall low-quality performance. The approval of Italy's mandatory vaccination law in 2017 resulted in a marked increase in vaccination coverage; however, this increase was not homogeneous among Regions. Secondly, more than 50% of Regions did not report any supplemental immunization activity (SIA) for the period 2014-2016. Thirdly, from 2014 to 2016, fewer than one-third of Regions improved their reporting of outbreaks. Finally, over the study period, only two Regions reached the target required by the WHO for measles laboratory investigations. In countries with decentralized health policies, subnational monitoring can help identify local barriers to measles elimination. In Italy it has highlighted the need for further SIAs and a stronger surveillance system
Childhood vaccinations: A pilot study on knowledge, attitudes and vaccine hesitancy in pregnant women
No full textBackground. The objective of this pilot study was to test a questionnaire aimed at assessing knowledge of and attitudes towards vaccination, as well as intention to vaccinate, among pregnant women.
Methods. The questionnaire was self-administered by 49 pregnant women attending antenatal classes at three Family Centers in Rome.
Results. Poor knowledge of vaccinations, inadequate attention from healthcare professionals, recurrent consultation of unreliable sources of information, and misconceptions about the side effects of vaccines, all contribute to vaccine hesitancy. Where appropriate, questionnaire sections were shown to be internally consistent.
Conclusion. The questionnaire proved reliable and is suitable for further studies
Morbillo e rosolia: quale feedback ricevono le regioni sullo stato di avanzamento verso gli obiettivi di eliminazione? Il ruolo dei report regionali e dei resoconti regionali sintetici.
No full textINTRODUZIONE:
La Commissione Regionale di Verifica per l’eliminazione di morbillo e rosolia dell’OMS Europa richiede che gli stati membri attestino i propri progressi verso l’eliminazione mediante l’elaborazione di un report annuale. Sulla base dei report relativi al 2016, l’Italia risulta fra i 9 paesi in cui il morbillo è ancora endemico e tra i 14 paesi endemici per la rosolia. L’epidemia di morbillo in corso, con 4444 casi segnalati da quasi tutte le Regioni italiane dall’inizio del 2017, rende indispensabile la messa in atto di azioni prioritarie nella corsa verso l’eliminazione. La mobilitazione delle Regioni e il loro coinvolgimento attivo nel PNEMoRc sono alcune delle priorità individuate dall’OMS nel corso di una site-visit effettuata nel 2015. L’elaborazione di report regionali (RR) e di resoconti regionali sintetici (RRS) da affiancare al report nazionale dell’OMS può rappresentare una strategia efficace nel raggiungimento di questo obiettivo. La produzione di RR e RRS rientra nell’ambito di un progetto CCM a sostegno del PNEMoRc.
MATERIALI E METODI:
I RR ripropongono la struttura del report OMS. I RRS sono prospetti riassuntivi composti da 27 indicatori relativi alle sezioni più salienti del report regionale. Nei RRS ciascun indicatore viene confrontato con il rispettivo valore medio nazionale, con la conseguente assegnazione di una bandierina verde o rossa a seconda che il valore regionale sia migliore o peggiore. I dati provengono da tre flussi informativi: Ministero della Salute, Istituto Superiore di Sanità e Regioni.
RISULTATI:
I RR e i RRS relativi agli anni 2014, 2015 e 2016 sono stati prodotti e condivisi con le 21 Regioni italiane. Un’analisi degli indicatori relativi alle coperture vaccinali ha consentito di individuare per ogni anno le Regioni meno performanti. Le Regioni con basse coperture vaccinali generalmente presentano anche una percentuale di bandierine rosse superiore alla media nazionale.
CONCLUSIONI:
I RR e i RRS possono essere d’aiuto alle Regioni per identificare punti di forza e di debolezza dei rispettivi piani regionali di eliminazione mediante confronti con la situazione nazionale. Inoltre, i RR e i RRS rappresentano un valido strumento per l’individuazione delle Regioni maggiormente in difficoltà nel raggiungimento degli obiettivi del PNEMoRc e che in maggior misura beneficerebbero di attività di supporto come audit e site-visit
ER access by foreign citizens between 1999 and 2014 in five large hospital of Rome, Italy
No full text...Lack of information about the health services and the status of illegal immigrant can make difficult for foreign population to access primary care, leading to misuse of emergency rooms (ER). This study investigated the accesses between January 1999 and December 2014 to the ERs of five large hospital of Rome, Italy
Azienda Ospedaliera “Pia Fondazione di Culto e Religione.«Cardinale Giovanni Panico»” di Tricase (Italia)
No full textThe article presents history of “Cardinale Giovanni Panico” the hospital which was transformed into Hospital-Corporation “Pia fondazione di culto e religione ‘Cardinale Giovanni Panico’” in Tricase, Italy. The Hospital Corporation arose from the Vatican diplomat Giovanniego Panico’s idea and initiative. The activity of the International Institute of Sisters Marcellin (Istituto Internazionale delle Suore Marcelline) led to its actual functioning and constant development with continual help of suitable church and secular authorities. The future cardinal was sensitive to people’s suffering and lack of suitable health care; his work in many diplomatic agencies in different countries, usually poor and neglected, led to the idea of opening a small hospital in his hometown. The article is an attempt to show in an chronological order history and achievements of one of many Italian hospital corporations. However, the presented institution deserves special attention. The text shows how the private nursing home brought to life in 1963 (casa di cura privata) developed into an important Hospital Corporation in Italy which is defined as the only hospital-medical consortium classified as religious (ospedale religioso classificato). In the article the author does not only present mentioned chronology and achievements of the powerful medical facility, but also the role and need of transplanting on the ground of medical care catholic values as those which help to come back to physical health. The author also presents educational values of suffering in the Christian point of view.The article presents history of “Cardinale Giovanni Panico” the hospital which was transformed into Hospital-Corporation “Pia fondazione di culto e religione ‘Cardinale Giovanni Panico’” in Tricase, Italy. The Hospital Corporation arose from the Vatican diplomat Giovanniego Panico’s idea and initiative. The activity of the International Institute of Sisters Marcellin (Istituto Internazionale delle Suore Marcelline) led to its actual functioning and constant development with continual help of suitable church and secular authorities. The future cardinal was sensitive to people’s suffering and lack of suitable health care; his work in many diplomatic agencies in different countries, usually poor and neglected, led to the idea of opening a small hospital in his hometown. The article is an attempt to show in an chronological order history and achievements of one of many Italian hospital corporations. However, the presented institution deserves special attention. The text shows how the private nursing home brought to life in 1963 (casa di cura privata) developed into an important Hospital Corporation in Italy which is defined as the only hospital-medical consortium classified as religious (ospedale religioso classificato). In the article the author does not only present mentioned chronology and achievements of the powerful medical facility, but also the role and need of transplanting on the ground of medical care catholic values as those which help to come back to physical health. The author also presents educational values of suffering in the Christian point of view
Odeporica by Massimo Bontempelli
No full textL‘opera si basa sull‘autore Massimo Bontempelli e sulla sua opera Stato di grazia. Date le particolarità che sono state fornite, è stato di grande importanza prestare attenzione al lavoro. L‘autore si distingue per il suo modo di scrivere che, durante il periodo in cui è stato creato, si distingue dagli altri. Pertanto, all'inizio del documento, vengono fornite informazioni di base sull‘autore, sulla sua vita, sulle opere scritte e sulle fasi che ha attraversato fino a raggiungere la fine. Dopo che sono state fornite le informazioni sull‘autore si focalizza sulla letteratura di viaggio in generale per procedere alle caratteristiche dell‘opera bontempelliana appartenente all‘odeporica. La seconda parte della tesi si concentra sull‘opera Stato di grazia e mette in evidenzia i procedimenti narrativi tipici per tutta la produzione letteraria di Massimo Bontempelli. Nella terza parte si interpretano e si mettono in paragone diversi punti di vista presenti in tre capitoli: Italia, Europa e l‘America. Vengono inoltre evidenziate le caratteristiche della letteratura di viaggio nonché alcune peculiarità della poetica bontempelliana.U radu se analizira djelo Stato di grazia talijanskog autora Massima Bontempellija. Autor je to koji u povijesti europske književnosti ostaje zapamćen kao tvorac poetike magičnog realizma. Prvi dio rada donosi prikaz autorove biografije i književnog sazrijevanja podijeljenog u nekoliko faza. Kako navedeno djelo pripada putopisnoj književnosti, jedno je poglavlje posvećeno pokušaju definiranja osnovnih karakteristika putopisne književnosti. Slijedi poglavlje u kojem se polazeći od sadržaja analiziraju pripovjedni postupci koje Bontempelli primjenjuje u navedenom putopisu. U radu se naposlijetku nakon iscrpne interpretacije i usporedbe sličnosti i razlika vidljivih u tri poglavlja naslovljena Italija, Europa i Južna Amerika, upućuje na sve specifičnosti Bontempellijeve putopisne poetike.The paper analyzes the work Stato di grazia by the italian author Massimo Bontempelli. He is an author who is remembered in the history of European literature as the creator of the poetics of the magical realism. The first part of the paper presentrs the author‘s biography and literary maturation divided into several phases. As the mentioned work belongs to travel literature, one chapter is dedicated to the attempt to define the basic characteristics of travel literature. The following is a chapter in which, based on the content, the narrrative procedures that Bontempelli applies in the above travelogue are analyzed. Finally, after an exhaustive interpretation and comparison of the similarities and differences visible in the three chapters entitled Italy, Europe and South America, the paper refers to all the specifics of Bontempelli‘s travel poetics
Roofs in Messapia in Archaic Period
No full textIl lavoro affronta la problematica dei sistemi di copertura in messapia in età arcaica. Dopo una preliminare storia della ricerca nel settore ed un inquadramento metodologico dello studio si analizzano i materiali di copertura di s. Vito dei Normanni (BR) e di Cavallino (LE). Le recenti indagini archeologiche nei due siti hanno offerto nuovi dati sull'architettura ed il modo di abitare in età arcaica. A Cavallino è stato individuato un sistema di copertura sul modello laconico con l'impiego di soli coppi disposti alternativamente. A s. Vito dei Normanni la copertura degli edifici è più complessa. I tetti disponevano di tegole piatte con alette laterali rialzate e coppi utilizzati come coprigiunti tra le commettiture. In questo sito, lo studio analitico dei crolli durante lo scavo archeologico ha permesso di ricostruire la tecnica costruttiva dell'alzato ed i materiali impiegati. E' stato possibile individuare anche una prima forma di decorazione architettonica. I dati archeologici hanno consentito l'elaborazione di una ricostruzione grafica del grande edificio di s. Vito dei Normanni.
Il lavoro è completato da un'appendice sull'architettura rurale salentina, valido modello di confronto per lo studio delle soluzioni architettoniche. Un paragrafo affronta il problema delle incisioni su tegole e coppi chiarendo come spesso si tratti di semplici marche da montaggio.Analysis of roofs in messapia in archaic period. after a preliminary history of researches in the field and of methodology's discussion, the author examines the architectural material from san vito dei normanni (Br) and Cavallino (LE)
